Significant Predictors Of Hospital Mortality Research Articles

A Simple Risk Formula for the Prediction of COVID-19 Hospital Mortality.

SARS-CoV-2 respiratory infection is associated with significant morbidity and mortality in hospitalized patients. We aimed to assess the risk factors for hospital mortality in non-vaccinated patients during the 2021 spring wave in the Czech Republic. A total of 991 patients hospitalized between January 2021 and March 2021 with a PCR-confirmed SARS-CoV-2 acute respiratory infection in two university hospitals and five rural hospitals were included in this analysis. After excluding patients with unknown outcomes, 790 patients entered the final analyses. Out of 790 patients included in the analysis, 282/790 (35.7%) patients died in the hospital; 162/790 (20.5) were male and 120/790 (15.2%) were female. There were 141/790 (18%) patients with mild, 461/790 (58.3%) with moderate, and 187/790 (23.7%) with severe courses of the disease based mainly on the oxygenation status. The best-performing multivariate regression model contains only two predictors-age and the patient's state; both predictors were rendered significant (p < 0.0001). Both age and disease state are very significant predictors of hospital mortality. An increase in age by 10 years raises the risk of hospital mortality by a factor of 2.5, and a unit increase in the oxygenation status raises the risk of hospital mortality by a factor of 20.

Dehydroepiandrosterone sulfate to cortisol ratio as a prognostic factor in cirrhotic patients with spontaneous bacterial peritonitis

BackgroundChronic liver disease and decompensated cirrhosis are associated with serious complications; spontaneous bacterial peritonitis is considered one of them that may lead to sepsis and adrenal insufficiency. This trial aimed to study the role of dehydroepiandrosterone sulfate (DHEAS) and DHEAS/cortisol ratio for assessing cirrhotic patients’ adrenal function and as a possible prognostic factor in cirrhotic cases with spontaneous bacterial peritonitis (SBP).Patients and methodsIt was a prospective cohort trial carried out on 100 patients in the Internal Medicine Department, Tanta University Hospital, from June 2021 to July 2022 divided into 2 studied patient groups: group I, 50 cases with liver cirrhosis and sterile ascites; and group II, 50 cases with liver cirrhosis and SBP. Adrenal function was evaluated using serum cortisol levels (9 A.M, 9 P.M, and post synacthen stimulation test), DHEAS level, and DHEAS/cortisol ratio.ResultsThe cirrhotic patients with SBP have significantly decreased DHEAS, decreased DHEAS/cortisol ratio, and high cortisol level post stimulation compared with patients with sterile ascites, cirrhotic cases with decreased DHEAS/cortisol ratio (< 0.65) had elevated C-reactive protein (CRP) levels, a higher model for end-stage liver disease (MELD) score and Child–Pugh score had higher hospital mortality. Both DHEAS and the DHEAS/cortisol ratio were significant predictors of hospital mortality (area under the receiver operating characteristic curve 0.267 and 0.298, respectively). The cirrhotic patients with SBP had decreased DHEAS and DHEAS/cortisol ratio but higher hospital mortality, compared to the cirrhotic patients with sterile ascites.ConclusionsIt was found that a significant increase in cortisol level was after synacthen stimulation, decreased DHEAS, and low DHEAS to cortisol ratio in the cirrhotic patients with spontaneous bacterial peritonitis and was associated with high mortality compared to cirrhotic patients without spontaneous bacterial peritonitis.

Prognostic value of the qSOFA in patients with acute exacerbation of idiopathic pulmonary fibrosis

BackgroundPatients with idiopathic pulmonary fibrosis (IPF) have a slowly progressive clinical course, although some develop acute exacerbations (AEs). An easily obtained composite score is desirable for predicting the survival rate in patients with AE of IPF (AE-IPF). We investigated the quick sequential organ failure assessment (qSOFA), originally developed to identify sepsis, as a predictor of mortality in patients with AE-IPF and compared it to other composite assessments. MethodsConsecutive patients with IPF admitted for their first AE between 2008 and 2019 were recruited retrospectively. The association between the qSOFA score obtained at admission and mortality was investigated. ResultsDuring the study period, 97 patients with AE-IPF were hospitalized. The hospital mortality was 30.9%. Multivariate logistic regression analysis revealed that both the qSOFA and the Japanese Association for Acute Medicine (JAAM)-disseminated intravascular coagulation (DIC) scores were significant predictors of hospital mortality (odds ratio [OR] 3.86, 95% confidence interval [CI] 1.43–10.3; p = 0.007 and OR 2.71, 95% CI 1.56–4.67; p = 0.0004; respectively). Kaplan–Meier survival curves showed that both scores were consistently associated with survival. Furthermore, the sum of the two scores was a more effective predictor than the individual scores. ConclusionsThe qSOFA score of patients admitted with AE-IPF was associated with both in-hospital and long-term mortality, which was also true for the JAAM-DIC score. The qSOFA score plus the JAAM-DIC score should be determined during the diagnostic evaluation of a patient with AE-IPF. Both scores combined may be more effective at predicting outcomes than individual scores.

NLR, MLR, PLR and RDW to predict outcome and differentiate between viral and bacterial pneumonia in the intensive care unit

The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and red cell distribution width (RDW) are emerging biomarkers to predict outcomes in general ward patients. However, their role in the prognostication of critically ill patients with pneumonia is unclear. A total of 216 adult patients were enrolled over 2 years. They were classified into viral and bacterial pneumonia groups, as represented by influenza A virus and Streptococcus pneumoniae, respectively. Demographics, outcomes, and laboratory parameters were analysed. The prognostic power of blood parameters was determined by the respective area under the receiver operating characteristic curve (AUROC). Performance was compared using the APACHE IV score. Discriminant ability in differentiating viral and bacterial aetiologies was examined. Viral and bacterial pneumonia were identified in 111 and 105 patients, respectively. In predicting hospital mortality, the APACHE IV score was the best prognostic score compared with all blood parameters studied (AUC 0.769, 95% CI 0.705–0.833). In classification tree analysis, the most significant predictor of hospital mortality was the APACHE IV score (adjusted P = 0.000, χ2 = 35.591). Mechanical ventilation was associated with higher hospital mortality in patients with low APACHE IV scores ≤ 70 (adjusted P = 0.014, χ2 = 5.999). In patients with high APACHE IV scores > 90, age > 78 (adjusted P = 0.007, χ2 = 11.221) and thrombocytopaenia (platelet count ≤ 128, adjusted P = 0.004, χ2 = 12.316) were predictive of higher hospital mortality. The APACHE IV score is superior to all blood parameters studied in predicting hospital mortality. The single inflammatory marker with comparable prognostic performance to the APACHE IV score is platelet count at 48 h. However, there is no ideal biomarker for differentiating between viral and bacterial pneumonia.

Asthma and COVID-19 in the elderly: course, survival, predictors of mortality

Bronchial asthma occurs in 0.9 – 17% of patients hospitalized with COVID-19. However, it is not clear whether asthma is a risk factor for the development and severity of COVID-19. Studies have shown that patients with asthma appear to be more susceptible to COVID-19 infection, but severe disease progression is not related to medication use, including asthma biologics, but rather to older age and comorbidities.Aim.To evaluate the clinical course of SARS-CoV-2 infection in elderly patients with asthma, to examine the effect of asthma and comorbidities on COVID-19related outcomes, and to determine predictors of mortality.Methods.Elderly patients [WHO, 2020] (&gt; 60 years,n= 131, median age 74 (67; 80) years; 59 men, 72 women) with asthma hospitalized for COVID-19 were included in the study. COVID-19 was confirmed by laboratory tests (PCR smear) and/or clinical and radiological examinations. All patients had a history of a documented diagnosis of asthma (GINA, 2020).Results.Out of 131 patients, 30 (22.9%) died in the hospital, and 15 (14.9%) died after discharge from the hospital (within 90 days). The group of patients with lethal outcome showed the following differences from those who recovered: values of Charlson index, respiration rate, degree of lung damage on CT scan, absolute number of leukocytes, neutrophils and neutrophils-to-lymphocytes ratio, C-reactive protein on the 5th day of hospitalization, and LDH were statistically significantly higher, while absolute number of eosinophils, total protein content, SpO2and SpO2/FiO2levels were lower; steroid intake during the year and non-atopic asthma were more common. Multivariate and ROC analysis revealed the most significant predictors of hospital mortality and their thresholds: Charlson comorbidity index ≥ 6 points, neutrophil/lymphocyte ratio ≥ 4.5, total protein ≤ 60 g/l, eosinophil level ≤ 100 cells/μL.Conclusion.The most significant predictors of hospital mortality in elderly patients with severe COVID-19 against asthma are Charlson comorbidity, neutrophil/lymphocyte ratio; lower eosinophil and total protein levels. Survival time of patients has an inverse correlation with the number of mortality risk factors present.

Changes in characteristics and outcomes of critically ill COVID-19patients in Tyrol (Austria) over 1year.

BackgroundWidely varying mortality rates of critically ill Coronavirus disease 19 (COVID-19) patients in the world highlighted the need for local surveillance of baseline characteristics, treatment strategies and outcome. We compared two periods of the COVID-19 pandemic to identify important differences in characteristics and therapeutic measures and their influence on the outcome of critically ill COVID-19 patients.MethodsThis multicenter prospective register study included all patients with a SARS-CoV‑2 infection confirmed by polymerase chain reaction, who were treated in 1 of the 12 intensive care units (ICU) from 8 hospitals in Tyrol, Austria during 2 defined periods (1 February 2020 until 17 July: first wave and 18 July 2020 until 22 February 2021: second wave) of the COVID-19 pandemic.ResultsOverall, 508 patients were analyzed. The majority (n = 401) presented during the second wave, where the median age was significantly higher (64 years, IQR 54–74 years vs. 72 years, IQR 62–78 years, p < 0.001). Invasive mechanical ventilation was less frequent during the second period (50.5% vs 67.3%, p = 0.003), as was the use of vasopressors (50.3% vs. 69.2%, p = 0.001) and renal replacement therapy (12.0% vs. 19.6%, p = 0.061), which resulted in shorter ICU length of stay (10 days, IQR 5–18 days vs. 18 days, IQR 5–31 days, p < 0.001). Nonetheless, ICU mortality did not change (28.9% vs. 21.5%, p = 0.159) and hospital mortality even increased (22.4% vs. 33.4%, p = 0.039) in the second period. Age, frailty and the number of comorbidities were significant predictors of hospital mortality in a multivariate logistic regression analysis of the overall cohort.ConclusionAdvanced treatment strategies and learning effects over time resulted in reduced rates of mechanical ventilation and vasopressor use in the second wave associated with shorter ICU length of stay. Despite these improvements, age appears to be a dominant factor for hospital mortality in critically ill COVID-19 patients.Supplementary InformationThe online version of this article (10.1007/s00508-021-01945-5) contains supplementary material, which is available to authorized users.

Mortality Predictors in Patients with Infective Endocarditis Undergoing Surgery

Background: Infective endocarditis (IE) is considered a series disorder with high in-hospital mortality, so early detection and therapy can improve outcomes. Diagnosis relies upon consistent history and manifestations like persistent bacteremia, fungemia or active valvulitis. Surgical treatment in infective endocarditis is considered as a part of management rather than a consequence of medical treatment failure. Objectives: To assess the risk factors influencing the early outcome of surgical intervention in patients with IE. Patients and methods: This prospective cohort study was conducted on sixty patients diagnosed with infective endocarditis and underwent cardiac surgery. We tested preoperative, intraoperative and postoperative factors that may act as prospective predictors of mortality. Results: Rheumatic heart was found to be the most common underlying fundamental issue among most of the cases. Mitral valve regurgitation was the frequent lesion found (61.7%). The mean EuroScore II in non-survivor group was 25.69 ± 8.13. The hospital mortality was 21.7% (13 patient), while the 6-month mortality was 12.8% (6 patients). Congestive heart failure, embolization, and periannular extension of infection are the most significant predictors of hospital mortality and 6 month mortality also. Conclusion: Surgery for IE keeps on being challenging. EuroScore II was found to have a very good capability to anticipate mortality in IE surgery. Also favorable outcomes could be acquired with valve repair techniques even in cases of IE.

Thrombo-inflammatory biomarkers to predict sepsis outcome.

Background: Sepsis has been redefined recently as life-threatening organ dysfunction caused by dysregulated host responses to infection and septic shock. Soluble urokinase plasminogen activator receptor (SuPAR) and plasminogen activator inhibitor-1(PAI-1) concentration positively correlate to the activation level of the immune system, and are markers of disease severity and aggressiveness. Objective: The study aimed to identify the blood level of plasminogen activator inhibitor-1 (PAI-1) and soluble urokinase plasminogen activator receptor (SuPAR) in sepsis and its association with mortality. Patient and methods: This is an observational prospective study that enrolled 60 adult patients with sepsis (according to SOFA), admitted to Menoufia and Zagazig university hospitals during the period from December 2019 till October 2020. Plasminogen activator inhibitor-1 (PAI-1) and soluble urokinase plasminogen activator receptor (SuPAR) were checked in all participants. Results: SuPAR and PAI.1 were significant independent predictors of hospital mortality. SuPAR showed sensitivity 100%, specificity 95.9%, and accuracy 94% for prediction of early mortality at a cutoff value of 13.4(pg/ml). While, PAI-1 demonstrated sensitivity 100%, specificity 93.9%, and accuracy of 95% at a cutoff value of 122.5 for predicting mortality. Conclusion: PAI-1 and suPAR were significant predictors of hospital mortality among sepsis patients. The sample size was relatively small, which may have decreased the statistical power of the results of the present study. Hence, additional studies with large sample sizes are required for further validation of the present results.

Perioperative and Long-Term Morbidity and Mortality for Elderly Patients Undergoing Thoracic Aortic Surgery

The impact of age on outcome in elective thoracic aortic surgery is not well characterized. We aim to evaluate age-related differences in short- and long-term outcomes in elderly patients undergoing elective thoracic aortic surgery. From 2004 to 2018, 786 patients underwent elective thoracic aortic surgery at a single center and were divided into 2 groups; <75 years old (n = 651) and ≥75 years old (n = 135). Outcomes include in-hospital mortality, morbidity, and long-term survival. Median follow-up was 4.8 years. Multivariable logistic regression was used to identify independent predictors of mortality and morbidity; Kaplan-Meier curves were plotted for late survival. Similar analysis was performed to the propensity-matched cohort. The elderly cohort had higher in-hospital mortality (8.2% vs 1.7%; P < 0.01), stroke (11.9 vs 2.8%; P< 0.01) and prolonged ventilation (17.3% vs 8.3%; P < 0.01), and intensive care unit stay (5.6 ± 10.9 vs 2.9 ± 6.0 days; P < 0.01). After adjusting for baseline differences and surgical complexity, age ≥75 years remained a significant predictor of hospital mortality (odds ratio [95% confidence interval]: 3.7 [1.3-10.3]). Eight-year survival was 75.4 ± 7.7% in the older group compared to 93.3 ± 1.9% in the younger group (hazard ratio [95% confidence interval]: 4.2 [1.7-11.0]). Propensity score-matched analysis also confirmed worse early- and long-term outcomes in the elderly group. Elderly patients experience higher in-hospital mortality and morbidity following elective thoracic aortic surgery compared to their younger counterparts and have a higher burden of mortality over long-term follow-up.

Abstract 417: The Prognostic Value of Lactate in Cardiac Intensive Care Unit Patients With and Without Cardiac Arrest

Introduction: Lactate is a known prognostic marker in critically ill patients, including patients with shock and cardiac arrest (CA). We sought to describe the association between admission lactate and hospital mortality in cardiac intensive care unit (CICU) patients, particularly those with CA. Methods: We retrospectively evaluated adult patients admitted to a tertiary care CICU from January 1, 2007, to April 30, 2018, with measured lactate on admission. We examined hospital mortality as a function of admission lactate level in patients with and without CA. Multivariable logistic regression was used to determine predictors of hospital mortality in the overall cohort, after adjustment for clinical characteristics, therapies, and illness severity. Results: We included 3,042 patients with a median age of 70 years (IQR 60-80), including 40.5% (n=1,233) females. There were 789 patients (26.1%) with a diagnosis of CA. The median APACHE-4 predicted mortality was 24.2% (IQR 10.9-50.7), and 50.8% (n=1546) were treated with vasoactive infusions. The median lactate on admission was 1.8 mmol/L (IQR 1.1-3.0). CICU mortality occurred in 478 (15.7%) patients) and hospital mortality occurred in 706 (23.2%) patients. Hospital mortality rose progressively as a function of admission lactate ( Figure ). On univariable analysis, lactate was associated with increased hospital mortality among the overall cohort (OR 1.36, CI 1.31-1.42, P &lt; .001; AUROC 0.71), patients with CA (OR 1.33 (95% CI 1.25-1.41, P &lt; .01; AUROC 0.73), and patients without CA (OR 1.27, CI 1.21-1.34, P &lt; .01; AUROC 0.64). On multivariable analysis, lactate was one of the most significant predictors of hospital mortality (adjusted OR 1.13 per mmol/L, 95% CI 1.08-1.18, P &lt; .001). Conclusions: Admission lactate levels are strongly associated with increased hospital mortality among CICU patients, especially those with CA. The prognostic value of lactate levels may help inform clinicians caring for CICU patients.

Predictors of Hospital Mortality and the Related Burden of Disease in Severe Traumatic Brain Injury: A Prospective Multicentric Study in Brazil.

Traumatic brain injury (TBI) is a worldwide social, economic, and health problem related to premature death and long-term disabilities. There were no prospective and multicentric studies analyzing the predictors of TBI related mortality and estimating the burden of TBI in Brazil. To address this gap, we investigated prospectively: (1) the hospital mortality and its determinants in patients admitted with severe TBI we analyzed in three reference centers; (2) the burden of TBI estimated by the years of life lost (YLLs) due to premature death based on the hospital mortality considering the hospital mortality. Between April 2014 and January 2016 (22 months), all the 266 patients admitted with Glasgow coma scale (GCS), ≤ 8 admitted in three TBI reference centers were included in the study. These centers cover a population of 1,527,378 population of the Santa Catarina state, Southern Brazil. Most patients were male (n = 230, 86.5%), with a mean (SD) age of 38 (17) years. Hospital mortality was 31.1% (n = 83) and independently associated with older age, worse cranial CT injury by the Marshall classification, the presence of subarachnoid hemorrhage in the CT, lower GCS scores and abnormal pupils at admission. The final multiple logistic regression model including these variables showed an overall accuracy for hospital mortality of 77.9% (specificity 88.6%, sensitivity 53.8%, PPV 67.7%, and NPV 81.1%). The estimated annual incidence of hospitalizations and mortality due to severe TBI were 9.5 cases and 5.43 per 100,000 inhabitants, respectively. The estimated YLLs in 22 months, in the 2 metropolitan areas were 2,841, corresponding to 1,550 YLLs per year and 101.5 YLLs per 100,000 people every year. The hospital mortality did not change significantly since the end of the 1990s and was similar to other centers in Brazil and Latin America. Significant predictors of hospital mortality were the same as those of studies worldwide, but their strength of association seemed to differ according to countries income. Present study results question the extrapolation of TBI hospital mortality models for high income to lower- and middle-income countries and therefore have implications for TBI multicentric trials including countries with different income levels.

What's New in SHOCK, September 2018?

What's New in SHOCK, September 2018?

Association Between the Inflammatory Biomarkers and Left Ventricular Systolic Dysfunction in Patients with Exacerbations of Chronic Obstructive Pulmonary Disease.

Background:Cardiovascular diseases are an important cause of morbidity and mortality in chronic obstructive pulmonary disease patients. The increased inflammatory biomarker levels predict exacerbations and are associated with cardiovascular diseases in stable chronic obstructive pulmonary disease patients but their role in the settings of acute chronic obstructive pulmonary disease exacerbations has not been determined.Aims:To analyse the association between inflammatory biomarkers and heart failure and also to determine the predictors of mortality in patients with exacerbations of chronic obstructive pulmonary disease.Study Design:Prospective observational study.Methods:We analysed 194 patients admitted for acute exacerbation of chronic obstructive pulmonary disease at The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. In all patients, C-reactive protein, fibrinogen, N-terminal of the pro-hormone brain natriuretic peptide and white blood count were measured and transthoracic echocardiography was performed.Results:There were 119 men (61.3%) and the median age was 69 years (interquartile range 62-74). Left ventricular systolic dysfunction (ejection fraction <50%) was present in 47 (24.2%) subjects. Patients with left ventricular systolic dysfunction had higher C-reactive protein levels (median 100 vs. 31 mg/L, p=0.001) and fibrinogen (median 5 vs. 4 g/L, p=<0.001) compared to those with preserved ejection fraction. The overall hospital mortality was 8.2% (16/178). The levels of C-reactive protein, fibrinogen, N-terminal pro-brain natriuretic peptide and ejection fraction predicted hospital mortality in univariate analysis. After adjusting for age, hypoxemia and C-reactive protein, ejection fraction remained significant predictors of hospital mortality (OR 3.89, 95% CI 1.05-15.8).Conclusion:Nearly a quarter of patients with the exacerbation of chronic obstructive pulmonary disease present with left ventricular systolic dysfunction which may be associated with mortality.

Factors associated with mortality risk in critical care patients treated with veno-arterial extracorporeal membrane oxygenation

ObjectivesTo identify factors associated with mortality in patients treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and to validate the discrimination of the risk assessment tools to predict mortality. BackgroundVA-ECMO is a rescue therapy for patients with life-threatening cardiac failure, but mortality remains high. MethodsIn this retrospective study, we reviewed the medical records of adult patients who underwent VA-ECMO in an intensive care unit of a university hospital, between 2009 and 2013. ResultsVA-ECMO was performed in 89 patients, with a median duration of 116 h. The survival rate until hospital discharge was 27%. The pre-ECMO simplified acute physiology score (SAPS) II and diabetes mellitus were significant predictors of hospital mortality. The optimal prognostic SAPS II score was 81 overall, 80 in patients with diabetes, and 84 in those without diabetes. ConclusionsOur findings indicate that high pre-ECMO SAPS II score and diabetes are risk factors for mortality in patients who undergo VA-ECMO.

Associations of arterial carbon dioxide and arterial oxygen concentrations with hospital mortality after resuscitation from cardiac arrest.

IntroductionArterial concentrations of carbon dioxide (PaCO2) and oxygen (PaO2) during admission to the intensive care unit (ICU) may substantially affect organ perfusion and outcome after cardiac arrest. Our aim was to investigate the independent and synergistic effects of both parameters on hospital mortality.MethodsThis was a cohort study using data from mechanically ventilated cardiac arrest patients in the Dutch National Intensive Care Evaluation (NICE) registry between 2007 and 2012. PaCO2 and PaO2 levels from arterial blood gas analyses corresponding to the worst oxygenation in the first 24 h of ICU stay were retrieved for analyses. Logistic regression analyses were performed to assess the relationship between hospital mortality and both categorized groups and a spline-based transformation of the continuous values of PaCO2 and PaO2.ResultsIn total, 5,258 cardiac arrest patients admitted to 82 ICUs in the Netherlands were included. In the first 24 h of ICU admission, hypocapnia was encountered in 22 %, and hypercapnia in 35 % of included cases. Hypoxia and hyperoxia were observed in 8 % and 3 % of the patients, respectively. Both PaCO2 and PaO2 had an independent U-shaped relationship with hospital mortality and after adjustment for confounders, hypocapnia and hypoxia were significant predictors of hospital mortality: OR 1.37 (95 % CI 1.17–1.61) and OR 1.34 (95 % CI 1.08–1.66). A synergistic effect of concurrent derangements of PaCO2 and PaO2 was not observed (P = 0.75).ConclusionsThe effects of aberrant arterial carbon dioxide and arterial oxygen concentrations were independently but not synergistically associated with hospital mortality after cardiac arrest.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-1067-6) contains supplementary material, which is available to authorized users.

Extended-Spectrum β-Lactamase and Multidrug Resistance in Urinary Sepsis Patients Admitted to the Intensive Care Unit

Background: The role of extended-spectrum β-lactamase (ESBL)-producing or multidrug-resistant (MDR) organisms in patients with sepsis secondary to urinary traction infection (UTI) has not been investigated extensively in the intensive care unit (ICU) setting. Methods: Patients with UTI sepsis admitted to the ICU were retrospectively enrolled in this study (January 2009-December 2012). We investigated the impact of ESBL-producing and ESBL-negative MDR organisms on hospital outcome. Results: In total, 94 patients were enrolled (median age, 73.0 years; female, 81.9%), and ESBL-producing and ESBL-negative MDR organisms accounted for 20.2% (n = 19) and 30.9% (n = 29), respectively. Both patients with ESBL-producing and ESBL-negative MDR organisms were more likely to experience a delay in adequate antibiotic therapy than those with non-ESBL/non-MDR organisms (p < 0.001 and p = 0.032, respectively). However, only patients with ESBL-producing organisms showed a higher mortality rate (ESBL vs. ESBL-negative MDR vs. non-ESBL/non-MDR, 31.6% vs. 10.3%.vs. 10.9%, respectively). In multivariate analyses, ESBL production was significantly associated with hospital mortality (odds ratio, 11.547; 95% confidence interval, 1.047-127.373), and prior admission was a significant predictor of ESBL production. Conclusions: Although both ESBL-producing and ESBL-negative MDR organisms are associated with delayed administration of appropriate antibiotics, only ESBL production is a significant predictor of hospital mortality among patients with UTI sepsis in the ICU setting.

A Simple Novel Model to Predict Hospital Mortality, Surgical Site Infection, and Pneumonia in Elderly Patients Undergoing Operation

Background/Aims: Predicting models of operative morbidity and mortality in the geriatric population are important in the prevention of adverse surgical outcomes. Methods: A retrospective review of medical records was performed for patients over 80 years of age who underwent gastrointestinal surgery from 1998 to 2008. Results: 215 patients were identified with a mean age of 83.7 years. Overall morbidity and mortality rates were 48.8 and 14.4%, respectively. Multivariate logistic regression analysis revealed that serum albumin levels [odds ratio (OR) = 0.367, p = 0.0267], postoperative pneumonia (OR = 3.471, p = 0.0101), hollow organ perforation or anastomosis combined with leakage (OR = 7.600, p = 0.0126), and preoperative systemic inflammatory response syndrome (OR = 3.186, p = 0.0323) were significant predictors of hospital mortality. Moreover, albumin (OR = 0.270, p = 0.0002) and physical disability (OR = 3.802, p = 0.0009) were significant predictors of postoperative pneumonia, and albumin (OR = 0.491, p = 0.0212) and enterotomy (OR = 3.335, p = 0.0208) were significant predictors of surgical site infections. Conclusion: This study provides novel predicting models to identify the elderly surgical patients at high risk, who should receive more intensive preventive and perioperative care.

Early prognostic value of the medical emergency team calling criteria in patients admitted to intensive care from the emergency department*

To evaluate the early prognostic value of the medical emergency team (MET) calling criteria in patients admitted to intensive care from the emergency department. Retrospective cohort study. Emergency department and department of intensive care medicine of a 960-bed tertiary referral hospital. A total of 452 consecutive adult patients admitted to intensive care from the emergency department from January 1, 2004, to December 31, 2004. None. MET calling criteria were retrospectively extracted from patient records, and the sum of positive criteria was calculated for the first hour in the emergency department (METinitial) and subsequently until admission to the intensive care unit in a series of time periods. The maximum number of positive MET calling criteria during any time period was defined (METmax). Logistic regression analysis revealed METinitial (odds ratio [OR] 3.392, 95% confidence interval [CI] 2.534-4.540) and METmax (OR 3.867, 95% CI 2.816-5.312) to be significant predictors of hospital mortality, the need for mechanical ventilation (METinitial: OR 4.151, 95% CI 3.53-4.652; METmax: OR 4.292, 95% CI 3.151-5.846), and occurrence of hemodynamic instability (METinitial: OR 1.548, 95% CI 1.258-1.905; METmax: OR 1.685, 95% CI 1.355-2.094) (all p < .0001). MET scores collected early after admission or throughout the stay in the emergency department allow for simple identification of patients at risk of unfavorable outcome during the subsequent intensive care unit stay.

High-Risk Aortic Valve Replacement: Are the Outcomes as Bad as Predicted?

Percutaneous aortic valve replacement (PAVR) trials are ongoing in patients with an elevated European System for Cardiac Operative Risk Evaluation (EuroSCOREs), patients believed to have high mortality rates and poor long-term prognoses with valve replacement surgery. It is, however, uncertain that the EuroSCORE model is well calibrated for such high-risk AVR patients. We evaluated EuroSCORE prediction vs a single institution's surgical results in this target population. From January 1996 through March 2006, 731 patients with EuroSCOREs of 7 or higher underwent isolated AVR. In this cohort, 313 (42.8%) were septuagenarians, 322 (44.0%) were octogenarians or nonagenarians, 233 (31.9%) had had previous cardiac procedures, 237 (32.4%) had atheromatous aortas, and 127 (17.4%) had cerebrovascular disease. A minimally invasive approach was used in 469 (64.2%). Data collection was prospective. Long-term survival was computed from the Social Security Death Benefit Index. The mean EuroSCORE was 9.7 (median, 10), and the mean logistic EuroSCORE was 17.2%. Actual hospital mortality was 7.8% (57 of 731). Multivariate analysis showed ejection fraction of less than 0.30 (p = 0.002; odds ratio [OR], 3.13), chronic obstructive pulmonary disease (p = 0.019; OR, 2.14), and peripheral vascular disease (p = 0.048; OR, 2.13) were significant predictors of hospital mortality. Complication(s) occurred in 73 patients (9.9%). Freedom from all-cause death (including hospital mortality) was 72.4% at 5 years (n = 152). Age (p < 0.001), previous cardiac operations (p < 0.014; OR, 1.51), renal failure (p < 0.002; OR, 2.37), and chronic obstructive pulmonary disease (p < 0.007; OR, 1.30) were predictors of worse survival. Logistic EuroSCORE greatly overpredicts mortality in these patients. Five-year survival is good, unlike suggestions from earlier EuroSCORE analyses. This raises concern about unknown long-term percutaneous prosthesis function. Clinical trials for these patients must include randomized surgical controls and have long-term end points.

Renal Failure After Cardiac Surgery: Timing of Cardiac Catheterization and Other Perioperative Risk Factors

The incidence of acute renal failure after cardiac surgery remains high, and the ability to predict renal failure using well-defined baseline risk factors is important. The relationship between the timing of preoperative cardiac catheterization and the incidence of postoperative renal failure has not been previously described. Perioperative variables for 649 patients over 12 months were prospectively collected. Variables included medical comorbidities, preoperative glomerular filtration rate calculated using the simplified Modification of Diet in Renal Disease equation, and date of cardiac catheterization. Endpoints were (A) renal failure defined as a rise in serum creatinine greater than 25% by the third postoperative day or renal dysfunction requiring the initiation of dialysis, and (B) hospital mortality. The incidence of renal failure and renal failure requiring dialysis were 24.0% and 4.2%, respectively. After multivariate analysis, age, cardiopulmonary bypass time, baseline glomerular filtration rate less than 60 mL/min (odds ratio [OR] 1.69; 95% confidence interval [CI]: 1.09 to 2.62; p = 0.047), and cardiac catheterization performed within 5 days before operation (OR 1.82; 95% CI: 1.17 to 2.84; p = 0.010) were independently associated with acute renal failure. Developing postoperative renal failure was independently related to hospital mortality (OR 3.70; 95% CI: 1.59 to 9.09; p = 0.003). Cardiac catheterization performed within 5 days before operation, baseline glomerular filtration rate less than 60 mL/min, and prolonged cardiopulmonary bypass duration are significant risk factors for acute renal failure after cardiac surgery. Acute renal failure after cardiac surgery is a significant predictor of hospital mortality.