Prognostic Factors For In-hospital Mortality Research Articles

Prognosis of patients with systemic rheumatic diseases admitted to the intensive care unit

To determine prognostic factors in patients with systemic rheumatic diseases admitted to the intensive care unit (ICU) and to examine whether the observed mortality rate is predicted using the Acute Physiology And Chronic Health Assessment II (APACHE II) score. Retrospective study with historical controls in a 31-bed medicosurgical ICU at a university hospital. Seventy-one patients admitted to the ICU for an acute illness related to a systemic rheumatic disease and/or its treatment and 353 ICU control patients. Systemic rheumatic diseases were mainly rheumatoid arthritis and vasculitides. In-hospital mortality rate was 28/71 (39%), including 23 patients who died in the ICU. Multivariable logistic regression showed that poor prior health status (Berdit's classification), APACHE II score, and admission for infection were associated with mortality, whereas prior use of immunosuppressive agents was not. APACHE II score at admission was higher in nonsurvivors (22+/-9) than in survivors (17+/-5) (p<0.01). The standard mortality ratio, i.e., the ratio between observed and predicted mortality, was 1.7 in the 71 study patients and 1.0 in the 353 control patients (p<0.0001). In patients with systemic rheumatic diseases admitted to the ICU for at least 48 h, poor prior chronic health status, APACHE II score, and infection were prognostic factors for in-hospital mortality. SMR was higher than in a control ICU population.

Factores pronósticos de mortalidad relacionados con el estado nutricional en ancianos hospitalizados

The proportion of elderly patients hospitalized in acute care wards has progressively increased. Patients with a decreased functional status are prone to have malnutrition which negatively affects their prognosis and increases mortality. However, it is unclear whether functional and nutritional status are independent risk factors of mortality. We investigated the relation between functional status (Katz index) and nutritional parameters and the incidence of mortality in a prospective, observational study of a cohort of elderly patients who were admitted to an internal medicine ward. Prevalence of malnutrition upon admission and cumulative incidence rate of in-hospital mortality were computed. Also, potential nutritional and functional prognostic factors for in-hospital mortality were identified by multiple logistic regression. The prevalence of malnutrition in 105 patients included in the cohort was 57.1% (95 percent confidence interval, 47.1% to 66.8%). The incidence of in-hospital mortality was 14.3% (95 percent confidence interval, 8.2% to 22.5%). After adjustment, independent prognostic factors for in-hospital mortality were: a high level of functional dependence (F and G categories of Katz index, OR 6.1; 95 percent confidence interval, 1.4 to 26.3), diminished levels of serum transferrin (each decrement of 1g/L, OR 8.3; 95 percent confidence interval, 3.4 to 20.0) and lymphocyte cell counts (each decrement of 0.5 x 10(9) cells/L, OR 2.3; 95 percent confidence interval, 1.5 to 3.5). The prevalence of malnutrition and the incidence of mortality are very high in the hospitalized elderly. In our cohort, decreased serum transferrin and lymphocyte cell count, and an increased level of functional status were associated with an increased risk of in-hospital mortality. Given the high prevalence of geriatric patients in acute care hospitals, strategies to promote an adequate nutrition may reduce the risk of death.

In-Hospital and 2-Year Survival of Patients Treated With Mechanical Ventilation for Acute Exacerbation of COPD

To analyze in-hospital and 2-year survival of patients who require mechanical ventilation with intubation after acute respiratory failure due to exacerbation of chronic obstructive pulmonary disease (COPD). The secondary objective was to identify the prognostic factors for in-hospital mortality and mortality at 2 years. We retrospectively studied 101 patients with suspected COPD admitted to the intensive care unit between July 1993 and December 1998. Variables potentially related to mortality were analyzed with a univariate model and by logistic regression. In-hospital survival was 74.3% and 2-year survival was 55.4%. Survival at 2 years was 81% for patients discharged from hospital. The variables associated with in-hospital mortality were age greater than 65 years, electrocardiographic diagnosis of chronic cor pulmonale, and development of multiorgan dysfunction syndrome. No factors predictive of mortality at 2 years were identified. The in-hospital survival rate for patients with an acute exacerbation of COPD who require mechanical ventilation is good and the 2-year survival rate is acceptable. Age, electrocardiographic signs of cor pulmonale, and development of multiorgan dysfunction syndrome were associated with greater risk of in-hospital mortality.

Predictive value of white blood cell count on admission for in-hospital mortality in acute stroke patients

Objective: In the present study, we sought to determine the predictive value of white blood cell (WBC) count measured on admission for in-hospital death in acute stroke patients. Methods: WBC count was measured automatically in 400 consecutive acute stroke patients (67.5±12.9 years old; 226 female) on admission to hospital. Patients included into the study had symptoms starting less than 12 h prior to hospitalization and no known causes of inflammation. Logistic regression adjusted for age, gender, the presence of diabetes, hypertension, atrial fibrillation, previous stroke and ischemic heart disease was used for the calculation of odds ratio (OR) with 95% confidence interval (CI) for in-hospital mortality. Results: Stroke patients with WBC counts in the third tertile (over 9.7×10 3 μL −1) had more than eight times (OR: 8.26; 95% CI: 3.95–17.25; P<0.0001) increased risk of in-hospital mortality as compared with the rest of the patients. The WBC count increment of every 1000 cell/μL was associated with OR for in-hospital death of 1.27 (95% CI: 1.17–1.39; P<0.0001). There was also a significant correlation between patients’ WBC count and their clinical condition and degree of disability at the time of admission to hospital. Conclusion: An increased WBC count within the first 12 h of onset of an ischemic stroke is a strong prognostic factor for in-hospital mortality.

Mortalidad hospitalaria en la hemorragia subaracnoidea. Experiencia del «Registro Barcelona de Enfermedades Cerebrovasculares»

To determine clinical predictors of in-hospital mortality in patients with non-traumatic subarachnoid hemorrhage. Data de 184 patients with subarachnoid hemorrhage were obtained from consecutive stroke included in the prospective "Barcelona Stroke Registry". Demographic, anamnestic, clinical, neuroimaging and outcome variables in the subgroup of patients who died were compared with those in the surviving subgroup. The independent predictive value of each variable on the development of death was assessed with a logistic regression analysis. Three predictive models were constructed. A first model was based on demographic and clinical variables (total 10 variables). A second model was based on demographic, clinical and neuroimaging variables (total 17). A third model was based on demographic, clinical, neuroimaging and outcome variables (total 21). In-hospital death was observed in 44 patients (24%). Transient neurological deficit (OR = 13.92; 95% CI: 1.01-191.95), progressive deficit (OR = 4.21; 95% IC: 1.28-13.86), limb weakness (OR = 3.24; 95% IC: 1.49-7.08) and age (OR = 1.05; 95% CI: 1.02-1.09) appeared to be independent prognostic factors of in-hospital mortality in the first predictive model. In addition to these variables, intraventricular hemorrhage (OR = 5.51; 95% CI: 1.94-16.04) was selected in the second predictive model. Transient neurological deficit (OR = 41.2; 95% CI: 1.61-1056.2), neurological complications (OR = 11.04; CI del 95%: 3.85-31.74), carotid aneurysm (OR = 6.61; 95% CI: 1.23-35.43), intraventricular hemorrhage (OR = 5.51; 95% CI: 1.65-18.4), progressive deficit (OR = 5.35; 95% CI: 1.11-25.90) and hemispheric intracerebral hemorrhage (OR = 4.32; 95% CI: 1.35-13.90), appeared to be independent prognostic factors of in-hospital mortality in the third model. Clinical features easily obtained at the patient's bedside in addition to neuroimaging data easily obtained in routine neuroimaging studies help clinicians to predict in-hospital mortality in patients with subarachnoid hemorrhage. Transient neurological deficit prior to definitive subarachnoid hemorrhage was the main clinical predictor of in-hospital mortality.

Predictive factors of early seizures after acute cerebrovascular disease.

Seizures within the first 48 hours of a first stroke or transient ischemic attack (TIA) are an independent prognostic factor for in-hospital mortality. The aim of this study was to determine predictive factors of early seizures in first-ever stroke patients. Data of 1220 first-ever stroke patients admitted consecutively to an acute stroke unit of a 450-bed teaching hospital between January 1986 and December 1993 were collected from a stroke registry. Demographic, anamnestic, clinical, neurological, and neuroimaging variables in the seizure and nonseizure group were compared using the t test and the chi 2 test. The independent predictive value of each variable on the development of early seizures was assessed with a logistic regression analysis. Early epileptic seizures were diagnosed in 29 patients (2.4%). Seizures were significantly more frequent in patients with hemorrhagic stroke (4.3%) than in those with ischemic stroke (2%). Patients with seizures were significantly younger and significantly more likely to have acute confusional state, cortical involvement, large stroke, and involvement of the parietal, frontal, occipital, and temporal lobes than patients without seizures. The in-hospital mortality rate was 37.9% in the seizure group and 14.4% in the nonseizure group (P < .0005). After multivariate analysis, only cortical involvement (odds ratio of 6.01) and acute agitated confusional state (odds ratio of 4.44) were independent clinical factors for developing epileptic seizures. Cortical involvement in the neuroimaging studies and agitated acute confusional state at the onset of stroke were independent predictive factors of early seizures in first-ever stroke patients. The efficacy of anticonvulsant drugs in the prophylactic control of seizures should be assessed in prospective, randomized, double-blind clinical trials conducted in the subgroup of patients with the highest risk of developing epileptic seizures.

Relevance of early seizures for in-hospital mortality in acute cerebrovascular disease.

We studied the influence of early poststroke seizures (within the first 48 hours of onset of a first stroke or transient ischemic attack) on in-hospital mortality in 1,099 consecutive patients collected in a prospective stroke registry. Differences in the frequency of demographic characteristics, clinical events, and outcome between patients with and those without epileptic seizures were assessed. To determine the independent predictive value of early seizures on in-hospital mortality, variables related to vital status at discharge (alive, dead) in the univariate analysis, plus age, were studied in two multiple linear regression models. The first predictive model was based on demographic, anamnestic, and clinical variables with a total of 13 variables, and the second model was based on clinical and neuroimaging variables with a total of 16 variables. A total of 27 patients (2.5%) had epileptic seizures during the first 48 hours of stroke. Advanced age, confusional syndrome, hemorrhagic stroke, large lesions, involvement of parietal and temporal lobes, and occurrence of neurologic and medical complications were significantly more frequent in seizure patients than in nonseizure patients. Overall in-hospital mortality rate was 33.3% in the seizure group and 14.2% in the nonseizure group (p = 0.02). The presence of early seizures was a significant predictive variable both in the model based on clinical variables (odds ratio [OR], 5.5; 95% confidence interval [CI], 1.81 to 16.72) and in the model based on clinical and neuroimaging variables (OR, 6.1; 95% CI, 2.13 to 17.93). Seizures at the onset of a first-ever stroke is an independent prognostic factor for in-hospital mortality. Patients with the highest risk of developing epileptic seizures-aged persons with a large hemorrhagic infarction of a parietal lobe-may be candidates to be treated prophylactically against seizures for a few days.