Risk Of Intensive Care Unit Admission Research Articles

Severity of respiratory syncytial virus compared with SARS-CoV-2 and influenza among hospitalised adults ≥65 years

Our aim was to estimate the risk of pneumonia, admission to intensive care unit (ICU) or death in individuals ≥65 years old admitted to hospital with RSV, compared to influenza or COVID-19. We included hospitalised patients from Severe Acute Respiratory Infection Surveillance in Spain between 2021-2024, aged ≥65 years, laboratory confirmed for RSV, influenza or SARS-CoV-2. Using a binomial regression with logarithmic link, we estimated the relative risk (RR) of pneumonia, ICU admission and in-hospital mortality, in patients with RSV compared to influenza or SARS-CoV-2, adjusting for age, sex, season and comorbidities. We stratified the estimates by vaccination status for influenza or SARS-CoV2. Among patients unvaccinated for influenza or SARS-CoV-2, those with RSV had similar or lower risk of pneumonia [vs. influenza: RR=0.91 (95% Confidence Interval: 0.72-1.16); vs. SARS-CoV-2: 0.81 (0.67-0.98)], ICU admission [vs. influenza: 0.93 (0.41-2.08); vs. SARS-CoV-2: 1.10 (0.61-1.99)] and mortality [vs. influenza: 0.64 (0.32-1.28); vs. SARS-CoV-2: 0.56 (0.30-1.04)]. Among the vaccinated, results were largely similar except for a higher risk of ICU admission with RSV [vs. influenza: 2.13(1.16-3.89); vs. SARS-CoV-2: 1.83 (1.02-3.28)] CONCLUSIONS: RSV presented similar or lower intrinsic severity than influenza or SARS-CoV2. Among vaccinated patients, RSV was associated to higher ICU-admission, suggesting the potential for preventive RSV vaccination.

Outcomes of Patients with End-Stage Renal Disease Hospitalized with COVID-19 in Ahvaz Razi Hospital from February 2020 to May 2021

Background: End-stage renal disease patients on maintenance hemodialysis (ESRD-HD) are at very high risk for COVID-19 infections due to their older age and comorbidities such as diabetes and hypertension. Objectives: This study aimed to investigate the outcomes of COVID-19 in ESRD-HD patients. Methods: This was a retrospective study conducted on ESRD-HD patients aged 18 years and older who were referred to Razi Hospitals in Ahvaz from February 2020 to May 2021 for hemodialysis and diagnosed with COVID-19. Patient information was extracted retrospectively from their medical records. Results: A total of 180 patients were examined. The average age of the patients was 61.5 years, and 118 (65.6%) were men. The most common underlying condition was hypertension (81.1%). The most prevalent clinical symptom was shortness of breath (70.6%), followed by cough (47.8%). Seventy-five patients (41.66%) were admitted to the intensive care unit (ICU), with an average stay of 5 days. Hypertension and ischemic heart disease were significantly more common among patients admitted to the ICU (P = 0.008 and 0.015, respectively). In-hospital mortality was 32.8%. Advanced age, fever, shortness of breath, cough, and the need for a ventilator were significant predictors of mortality in hospitalized ESRD patients with COVID-19 (P = 0.016, 0.033, 0.001, 0.012, and 0.011, respectively). Conclusions: Our study demonstrated that ESRD-HD patients with COVID-19 are at high risk for ICU admission and mortality. Advanced age and clinical symptoms such as fever, shortness of breath, cough, and the need for a ventilator significantly predict in-hospital mortality in these patients.

541. THE PHOENIX-HH SCORE: A TOOL TO PREDICT ADMISSION TO THE ICU AFTER HIATAL HERNIA REPAIR

Abstract Background Minimally invasive hiatal hernia (HH) repair is usually a safe procedure with low morbidity; however, a subset of patients may require intensive care unit (ICU) admission. To date, no specific and validated tool is available to predict the risk of ICU admission after HH repair. Although multiple tools to predict the risk of admission to the ICU after major surgical procedures have been reported, most of them are complex and require laboratory parameters. We propose a novel and quick intraoperative score that is useful for assessing unexpected ICU admission and tailoring patient management during HH repair. Methods A development cohort was established using a prospectively maintained database containing demographic, clinical, and surgical information of consecutive patients who underwent HH repair between September 2016 and July 2023. Clinical expertise and multiple logistic regressions were employed to select adequate demographic or surgical predictors to create an intuitive risk score (PHOENIX-HH). Further, a specific scoring system for each included variable was designated, and the total score (a scale from 0 to 9 points) was assessed for accuracy using the area under the receiver operating characteristic curve (AUC-ROC). Results The development cohort was formed by 391 patients who underwent primary HH repair (73.7% women; mean age 64.4±12.5 years; mean BMI 28.9±4.9 kg/m2). The mean AUC in the development cohort was 0.845 (95%CI: 0.756-0.934), and when defining a cut-off of ≥6 points, 12 of 15 patients who required ICU admission were identified using the proposed score (sensitivity, 80% [95%CI: 51.9-95.7%]; specificity, 80.1% [95%CI: 75.7-84%]; positive likelihood ratio, 4.0 [95%CI: 2.9-5.6]; negative predictive value, 99.0% [95%CI: 97.3-99.6%]). Conclusion The strongest predictor for unexpected ICU admission and postoperative complications following HH repair was the HH size (defined as the percentage of intrathoracic stomach); hence, the incorporation of this variable and other preoperative and intraoperative factors into a scoring system led to the development of the PHOENIX-HH score. This tool may allow early identification of patients who may require admission to the ICU after the surgery. Future validation using an external cohort is highly desirable.

The relationship of COVID-19 severity with laboratory findings and neutrophil-to-lymphocyte ratio in patients admitted to a large teaching hospital in Iran: A cross-sectional study.

COVID-19 patients might be admitted to the hospital based on their clinical manifestations or to the intensive care unit (ICU) due to the severity of their symptoms or critical situation. Our main objective was to investigate clinical and demographic factors influencing COVID-19 patients' admission to the ICU and length of stay (LOS) using extracted data from the hospital information systems in Iran. The data of hospitalized patients with confirmed COVID-19 were retrieved from the health information system of Imam Khomeini Hospital Complex, Tehran, Iran between March 2020 and February 2022. The primary outcome was the ICU admission, and the secondary outcome was the LOS. The correlation analysis between laboratory findings and demographic data with ICU admission and LOS was done using SPSS 21.0, and p < 0.05 was considered significant. Of all the 4156 patients, 2391 (57.5%) were male and the mean age was 58.69 ± 8.19 years. Of these, 9.5% of patients were admitted to ICU at any time point during their hospital stay. Age and laboratory variables such as neutrophil-to-lymphocyte ratio (NLR), ALT (U/L), albumin (g/dL), plasma glucose (mg/dL), ferritin levels (ng/mL), and phosphorous levels (mg/dL) shown the significant relationship with ICU admission. Also, being a smoker and having hypoxemia had a significant relationship with longer stays in the hospital. In this study, we validated a cut-off value of 4.819 for NLR, calculated at hospitalization, as a useful predictor of disease progression and occurrence of serious clinical outcomes, such as ICU admission. The study examined various clinical factors associated with ICU admission in COVID-19 patients. The findings suggest that certain factors can increase the risk of ICU admission and influence the length of hospital stay which should be focused in future studies.

Association of Human Leukocyte Antigen Alleles with COVID-19 Severity and Mortality in a Spanish Population.

Background and Objectives: The aim of the following cross-sectional study is to determine the association between human leukocyte antigen (HLA) alleles and outcomes in patients presenting to the emergency department (ED) with SARS-CoV-2 infection. Methods and Materials: Genotyping was made using the Axiom Human Genotyping SARS-CoV-2 Research Array. Statistical analysis was made with Fisher's exact test and multivariable logistic regression, adjusted for sex, age and clinical variables. Results: Of 190 patients, 11.1% were discharged from the ED; 57.9% were admitted to the COVID-19 ward, without intensive care unit (ICU) admission; 15.3% survived an ICU admission; and 15.8% died. After multivariable analysis, two HLA alleles protected against hospital admission (HLA-C*05:01, adjusted odds ratio [aOR] 0.2, 95% confidence interval [CI] 0.055-0.731; and HLA-DQB1*02:02, aOR 0.046, CI 0.002-0.871) and one was associated with higher risk for ICU admission or death (HLA-DQA1*05:01, aOR 2.517, CI 1.086-5.833). Conclusions: In this population, HLA-C*05:01 and HLA-DQB1*02:02 are associated with a protective effect against hospital admission and HLA-DQA1*05:01 is associated with higher risk of ICU admission or death in the multivariable analysis. This may help stratify risk in COVID-19 patients.

Alloimmunization in myelodysplastic syndrome is associated with higher healthcare costs, longer hospitalizations, and increased mortality.

Transfusion of red blood cells (RBC) is an important component of treatment for myelodysplastic syndromes (MDS). Patients receiving frequent transfusions are more likely to develop alloimmunization, an immune reaction to minor RBC antigens that increases the risk of complications including delayed hemolysis. Phenotypic matching is believed to reduce alloimmunization although rigorous evidence is lacking. This study examines the association of alloimmunization with clinical and economic outcomes and may give insight into the potential benefit of phenotypic matching in MDS. This study used data from 1054 hospitals included in the Premier hospital chargemaster dataset. Alloimmunized MDS patients (January 2015 to June 2019) were indirectly identified by ICD-10 codes (antiglobulin crossmatch and RBC antibody identification). The primary objective was assessment of the association between incremental cost per patient encounter and alloimmunization in MDS patients. Secondary objectives were assessment of the association of length of stay, intensive care unit (ICU) admission, and inpatient mortality for alloimmunized versus non-alloimmunized MDS patients. Worse clinical and economic outcomes were observed for the alloimmunized group. Higher costs (14%), more ICU admissions (38%), longer hospital (21%) and ICU stays (55%), and greater mortality (30%) were observed among alloimmunized MDS patients compared to non-alloimmunized (p < .0001 for all comparisons). Alloimmunization may be associated with higher costs and greater risk of ICU admission and death in patients with MDS. While further mechanistic research is needed, it seems that MDS patients may benefit substantially from practices that limit risk of alloimmunization, including providing prophylactic antigen matching.

Development and Validation of a Risk Score for Predicting ICU Admission in Adults with New-Onset Encephalitis.

Timely intensive care unit (ICU) admission for patients with encephalitis is associated with better prognosis. Therefore, our aim was to create a risk score predicting ICU admission in adults with encephalitis, which could aid in optimal management and resource allocation. We initially identified variables that would be most predictive of ICU admission among 372 patients with encephalitis from two hospital systems in Houston, Texas (cohort 1), who met the International Encephalitis Consortium (IEC) criteria from 2005 to 2023. Subsequently, we used a binary logistic regression model to create a risk score for ICU admission, which we then validated externally using a separate cohort of patients from two hospitals in Baltimore, Maryland (cohort 2), who met the IEC criteria from 2006 to 2022. Of 634 patients with encephalitis, 255 (40%) were admitted to the ICU, including 45 of 113 (39.8%) patients with an autoimmune cause, 100 of 272 (36.7%) with an infectious cause, and 110 of 249 (44.1%) with an unknown cause (p = 0.225). After conducting a multivariate analysis in cohort 1, we found that the presence of focal neurological signs, new-onset seizure, a Full Outline of Unresponsiveness score ≤ 14, leukocytosis, and a history of chronic kidney disease at admission were associated with an increased risk of ICU admission. The resultant clinical score for predicting ICU admission had an area under the receiver operating characteristic curve (AUROC) of 0.77 (95% confidence interval [CI] 0.72-0.82, p < 0.001). Patients were classified into three risk categories for ICU admission: low risk (score 0, 12.5%), intermediate risk (scores 1-5, 49.5%), and high risk (scores 6-8, 87.5%). External validation in cohort 2 yielded an AUROC of 0.76 (95% CI 0.69-0.83, p < 0.001). ICU admission is common in patients with encephalitis, regardless of etiology. Our risk score, encompassing neurologic and systemic factors, may aid physicians in decisions regarding intensity of care for adult patients with encephalitis upon hospital admission.

Morbidity and Mortality of Hospital-Onset SARS-CoV-2 Infections Due to Omicron Versus Prior Variants : A Propensity-Matched Analysis.

Many hospitals have scaled back measures to prevent nosocomial SARS-CoV-2 infection given large decreases in the morbidity and mortality of SARS-CoV-2 infections for most people. Little is known, however, about the morbidity and mortality of nosocomial SARS-CoV-2 infections for hospitalized patients in the Omicron era. To estimate the effect of nosocomial SARS-CoV-2 infection on hospitalized patients' outcomes during the pre-Omicron and Omicron periods. Retrospective matched cohort study. 5 acute care hospitals in Massachusetts, December 2020 to April 2023. Adults testing positive for SARS-CoV-2 on or after hospital day 5, after negative SARS-CoV-2 test results on admission and on hospital day 3, were matched to control participants by hospital, service, time period, days since admission, and propensity scores that incorporated demographics, comorbid conditions, vaccination status, primary diagnosis category, vital signs, and laboratory test values. Primary outcomes were hospital mortality and time to discharge. Secondary outcomes were intensive care unit (ICU) admission, need for advanced oxygen support, discharge destination, hospital-free days, and 30-day readmissions. There were 274 cases of hospital-onset SARS-CoV-2 infection during the pre-Omicron period and 1037 cases during the Omicron period (0.17 vs. 0.49 cases per 100 admissions). Patients with hospital-onset SARS-CoV-2 infection were older and had more comorbid conditions than those without. During the pre-Omicron period, hospital-onset SARS-CoV-2 infection was associated with increased risk for ICU admission, increased need for high-flow oxygen, longer time to discharge (median difference, 4.7 days [95% CI, 2.9 to 6.6 days]), and higher mortality (risk ratio, 2.0 [CI, 1.1 to 3.8]) versus matched control participants. During the Omicron period, hospital-onset SARS-CoV-2 infection remained associated with increased risk for ICU admission and increased time to discharge (median difference, 4.2 days [CI, 3.6 to 5.0 days]). The association with increased hospital mortality was attenuated but still significant (risk ratio, 1.6 [CI, 1.2 to 2.3]). Residual confounding may be present. Hospital-onset SARS-CoV-2 infection during the Omicron period remains associated with increased morbidity and mortality. Harvard Medical School Department of Population Medicine.

Serum Uric Acid Levels as a Risk Stratification Tool in Hypertensive Disorders of Pregnancy: A Retrospective Study.

Worldwide, hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal and fetal morbidity and mortality. Serum uric acid is a test that can evaluate the severity of HDP and the associated maternal and fetal morbidity and mortality. To examine the relationship between maternal serum uric acid levels and the severity of HDP and overall pregnancy outcomes. A retrospective study was conducted on women with a gestational age > 20 weeks and BP >140/90 mmHg over three years. A total of 134 patients were included in the study. Patients with chronic hypertension, hyperuricemia without hypertension, and other major illnesses were excluded. Data were collected from medical records, including age, gravida, parity, weight, height, gestational age, blood pressure at admission, urine albumin, and serum uric acid levels. Of the 134 enrolled women with HDP, 76 had gestational hypertension, 41 had preeclampsia, and 17 had eclampsia. Mean uric acid levels in mg/dL were 6.06±1.651, 6.20±0.824, and 7.38±1.26 in gestational hypertension, preeclampsia, and eclampsia, respectively, which was a significant association (p=0.002). Mean uric acid in mg/dL was 5.86±1.27 in intensive care unit (ICU) patients compared to 6.45±1.39 in ward patients (p=0.015). There was a significantly increased risk of ICU admission and preterm delivery (r=-0.401, p<0.001) in patients with elevated uric acid levels. There was a significantly increased risk of low-birth-weight babies with elevated uric acid levels (r=-0.278, p=0.001). However, there was no statistically significant increased risk of newborn intensive care unit admissions (p=0.264) with elevated uric acid levels. Serum uric acid levels vary significantly in HDP and were found to be elevated in severe preeclampsia and eclampsia. It can be considered for risk stratification in HDP based on disease severity; however, its role in determining outcomes is debatable. Using serum uric acid levels in predictive models along with known biomarkers may determine its possible additional value in disease prediction and severity.

Role of Inflammatory Markers in Severity, ICU Admission, and Mortality in COVID-19: A Systematic Review and Meta-analysis of 79,934 Patients

Introduction Despite extensive investigations into the roles of inflammatory biomarkers in the prognosis of COVID-19 through systematic reviews and meta-analyses, they are limited by small sample sizes and focus on a specific marker. This meta-analysis investigated the role of 11 inflammatory biomarkers in severity, intensive care unit (ICU) admission, and mortality among COVID-19 patients. Methods Studies up to October 25, 2023, were identified through a search of Google Scholar, limited to human studies published in English. Inclusion criteria required confirmed COVID-19 cases diagnosed via reliable laboratory methods, original articles from eligible journals, proper grouping of severity status, ICU admission, or mortality outcomes, and presentation of continuous data in mean and standard deviation, median with range, or interquartile range. Results A total of 241 studies, comprising 79,934 cases of COVID-19, were included in this study. Albumin levels significantly declined in severe, ICU, and dead cases compared to mild, moderate, non-ICU, and survived cases (p&lt;0.001). C-reactive protein (CRP), D-dimer, erythrocyte sedimentation rate (ESR), ferritin, fibrinogen, Interleukin-6 (IL-6), lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), procalcitonin, and white blood cell (WBC) were all significantly (p&lt;0.001) increased and correlated with the severity of COVID-19. CRP, D-dimer, ferritin, fibrinogen, IL-6, LDH, NLR, procalcitonin, and WBC were all significantly (p&lt;0.05) elevated and correlated with the risk of ICU admission (except fibrinogen) and mortality in COVID-19 in both fixed and random effects. Conclusion Inflammatory biomarkers like albumin, CRP, D-dimer, ferritin, IL-6, LDH, NLR, procalcitonin, and WBC all significantly impact severity status, ICU admission, and mortality in COVID-19.

Racial/ethnic disparity in severe maternal morbidity among women who conceived by in vitro fertilization

BackgroundIn vitro fertilization (IVF) as a fertility treatment is associated with adverse perinatal outcomes. Racial/ethnic disparity in severe maternal morbidity (SMM) in women who conceived by IVF is understudied. ObjectiveTo examine differences in the association between race/ethnicity and SMM between women who conceived spontaneously and those who conceived using IVF. MethodsWe included all singleton live births and stillbirths in the United States, 2016–2021; data were obtained from the National Center for Health Statistics. Maternal race/ethnicity included non-Hispanic White (NHW), non-Hispanic Black (NHB), American Indian and Alaska Native (AIAN), Asian, Pacific Islander (PI), Hispanic, and mixed-race categories. The SMM composite outcome included eclampsia, uterine rupture, peripartum hysterectomy, blood transfusion, and intensive care unit (ICU) admission. We used logistic regression to adjust for potential confounders (such as age, education, parity, prepregnancy body mass index, smoking during pregnancy, chronic hypertension, and preexisting diabetes) and to assess modification of the association between race/ethnicity and SMM by IVF. ResultsThe study population included 21,585,015 women: 52% were NHW, 15% NHB, 0.8% AIAN, 6% Asian, 0.2% PI, 24% Hispanic, and 2% were of mixed race. IVF was used by 183,662 (0.85%) women; the rate of the SMM composite outcome was 18.5 per 1000 deliveries and 7.9 per 1000 deliveries in the IVF and spontaneous conception groups, respectively (unadjusted rate ratio 2.34, 95% confidence interval [CI] 2.26–2.43). In women with spontaneous conception, NHB, Asian and mixed-race women had elevated odds of SMM compared with NHW women (adjusted odds ratio [aOR]=1.39, 95% CI 1.37–1.41; aOR=1.04, 95% CI 1.02–1.07; and aOR=1.42, 95% CI 1.38–1.46, respectively). Racial/ethnic disparities in SMM and its components were not different between the IVF and spontaneous conception groups for the mixed-race category. NHB and Hispanic women had significantly higher aORs for uterine rupture/intrapartum hysterectomy compared with NHW women in the IVF group, while Asian women had a higher aOR for ICU admission compared with NHW women in the IVF group. ConclusionWomen who conceived by IVF have a greater than two-fold higher risk of SMM and this higher risk is evident across all racial/ethnic groups. However, NHB and Hispanic women who conceived by IVF had a higher risk of uterine rupture/hysterectomy, and Asian women who conceived by IVF had a higher risk of ICU admission. Our results warrant further investigation examining pregnancy and postpartum care issues among racial/ethnic minority women who conceive using IVF.

Sarcopenic Obesity and Outcomes for Patients With Cancer

The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) have recently proposed a consensus definition and diagnostic criteria for sarcopenic obesity (SO). To implement the ESPEN-EASO diagnostic algorithm to investigate the prevalence of SO and its association with outcomes in patients with solid tumor cancers, with particular regard to associations among SO, overall survival (OS), and patient quality of life (QoL). This prospective cohort study included patients diagnosed with solid tumor starting in May 7, 2013, with the last follow-up on June 30, 2022. Patients with solid tumors were categorized into SO and non-SO groups according to ESPEN-EASO criteria. The primary outcome was OS and the secondary outcomes included patient QoL and risk of intensive care unit (ICU) admission. Data were analyzed from June to December 2023. A total of 6790 patients were included in the study (mean [SD] age, 59.64 [10.77] years; 3489 were female [51.4%]). The prevalence of SO was 4.36% (296 of 6790) in the whole cohort and 14.98% (296 of 1976) in the subgroup with obesity. SO prevalence increased with age. During a median (IQR) follow-up period of 6.83 (5.67-7.04) years, 2103 patients died. Cox regression analysis indicated that SO was independently associated with lower OS (hazard ratio [HR], 1.54; 95% CI, 1.23-1.92), which was observed in both men (HR, 1.51; 95% CI, 1.09-2.10) and women (HR, 1.53; 95% CI, 1.12-2.07). SO was also associated with poorer QoL and higher risk of ICU admission (odds ratio, 2.39; 95% CI, 1.06-5.29). Among the diagnostic components of SO, low hand grip strength (HGS) was the only SO component associated with poor OS (HR, 1.15; 95% CI, 1.04-1.28). This cohort study of SO found that SO was significantly associated with lower OS, poorer QoL, and higher risk of ICU admission. Weak HGS, 1 of the diagnostic conditions, was the only component of SO associated with OS. The ESPEN-EASO algorithm appears to be an applicable tool to identify cancer-associated SO, which represents a major clinical complication and factor associated with risk for poor outcomes in these patients.

Comparison of clinical characteristics and outcomes of patients with sepsis identified by the Sepsis-3 criteria by blood and urine culture results: A multicentre retrospective cohort study.

Blood and urine are the most common culture testing for sepsis patients. This study aimed to compare clinical characteristics and outcomes of sepsis patients by blood and urine culture positivity and to identify factors associated with positive cultures. This retrospective study included patients aged ≥16 years with sepsis identified by the Sepsis-3 criteria presenting to the emergency department at four hospitals between 2017 and 2019 in Australia. Patient clinical outcomes were in-hospital mortality, intensive care unit (ICU) admission, hospital length of stay, and representation following discharge. Four culture groups were defined based on the positivity of blood cultures (BC) and urine cultures (UC) ordered within 24 h of triage. Of 4109 patient encounters with sepsis, 2730 (66%) were nonbacteremic, urine culture-negative (BC-UC-); 767 (19%) nonbacteremic, urine culture-positive (BC-UC+); 359 (9%) bacteremic, urine culture-negative (BC+UC-); and 253 (6%) bacteremic, urine culture-positive (BC+UC+). Compared with BC-UC- patients, BC+UC- patients had the highest risk of ICU admission (adjusted odds ratio [AOR] 95% CI: 1.60 [1.18-2.18]) while BC-UC+ patients had lowest risk (adjusted odds ratio [AOR]: 0.56 [0.41-0.76]). BC+UC- patients had the highest risk of 3-day representation (AOR: 1.51 [1.02-2.25]) and second longest hospital stay (adjusted relative risk 1.17 [1.03-1.34]). Antibiotic administration before sample collection for culture was associated with lower odds of positive blood or urine culture results (AOR: 0.38, p < 0.0001). Enhanced clinical care should be beneficial for nongenitourinary sepsis patients (BC+UC-) who had the highest comparative risk of adverse clinical outcomes. Every effort needs to be made to collect relevant culture samples before antibiotic administration, to follow up on culture results, and tailor treatment accordingly.

Association of admission serum triglyceride levels with intensive care unit hospitalization rates in acute pancreatitis patients: A retrospective study.

Acute pancreatitis (AP) is a complex and unpredictable condition, of which hypertriglyceridemia (HTG) is the third most prevalent cause. This study aimed to conduct a retrospective analysis of clinical data from hospitalized AP patients to uncover a potential correlation between triglyceride (TG) levels and the necessity for intensive care unit (ICU) admission. This retrospective cohort study utilized the Medical Information Mart for Intensive Care IV 2.2 (MIMIC-IV) critical care dataset, incorporating data from 698 patients with hypertriglyceridemic acute pancreatitis (HTG-AP). The analysis employed the RCS model along with univariate and multivariate logistic regression methods to affirm the association between triglyceride levels and ICU admission. Subgroup analysis was performed to investigate specific populations. The study included 698 patients with AP, 42.41% of whom experienced HTG during hospitalization. RCS analysis revealed a linear association between TG levels and risk of ICU admission (p for nonlinear = .219, p for overall = .009). Multivariate logistic regression analysis indicated an increased risk of ICU admission in the TG range of 1.7-5.65 mmol/L (aOR = 1.83, 95% CI 1.12-2.99, P = .015) and TG >11.3 mmol/L (aOR = 5.69, 95% CI 2.36-13.74, P < .001) compared to the normal group. Similar results were observed across the various subgroups. As triglyceride levels increased, there was a corresponding increase in ICU admissions. Patients within the 1.7 to 5.65 mmol/L and > 11.3 mmol/L triglyceride groups exhibited higher rates of ICU admissions. Moreover, we observed a higher risk of ICU hospitalization even with mild TG elevation.

The role of plant-based dietary patterns in reducing COVID-19 risk and/or severity in adults: A systematic review and meta-analysis of observational studies

Background & AimsPlant-based dietary patterns (PBDs) might protect against COVID-19 risk and reduce severity of infection. This systematic review with meta-analysis aimed to examine the association between PBDs and risk of COVID-19 infection, hospitalization, intensive care unit (ICU) admission, and/or mortality, in adults. MethodsPubmed, Embase, CINAHL and Web of Science were searched for observational studies, published in English up to 3rd April 2023, comparing the highest with the lowest adherence to a specific PBD. Data were screened, extracted, and risk of bias assessed using the Newcastle-Ottawa Quality Assessment Scale, by independent reviewers. ResultsSeven studies (one cross-sectional, three case-control, and three prospective cohort), reporting on 649,315 participants, were eligible. Across them, there were 8,512 events of COVID-19 infection (six studies), and 206 events of COVID-19 hospitalization (four studies), in addition to one study reporting on a composite hospitalization outcome (740 events). The pooled analysis showed that PBDs are associated with a 59% (odds ratio (OR)=0.41, 95% confidence intervals (CI) 0.23-0.59; two studies) and 18% (OR=0.82, 95% CI 0.78-0.85; three studies) reduction in COVID-19 infection risk in case-control and cohort studies, respectively. The pooled analysis of one case-control and two cohort studies showed an inverse association between high adherence to a PBD and risk of COVID-19 hospitalization (OR=0.38, 95% CI 0.04-0.72). ConclusionFindings suggest a protective role of PBDs against the risk of COVID-19 infection and severity. More studies are needed to establish the association between PBDs and risk of ICU admission and mortality due to COVID-19.

Clinical complexity of an Italian cardiovascular intensive care unit: the role of mortality and severity risk scores.

The identification of patients at greater mortality risk of death at admission into an intensive cardiovascular care unit (ICCU) has relevant consequences for clinical decision-making. We described patient characteristics at admission into an ICCU by predicted mortality risk assessed with noncardiac intensive care unit (ICU) and evaluated their performance in predicting patient outcomes. A total of 202 consecutive patients (130 men, 75 ± 12 years) were admitted into our tertiary-care ICCU in a 20-week period. We evaluated, on the first 24 h data, in-hospital mortality risk according to Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score 3 (SAPS 3); Sepsis related Organ Failure Assessment (SOFA) Score and the Mayo Cardiac intensive care unit Admission Risk Score (M-CARS) were also calculated. Predicted mortality was significantly lower than observed (5% during ICCU and 7% at discharge) for APACHE II and SAPS 3 (17% for both scores). Mortality risk was associated with older age, more frequent comorbidities, severe clinical presentation and complications. The APACHE II, SAPS 3, SOFA and M-CARS had good discriminative ability in distinguishing deaths and survivors with poor calibration of risk scores predicting mortality. In a recent contemporary cohort of patients admitted into the ICCU for a variety of acute and critical cardiovascular conditions, scoring systems used in general ICU had good discrimination for patients' clinical severity and mortality. Available scores preserve powerful discrimination but the overestimation of mortality suggests the importance of specific tailored scores to improve risk assessment of patients admitted into ICCUs.

Effect of Vitamin D3 Supplementation on Severe COVID-19: A Meta-Analysis of Randomized Clinical Trials.

Since the beginning of the COVID-19 pandemic, vitamin D has attracted interest due to its immunomodulatory properties. Numerous studies show a correlation between vitamin D levels and COVID-19 cases and mortality. Therefore, we conducted a meta-analysis in order to assess the relationship between vitamin D3 supplementation and COVID-19 severity. We included 13 randomized clinical trials that contained the analyzed endpoints: length of COVID-19 hospitalization, number of intensive care unit (ICU) admissions, length of stay in the ICU, number of cases requiring any supplemental oxygenation, duration of any supplemental oxygenation, number of overall mortality and number of deaths associated with COVID-19. The relative risk with 95% confidence interval (CI) and the mean difference with 95% CI were calculated to compare the effect. A random effects model was used to calculate effect sizes. Our meta-analysis showed a positive effect of vitamin D3 supplementation on ICU admission (RR = 0.73; 95% CI [0.57; 0.95], p = 0.02, I2 = 19.6%) and mortality associated with COVID-19 among patients (RR = 0.56; 95% CI [0.34; 0.91]; p = 0.02; I2 = 0%). Vitamin D3 supplementation may potentially reduce the risk of ICU admission and death associated with COVID-19.

Golf cart injuries have similar severity to all-terrain vehicle injuries in children: a multicenter comparison over a 5-year period

BackgroundGolf carts (GCs) and all-terrain vehicles (ATVs) are popular forms of personal transport. Although ATVs are considered adventurous and dangerous, GCs are perceived to be safer. Anecdotal experience suggests increasing...

Association between SARS-CoV-2 Infection and Adverse Perinatal Outcomes by Race/Ethnicity in a Large Integrated Health Care System.

Recent studies have reported associations between severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during pregnancy and adverse perinatal outcomes but the extent to which these associations vary by race/ethnicity remains uncertain. Therefore, we examined how the association between prenatal SARS-CoV-2 infection and adverse perinatal outcomes may be modified by race/ethnicity. A retrospective cohort study was performed using data on 67,986 pregnant women extracted from the Kaiser Permanente Southern California electronic health records between April 6, 2020, and December 31, 2021. Upon admission to labor and delivery, all women were routinely tested for coronavirus disease 2019 (COVID-19) using real-time reverse-transcriptase polymerase chain reaction test. Adjusted odds ratios (aORs) were used to estimate associations. During the study period, COVID-19 was diagnosed in 4,960 (7%) of singleton pregnancies, with the highest rates observed among Hispanics (9.4%) and non-Hispanic Blacks (6.2%). Compared with non-Hispanic Whites, Hispanics (aOR: 1.12, 95% CI: 1.03, 1.21) with SARS-CoV-2 infection had the highest odds of a pregnancy associated with nonreassuring fetal heart rate tracing. Neonates of all races/ethnicities, except for non-Hispanic Blacks, showed significantly increased odds of SARS-CoV-2 infection, with the highest risk observed among Asians/Pacific Islanders (aOR: 10.88, 95% CI: 1.33, 89.04). Non-Hispanic White mothers who tested positive were admitted to intensive care unit (ICU) at a higher rate at delivery and within 7 days of delivery (aOR: 34.77, 95% CI: 11.3, 107.04; aOR: 26.48, 95% CI: 9.55, 73.46, respectively). Hispanics were also at a significantly higher odds of admission to ICU (aOR: 4.62, 95% CI: 2.69, 7.94; aOR: 4.42, 95% CI: 2.58, 7.56, respectively). Non-Hispanic Black, Hispanic, and Asian/Pacific Islander mothers who tested positive for SARS-CoV-2 prenatally, were at increased risk for preeclampsia/eclampsia, and preterm birth as compared to non-Hispanic White mothers. The findings highlight racial/ethnic disparities in the association between SARS-CoV-2 infection and adverse perinatal outcomes. The risk of neonatal SARS-CoV-2 infection was highest for Asian/Pacific Islanders. We also observed a remarkably high risk of ICU admission for non-Hispanic White mothers infected with SARS-CoV-2. · Race/ethnicity influences perinatal outcomes in pregnancies impacted by SARS-CoV-2.. · The risk of neonatal SARS-CoV-2 infection was highest for Asian/Pacific Islanders.. · White mothers had a notably high risk of ICU admission at delivery following SARS-CoV-2 infection..

Superinfections in COVID-19

Introduction Bacterial superinfection rates in SARS-CoV-2 (COVID-19) range from 8% to 49.6%, but the diagnosis remains a challenge. We conducted a study to determine the utility of the Pneumonia Severity Index (PSI) to predict the risk of superinfections and outcomes in COVID-19 patients. Methods A cross-sectional retrospective study was conducted on COVID-19 positive patients admitted during 2020–2022. The PSI scores were calculated at admission and at every 72-hour intervals. Data regarding clinical course, antibiotic use and overall outcome were collected. Results A total of 149 patients were included, with a mean age of 67 years. The PSI score at admission and the mean PSI score were higher for those who required antibiotics, intensive care unit (ICU) admission, or succumbed. Patients with a PSI score &gt;107 at admission had a high risk of ICU admission, &gt;113 had a high risk of antibiotic requirements, and &gt;110 had a higher risk of death. An increase in PSI score ≥25 between the day of admission and day 3 of hospitalization; or between day 3 and day 6 of hospitalization, predicted a higher chance of mortality; but had no association with the development of superinfections. Discussion The PSI score at admission can be used to predict the severity of disease requiring ICU admission, antibiotic requirement, and overall mortality, with serial monitoring of the score predicting possible clinical deterioration and increased mortality. However, it was not helpful in predicting the chances of developing superinfections and the need for antibiotic therapy. Conclusions The PSI score can be used to prognosticate the outcome in patients admitted with COVID-19, but further studies are needed to determine its utility in predicting the risk of superinfections.