Prognosis Of ICU Patients Research Articles

Fallo renal agudo y sepsis en el paciente oncológico.

Introduction: The precise incidence of acute kidney injury (AKI) in the population oncology remains unknown; however, the impact is strong on morbidity and mortality and in hospitalization costs. Sepsis and hypoperfusion are very common etiologies of AKI in cancer patients converge on pre-renal and intrinsic causes. Objective of the review: The review aims to describe the main aspects of pathophysiological and establish diagnostic and treatment criteria in patients with Acute kidney injury and sepsis in cancer patients. Essential points of the review: A significant group of cancer patients With immunosuppressants, they develop viral infections with sepsis and acute kidney failure. Although the AKI in patients with sepsis is multifactorial; the primary mechanism is tubular necrosis acute after renal hypoperfusion due to circulatory failure. The early administration of Antibiotics and control of the etiological basis of sepsis are usually the pillars of prevention. Conclusion: The prognosis of ICU patients with severe sepsis-related ARF is poor, reaching an in-hospital mortality rate of 70%. Furthermore, the presence of leukemia or lymphoma is an independent predictor of mortality in the ICU. Unfortunately, no agent has proven effective in preventing severe sepsis.

Predictive factors for severe long-term chronic kidney disease after acute kidney injury requiring renal replacement therapy in critically ill patients: an ancillary study of the ELVIS randomized controlled trial

BackgroundAcute kidney injury (AKI) requiring renal replacement therapy (RRT) is a serious complication in the ICU that results in increased mortality and risk of chronic kidney disease (CKD). Some studies suggest RRT modality may have an impact on long-term renal recovery after AKI. However, other predictive factors of severe long-term CKD in ICU patients with AKI requiring RRT are unknown.MethodsWe performed an ancillary study of the multicenter ELVIS trial in the population with AKI requiring RRT. Patients alive 3 months after RRT initiation were eligible. Serum creatinine levels available at 3, 6 and 12 months and 3 and 5 years were recorded. CKD stage was determined according to the glomerular filtration rate as estimated by the CKD-EPI formula. At each timepoint, two groups of patients were compared, a no/mild CKD group with normal or mildly to moderately decreased renal function (stages 1, 2 and 3 of the international classification) and a severe CKD group (stages 4 and 5). Our objective was to identify predictive factors of severe long-term CKD.ResultsOf the 287 eligible patients, 183 had follow-up at 3 months, 136 (74.3%) from the no/mild CKD group and 47 (25.7%) from the severe CKD group, and 122 patients at 5 years comprising 96 (78.7%) from the no/mild CKD group and 26 (21.3%) from the severe CKD group. Multivariate analysis showed that a long RRT period was associated with severe CKD up to 12 months (ORM12 = 1.03 95% CI [1.02–1.05] per day) and that a high SOFA score at the initiation of RRT was not associated with severe CKD up to 5 years (ORM60 = 0.85 95% CI [0.77–0.93] per point).ConclusionSevere long-term CKD was found in 21% of ICU survivors who underwent RRT for AKI. The duration of the RRT in AKI patients was identified as a new predictive factor for severe long-term CKD. This finding should be taken into consideration in future studies on the prognosis of ICU patients with AKI requiring RRT.Trial registration ELVIS trial was registered with ClinicalTrials.gov, number: NCT00875069 (June 16, 2014), and this ancillary study was registered with ClinicalTrials.gov, number: NCT03302624 (October 6, 2017).

Predictive Value of Platelet-to-Albumin Ratio (PAR) for the Cardiac-Associated Acute Kidney Injury and Prognosis of Patients in the Intensive Care Unit.

We wanted to demonstrate whether the initial platelet-to-albumin ratio (PAR) had predictive value for cardiac surgery-associated acute kidney injury (CSA-AKI) and prognosis of critical care patients. This is an observational and multi-center study from the MIMIC-IV database, the eICU-CRD database as well as CS patients at our institution. Logistic regression and Cox regression analyses were applied to determine the predictive value for CSA-AKI and in-hospital mortality. LASSO and SVM-RFE models were then employed to discover the coincident variables connected with CSA-AKI. The main objective of this research was the incidence of CSA-AKI, whereas the secondary endpoint was in-hospital death. The higher PAR value (≥4.67) had a higher risk of CSA-AKI (adjusted OR = 4.02, 95% CI 3.41-4.75, P < 0.001) and in-hospital mortality (HR = 2.41 95% CI 1.44-4.03, P = 0.001) after adjusted for other confounding factors including patients with or without chronic kidney disease. The proposed nomogram based on PAR and others clinical factors selected by LASSO and SVM-RFE models for CSA-AKI had the C-index 0.821 (95% CI 0.807-0.834), 0.808 (95% CI 0.787-0.829), 0.745 (95% CI 0.728-0.762), and 0.826 (95% CI 0.753-0.899) in these cohorts, respectively. The nomogram exhibited both remarkable calibration capacity and therapeutic helpfulness in all groups. PAR is a relative excellent measure for the event AKI and prognosis of ICU patients who undergone CS. The suggested nomogram based on PAR resulted in an accurate prediction for the detection of critical care patients with CSA-AKI.

Free Fatty Acids in CSF and Neurological Clinical Scores: Prognostic Value for Stroke Severity in ICU.

Introduction Brain ischemia initiated significant increase in FFAs in animal studies. Accumulation of FFA can lead to liberation of inflammatory byproducts that contribute to neuronal death. Increased risk of systemic thromboembolism was seen in animal models after FFA infusion possibly through activation of factor XII by stearic acids. The clinical studies that examined the relation between stroke in humans and CSF biomarkers are infrequent. Aim of Work. We tried to evaluate the potential role of FFAs in CSF in the diagnosis and the prognosis of ICU patients with AIS while comparing the results to traditional neurological scoring systems. Patients and Methods. Our study included 80 patients who were admitted to ICU with acute ischemic stroke (AIS) within 24 hours of the onset of cerebral infarction. CSF samples were obtained at admission. The FFA levels were measured using the sensitive enzyme-based colorimetric method. The NIHSS, GCS, and mRS were evaluated at admission and at 30 days. Univariate and multivariate analysis were used to evaluate the stroke outcome according to FFA levels in CSF. Results Worsening of the GCS (<7) at 30 days showed a significant correlation with FFA in CSF. The ROC curve showed a cutoff value of 0.27 nmol/µl, sensitivity of 62.9%, and specificity of 72.2%. There was a significant correlation between FFA in CSF and the mRS >2 at 30 days. The ROC curve showed a cutoff value of 0.27 nmol/µl, specificity of 69.2%, and sensitivity of 59.7%. There was a significant correlation between FFA in CSF and the NIHSS ≥ 16 at 30 days. The ROC curve showed a cutoff value of 0.27 nmol/µl, specificity of 72.2%, and sensitivity of 62.9%. Our study subdivided patients according to infarction volume and compared the 2 subgroups with FFA in CSF. We found a significant difference between 2 subgroups. FFA levels showed a positive correlation with infarction volume ≥145 ml. The ROC curve showed a cutoff value of 0.25 nmol/µl, sensitivity of 76.9%, and specificity of 71.4%. Our study showed that FFA in CSF was a significant predictor of all-cause mortality (0.37 + 0.26, P value 0.007). The ROC curve showed a cutoff value of 0.27, specificity of 72.2%, and sensitivity of 62.9%. There was a positive correlation between FFA in CSF and neurological causes of mortality (0.48 + 0.38, P value 0.037). The ROC curve showed a cutoff value of 0.37 nmol/µl, specificity of 76.1%, and sensitivity of 61.5%. Conclusion FFA in CSF may serve as an independent prognostic biomarker for assessing the prognosis of acute ischemic stroke and the clinical outcome. It might be a useful biomarker for early detection of high-risk patients for poor outcome and hence more aggressive treatment.

Effects of cholestasis and hypoxic hepatitis on prognosis of ICU patients: a retrospective study based on MIMIC Ⅲ database

Abnormalities of liver-related indices are common in ICU patients, but the effects of cholestasis and hypoxic hepatitis in critically ill patients remains unclarified. The purpose of this study was to investigate the effects of cholestasis and hypoxic liver dysfunction on the prognosis of ICU patients. A retrospective study was conducted based on the data of patients admitted to the ICU for the first time between 2001 and 2011 archived in the MIMIC-Ⅲ database. The patients were divided into cholestasis, hypoxic hepatitis and control groups, and their 28-day case fatality rate as the primary outcome was compared among the groups. A total of 5852 ICU patients were included in the analysis. The incidence of cholestasis and hypoxic liver dysfunction was 31.9% (1869/5852) and 17.9% (1046/5852), respectively. There was no significant difference in 28-day case fatality rate between cholestasis group and the control group. Compared with the control group, the patients with hypoxic hepatitis had a significantly higher 28-day case fatality rate (46% vs 35%, P &lt; 0.01), a higher hospital case fatality rate (40% vs 31%, P &lt; 0.01), and a higher ICU case fatality rate (35.7% vs 22.2%, P &lt; 0.01). Logistic regression analysis showed that lactic acid (LAC), aspartate transaminase (AST), and international standard ratio (INR) were independent risk factors for 28-day case fatality rate. The incidence of cholestatic liver dysfunction is higher than that of hypoxic hepatitis, but it does not increase the 28-day case fatality rate of the ICU patients, suggesting that cholestatic liver dysfunction may be the early adaptation of the liver to critical diseases.

Tu1520 – Prognosis of Icu Patients with Cirrhosis and Acute Kidney Injury Who Initiate Dialysis

Tu1520 – Prognosis of Icu Patients with Cirrhosis and Acute Kidney Injury Who Initiate Dialysis

Application of Omaha system-based case management model in ICU patients with severe respiratory failure

Objective To explore the effects of Omaha system-based case management model on the prognosis of ICU patients with severe respiratory failure. Methods Totally 84 cases of patients with severe respiratory failure in our hospital from June 2014 to June 2016 were selected and divided into the observation group (n=42) and the control group (n=42) according to random number table. Patients in the control group were given routine nursing during ventilation, while patients in the observation group were given Omaha system-based case management model. The prognosis and complications of patients in two groups were compared. Results The level of blood lactate, the scores of acute physiology and chronic health evaluation system (APACHEⅡ), and the rates of ventilator-dependent, ventilator associated pneumonia (VAP) and reintubation were all lower than the data in the control group, while the time of mechanical ventilation and staying in ICU, as well as the total hospitalization time were all shorter than the time in the control group (P<0.05). Conclusions The Omaha system-based case management model can effectively improve the prognosis of ICU mechanically ventilated patients with severe respiratory failure, shorter the hospitalization time, and improve patient satisfaction. Key words: Respiration, artificial; Prognosis; Severe respiratory failure; Omaha system; Case management model

Nutrition risk screening of ICU patients

It′s known that ICU patients is in critical condition and might deteriorate rapidly, so it′s important for them to get appropriate nutritional support in order to recover. We must make proper nutrition treatment plan for patients according to their different nutritional condition and potential risk. Nutritional risk screening can not only assess the nutritional status of children, is more likely to predict its potential nutritional risk, to guide nutritional support treatment plan, and ultimately improve the prognosis. Looking out for comprehensive, simple, fast, and easy nutritional risk screening tools as soon as possible and appropriate nutrition risk screening is significantly for growth and development as well as prognosis of ICU patients. Key words: ICU; Nutrition risk screening; Nutrition assessment; Malnutrition

Iatrogenic anemia in intensive care unit

Acute and chronic anemias are frequently seen in patients of ICU.Besides the underlying diseases,anemia can also be induced by the examination and treatment.In this paper,the reasons of iatrogenic anemia were analyzed.On the base of the essential diagnosis and treatment,it is helpful to improve the prognosis of ICU patients by strengthening the administration of blood collection.The risk of iatrogenic anemia could be minimized by making a reasonable project of blood transfusion. Key words: Intensive care unit; Anemia,iatrogenic; blood Transfusion

Automating Blood Glucose Control

Blood glucose control in ICUs and operation rooms has some issues. First, hypoglycemia worsens the neurological prognosis of ICU patients and should definitely be avoided. To avoid hypoglycemic attacks require extensive attention by hospital staff. The two biggest advantages of continuous monitoring are the avoidance of hypoglycemia and the reduced workload for ICU staff. However, to achievement of automating blood glucose control, closed loop continuous glucose monitoring is essential. In this review, topics of blood glucose management in ICUs and operation rooms are introduced and advantages and limitations of closed loop continuous glucose monitoring are discussed.

Clinical value of serial blood lactic acid monitoring in prognostic prediction for ICU patients

Objective To investigate the clinical value of serial blood lactic acid monitoring in predicting prognosis for ICU patients. Method Physiological parameters and arterial blood lactate level of 110 patients suffered from respiratory failure (RF), acute myocardial infarction (AMI), infectious shock, and so on admitted to ICU of the 12th Hospital, Guangzhou during January 2004 to December 2005 were measured 24 h within admission, as well as their acute physiology and ehronie health evaluation Ⅱ (APACHE Ⅱ) score was evaluated according to their worst physiological parameters or results of laboratory examinations at the same time. Those measurements were repeated every 24 h. Relationship between lactate clearance rate and APACHE Ⅱ scores was evaluated for predicting prognosis of the patients. Results Forty-eight of 110 patients died during hospitalization, with a case-fatality of 43.6%. There were 89. 7% (26/29), 66. 7% (18/27) and 7.4% (4/54) fatalities for those with progressive increasing, stable and progressive reducing blood lactate levels, respectively. Lactic acid clearance rate correlated with difference of APACHE Ⅱ scores at the same times (r =0. 836, P =0. 000). Lactate clearance contributed more than APACHE Ⅱ scores in predicting the patients'prognosis, with ORs of 2.21 and 1.26, respectively, and with areas under the ROC curve of 0. 863 and 0. 900 for the APACHE Ⅱ score and blood lactic acid level, respectively. Condusions Both serial blood lactic acid monitoring and APACHE Ⅱ scoring can reflect the prognosis of ICU patients sensitively. And, they correlate each other well in evaluating patients'prognosis. But, APACHE Ⅱ scoring system is not so convenient and too complicated for clinical use because too many variables are needed in evaluation. Serial blood lactic acid monitoring is simple, easy and practical to use in predicting prognosis of ICU patients sensitively. Key words: Lactic acid; Metabolic clearance rate; Forecasting

Validation of the APACHE IV scoring system in patients with severe sepsis and comparison with the APACHE II system

APACHE IV is a successful scoring system assessing severity of illness and prognosis of ICU patients [1]. It has been evaluated and validated in our patients for mortality outcome [2]. The objective of this study was to validate the APACHE IV benchmark for patients admitted with severe sepsis and septic shock to the ICU and to compare the performance of the APACHE IV system with APACHE II.

Gastrointestinal Dysfunction Among Intensive Care Unit Patients

This study used the Acute Physiological and Chronic Health Evaluation (APACHE II) system to select two groups of ICU patients with comparable risk of hospital death to evaluate the importance of GI dysfunction, defined as failure to tolerate enteral nutrition (EN), as a prognostic factor. In our ICU, patients who have not undergone recent bowel surgery are treated by EN. Those patients who cannot tolerate EN are treated by total parenteral nutrition (TPN). One hundred and eleven patients who tolerated EN (functioning gut) and 97 TPN patients who failed to tolerate EN (GI dysfunction) were studied. The mean APACHE II scores of the two groups were 17.7 +/- 6.5 (SD) and 17.7 +/- 5.1, respectively. The observed mortality of patients with GI dysfunction (51%) was significantly higher (p less than .0005) than that of patients with a functioning gut (25%). This was associated with significantly poorer APACHE II mean BP, oxygenation, and creatinine scores among the GI dysfunction patients. Our results suggest that shock, ischemia, and hypoxemia, in addition to causing impairment of renal function, may bring about changes in the GI tract, evident clinically only as a failure to tolerate EN, which have an adverse effect on the prognosis of ICU patients so affected.

Gastrointestinal dysfunction among intensive care unit patients.

This study used the Acute Physiological and Chronic Health Evaluation (APACHE II) system to select two groups of ICU patients with comparable risk of hospital death to evaluate the importance of GI dysfunction, defined as failure to tolerate enteral nutrition (EN), as a prognostic factor. In our ICU, patients who have not undergone recent bowel surgery are treated by EN. Those patients who cannot tolerate EN are treated by total parenteral nutrition (TPN). One hundred and eleven patients who tolerated EN (functioning gut) and 97 TPN patients who failed to tolerate EN (GI dysfunction) were studied. The mean APACHE II scores of the two groups were 17.7 +/- 6.5 (SD) and 17.7 +/- 5.1, respectively. The observed mortality of patients with GI dysfunction (51%) was significantly higher (p less than .0005) than that of patients with a functioning gut (25%). This was associated with significantly poorer APACHE II mean BP, oxygenation, and creatinine scores among the GI dysfunction patients. Our results suggest that shock, ischemia, and hypoxemia, in addition to causing impairment of renal function, may bring about changes in the GI tract, evident clinically only as a failure to tolerate EN, which have an adverse effect on the prognosis of ICU patients so affected.