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1.
Clin Chem ; 70(3): 506-515, 2024 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-38431275

RESUMO

BACKGROUND: Timely diagnosis is crucial for sepsis treatment. Current machine learning (ML) models suffer from high complexity and limited applicability. We therefore created an ML model using only complete blood count (CBC) diagnostics. METHODS: We collected non-intensive care unit (non-ICU) data from a German tertiary care centre (January 2014 to December 2021). Using patient age, sex, and CBC parameters (haemoglobin, platelets, mean corpuscular volume, white and red blood cells), we trained a boosted random forest, which predicts sepsis with ICU admission. Two external validations were conducted using data from another German tertiary care centre and the Medical Information Mart for Intensive Care IV database (MIMIC-IV). Using the subset of laboratory orders also including procalcitonin (PCT), an analogous model was trained with PCT as an additional feature. RESULTS: After exclusion, 1 381 358 laboratory requests (2016 from sepsis cases) were available. The CBC model shows an area under the receiver operating characteristic (AUROC) of 0.872 (95% CI, 0.857-0.887). External validations show AUROCs of 0.805 (95% CI, 0.787-0.824) for University Medicine Greifswald and 0.845 (95% CI, 0.837-0.852) for MIMIC-IV. The model including PCT revealed a significantly higher AUROC (0.857; 95% CI, 0.836-0.877) than PCT alone (0.790; 95% CI, 0.759-0.821; P < 0.001). CONCLUSIONS: Our results demonstrate that routine CBC results could significantly improve diagnosis of sepsis when combined with ML. The CBC model can facilitate early sepsis prediction in non-ICU patients with high robustness in external validations. Its implementation in clinical decision support systems has strong potential to provide an essential time advantage and increase patient safety.


Assuntos
Sepse , Humanos , Sepse/diagnóstico , Unidades de Terapia Intensiva , Aprendizado de Máquina , Hospitalização , Pró-Calcitonina , Curva ROC , Estudos Retrospectivos , Prognóstico
2.
J Bodyw Mov Ther ; 37: 131-135, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38432794

RESUMO

OBJECTIVE: The purpose of this case is to describe an outpatient treatment course using previously published systemic manual therapy protocol to treat a 65-year-old patient who, after prolonged COVID-related intubation, presented with polyneuropathy, organ failure and other residuals. DESIGN: A single-subject case study. METHODS: Review of clinical records and follow-up interview. RESULTS: The patient identified problem scale (PIP) had improved from a high score of 52 to 11; QUICKDASH score improved from 68 to 16. All individual problems had either resolved or remained at a minimal level and the patient had generally returned to his prior level of function including return to work. DISCUSSION AND CONCLUSION: It appears that Despite factors such as age, length of ICU stay, length of symptoms before initiation of physical therapy, and complicated hospital stay including multiple organ failure, after receiving physical therapy consists of the systemic manual therapy protocols, the patient rapidly improved during the outpatient episode.


Assuntos
COVID-19 , Manipulações Musculoesqueléticas , Humanos , Idoso , Cognição , Tempo de Internação , Unidades de Terapia Intensiva
3.
Eur Rev Med Pharmacol Sci ; 28(4): 1295-1305, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38436163

RESUMO

OBJECTIVE: Acinetobacter baumannii (A. baumannii) causes serious nosocomial infections, especially in Intensive Care Units (ICU). Studies have shown that magnesium (Mg) levels change in sepsis. This study aimed to investigate the effect of Mg levels on mortality in patients with A. baumannii sepsis in the ICU. PATIENTS AND METHODS: 140 patients who were hospitalized in the tertiary ICU between January 2018 and March 2020 and who were found to have A. baumannii sepsis in their culture follow-ups were included in the study. Demographic information of the patients, Mg levels during hospitalization and follow-up, and various data in the ICU were recorded. RESULTS: The factors that predicted one-month mortality were old age, APACHE II score, CCIS, A. baumannii detection in the early stages of ICU admission, and high Mg level on day A. baumannii was detected, and the lowest Mg level after A. baumannii was detected in the early period. According to the multivariate logistic regression analysis, age increase [OR (95% CI): 1.062 (1.009-1.117)], APACHE II increase [OR (95% CI): 1.251 (1.141-1.372)], and early detection of A. baumannii during ICU admission [OR (95% CI): 0.902 (0.845-0.962)] were found to be factors that increase one-month mortality. CONCLUSIONS: Hypermagnesemia in patients with A. baumannii indicates longer-term mortality, while a rapid decrease in Mg levels is a predictor of early mortality. Keeping Mg levels of patients within the reference range with frequent Mg measurement reduces mortality. Knowing colonized patients during admission to the ICU may be useful as an indicator of A. baumannii infection development and mortality risk.


Assuntos
Acinetobacter baumannii , Sepse , Humanos , Magnésio , APACHE , Unidades de Terapia Intensiva
4.
Eur Rev Med Pharmacol Sci ; 28(4): 1392-1397, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38436172

RESUMO

OBJECTIVE: The Pleth Variability Index (PVI) can guide the approach to hypovolemia, which is sometimes the cause and sometimes the result of major diseases; further studies are needed on this index. Therefore, in the present study, we aimed to evaluate the prognostic value of PVI and its relationship with 28-day mortality. PATIENTS AND METHODS: A total of 158 patients were included. Patients were divided into two groups according to 28-day mortality. Patients who died within 28 days were assigned to Group M (Mortal), while those who survived were included in Group S (Survive). Patients' demographics, definitive diagnosis, arterial blood pressure, fingertip oxygen saturation, PVI, fingertip blood glucose, fever, pulse, shock index, and serum lactate level were recorded. RESULTS: Regarding demographics, no statistically significant difference was found between the two groups in terms of age, gender, and Body Mass Index (BMI) (p=0.356, p=0.966, and p=0.977, respectively). The rate of intubation, the use of vasopressors, Acute Physiology and Chronic Health Evaluation (APACHE) II score, shock index, and PVI values were statistically significantly higher in Group M compared to Group S (for all, p<0.001). Glasgow Coma Score (GCS), Perfusion Index (PI), and length of stay were statistically significantly lower in Group M than in Group S (p<0.001, p<0.001, and p=0.025, respectively). PVI predicted 28-day mortality with 83.8% sensitivity and 97.9% specificity. CONCLUSIONS: PVI, serum lactate level, PI, APACHE II, GCS, and need for vasopressors were independent risk factors for 28-day mortality in the Intensive Care Unit (ICU). PVI and serum lactate have a prognostic value in predicting mortality.


Assuntos
Glicemia , Unidades de Terapia Intensiva , Humanos , Prognóstico , APACHE , Lactatos
5.
Eur Rev Med Pharmacol Sci ; 28(4): 1433-1438, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38436177

RESUMO

OBJECTIVE: Fiberoptic bronchoscopy (FOB) is widely used in the intensive care unit for diagnostic and therapeutic purposes. Our study aimed to evaluate FOB's indications, complications, and clinical outcomes in our intensive care unit's mechanically ventilated patients and identify the microorganisms grown in bronchoalveolar lavage (BAL) specimens. PATIENTS AND METHODS: Between January 1, 2022, and June 30, 2023, a total of 332 FOBs were performed on 178 patients in the respiratory intensive care unit. RESULTS: Patients' mean age was 64±19.4 years. Females accounted for 65 (36.6%) and males accounted for 113 (63.4%) of the cases. Leading diagnoses included pneumonia (59.5%), acute respiratory distress syndrome (ARDS) (20.7%), sepsis (17.9%), chronic obstructive pulmonary disease (COPD) attack (21.9%), pulmonary embolism (10.1%), lung malignancy (43.8%), hemoptysis (8.9%), heart failure (15.1%), neurological/neuromuscular conditions (8.4%), and post cardiopulmonary resuscitation (CPR) (2.8%). FOB purposes were BAL retrieval (43.6%), secretion clearance (30.4%), guided tracheostomy (11.7%), atelectasis (8.7%), and hemoptysis (5.4%). Hypoxemia marked the primary FOB complication (3.6%). Other issues encompassed hypotension (1.5%), bradycardia (1.2%), bleeding (1.2%), tachycardia (0.9%), and hypertension (0.6%). No statistical significance was found in arterial blood gas pH, arterial partial pressure of oxygen (PaO2), and arterial partial pressure of carbon dioxide (PaCO2) values before and after the FOB procedure (p>0.05). Predominant pathogens in aspiration samples were non-albicans Candida (28.9%), Klebsiella pneumoniae (24.8%), Pseudomonas aeruginosa (14.4%), and Acinetobacter baumannii (11.7%). CONCLUSIONS: FOB is an important diagnostic and therapeutic method with a low complication rate when performed by an experienced team with appropriate indication in the intensive care unit.


Assuntos
Broncoscopia , Hemoptise , Feminino , Masculino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Unidades de Terapia Intensiva , Cuidados Críticos
6.
Stud Health Technol Inform ; 310: 1593-1597, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38426884

RESUMO

The health product circuit corresponds to the chain of steps that a medicine goes through in hospital, from prescription to administration. The safety and regulation of all the stages of this circuit are major issues to ensure the safety and protect the well-being of hospitalized patients. In this paper we present an automatic system for analyzing prescriptions using Artificial Intelligence (AI) and Machine Learning (ML), with the aim of ensuring patient safety by limiting the risk of prescription errors or drug iatrogeny. Our study is made in collaboration with Lille University Hospital (LUH). We exploited the MIMIC-III (Medical Information Mart for Intensive Care) a large, single-center database containing information corresponding to patients admitted to critical care units at a large tertiary care hospital.


Assuntos
Inteligência Artificial , Aprendizado de Máquina , Erros de Medicação , Humanos , Hospitais Universitários , Unidades de Terapia Intensiva , Preparações Farmacêuticas , Sistemas de Apoio a Decisões Clínicas , Segurança do Paciente , Erros de Medicação/prevenção & controle , Bases de Dados Factuais
7.
Sci Rep ; 14(1): 5073, 2024 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-38429378

RESUMO

Vitamin C played pleiotropic roles in critical illness and vitamin C insufficiency was predictive of the development of multiple organ failure. Currently, the prevalence of vitamin C insufficiency in Chinese critically ill patients is rarely determined and there are no established bedside tools to predict hypovitaminosis C. To develop a nomogram to identify patients with high risk of hypovitaminosis C, we performed a bi-center prospective cohort study at two ICUs of the first and sixth medical center in PLA General Hospital, Beijing, China from May 6th to July 31st, 2021 We identified 322 eligible patients. 62.4% patients were hypovitaminosis C. 7 features, including source of infection, the level of serum albumin, age, male gender, sepsis, vascular disease, and wasting of vitamin C by the kidney, were selected using LASSO algorithm and therefore included in the nomogram. In the testing set, our model showed moderate discrimination ability with areas under the curve of 0.75 [0.64-0.84]. Variable importance evaluated by SHAP value highlighted two novel important predictors, i.e., abdominal infection and the level of serum albumin. In conclusion, we first reported a high burden of vitamin C insufficiency in Chinese adult patient in the ICU. We also constructed a prediction model to timely identify patients with high risk of hypovitaminosis C, which allows the clinicians to choose appropriate candidates for Vitamin C repletion in clinical practice or clinical trials.


Assuntos
Deficiência de Vitaminas , Estado Terminal , Adulto , Humanos , Masculino , Estudos Prospectivos , Vitaminas , Ácido Ascórbico , Algoritmos , Hospitais Gerais , Unidades de Terapia Intensiva , Albumina Sérica , Cuidados Críticos
8.
J Orthop Surg Res ; 19(1): 160, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38429736

RESUMO

BACKGROUND: To evaluate if bupivacaine-fentanyl isobaric spinal anesthesia could reduce the risk of ICU admission compared with general anesthesia in elderly patients undergoing lower limb orthopedic surgery. METHODS: This study comprised a retrospective review of all lower limb orthopedic surgeries performed at our hospital between January 2013 and December 2019. According to anesthesia methods, patients were divided into the spinal anesthesia group (n = 1,728) and the general anesthesia group (n = 188). The primary outcome evaluated was the occurrence of ICU admission. Secondary outcomes included hemodynamic changes, postoperative complications, and mortality. RESULTS: Repeated measure analysis of variance indicated that the difference between the two groups in the systolic blood pressure (SBP) was not significant before anesthesia (T0), immediately after anesthesia (T1), and before leaving the operation room (T8) (P > 0.05), but significant (P < 0.01) from 5 min after anesthesia (T2) to after operation (T7). The proportions of ICU admission (6.4% vs. 23.8%, P < 0.01) and unplanned intubation (0.1% vs. 3.8%, P < 0.01) were significantly lower in the spinal anesthesia group compared with those in the general anesthesia group. Multivariate logistic regression revealed that after controlling for potential confounding factors, the odds of ICU admission for patients in the spinal anesthesia group was 0.240 times (95% CI 0.115-0.498; P < 0.01) than those in the general anesthesia group. CONCLUSIONS: Bupivacaine-fentanyl isobaric spinal anesthesia significantly reduced the risk of ICU admission and unplanned intubation, and provided better intraoperative hemodynamics in elderly patients undergoing lower limb orthopedic surgery. TRIAL REGISTRATION: This study has been registered in the Chinese Clinical Trial Registry (ChiCTR2000033411).


Assuntos
Raquianestesia , Procedimentos Ortopédicos , Humanos , Idoso , Raquianestesia/efeitos adversos , Raquianestesia/métodos , Anestésicos Locais , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Bupivacaína , Fentanila , Extremidade Inferior/cirurgia , Unidades de Terapia Intensiva
9.
Front Cell Infect Microbiol ; 14: 1281759, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38469345

RESUMO

Objectives: Invasive fungal super-infection (IFSI) is an added diagnostic and therapeutic dilemma. We aimed to develop and assess a nomogram of IFSI in patients with healthcare-associated bacterial infection (HABI). Methods: An ambispective cohort study was conducted in ICU patients with HABI from a tertiary hospital of China. Predictors of IFSI were selected by both the least absolute shrinkage and selection operator (LASSO) method and the two-way stepwise method. The predictive performance of two models built by logistic regression was internal-validated and compared. Then external validity was assessed and a web-based nomogram was deployed. Results: Between Jan 1, 2019 and June 30, 2023, 12,305 patients with HABI were screened in 14 ICUs, of whom 372 (3.0%) developed IFSI. Among the fungal strains causing IFSI, the most common was C.albicans (34.7%) with a decreasing proportion, followed by C.tropicalis (30.9%), A.fumigatus (13.9%) and C.glabrata (10.1%) with increasing proportions year by year. Compared with LASSO-model that included five predictors (combination of priority antimicrobials, immunosuppressant, MDRO, aCCI and S.aureus), the discriminability of stepwise-model was improved by 6.8% after adding two more predictors of COVID-19 and microbiological test before antibiotics use (P<0.01).And the stepwise-model showed similar discriminability in the derivation (the area under curve, AUC=0.87) and external validation cohorts (AUC=0.84, P=0.46). No significant gaps existed between the proportion of actual diagnosed IFSI and the frequency of IFSI predicted by both two models in derivation cohort and by stepwise-model in external validation cohort (P=0.16, 0.30 and 0.35, respectively). Conclusion: The incidence of IFSI in ICU patients with HABI appeared to be a temporal rising, and our externally validated nomogram will facilitate the development of targeted and timely prevention and control measures based on specific risks of IFSI.


Assuntos
Infecções Bacterianas , Infecção Hospitalar , Infecções Fúngicas Invasivas , Humanos , Estudos de Coortes , Nomogramas , Infecção Hospitalar/epidemiologia , Unidades de Terapia Intensiva , China/epidemiologia , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/epidemiologia , Atenção à Saúde
10.
Sci Rep ; 14(1): 5833, 2024 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-38461349

RESUMO

Renal replacement therapy (RRT) is a crucial treatment for sepsis-associated acute kidney injury (S-AKI), but it is uncertain which S-AKI patients should receive immediate RRT. Identifying the characteristics of patients who may benefit the most from RRT is an important task. This retrospective study utilized a public database and enrolled S-AKI patients, who were divided into RRT and non-RRT groups. Uplift modeling was used to estimate the individual treatment effect (ITE) of RRT. The validity of different models was compared using a qini curve. After labeling the patients in the validation cohort, we characterized the patients who would benefit the most from RRT and created a nomogram. A total of 8289 patients were assessed, among whom 591 received RRT, and 7698 did not receive RRT. The RRT group had a higher severity of illness than the non-RRT group, with a Sequential Organ Failure Assessment (SOFA) score of 9 (IQR 6,11) vs. 5 (IQR 3,7). The 28-day mortality rate was higher in the RRT group than the non-RRT group (34.83% vs. 14.61%, p < 0.0001). Propensity score matching (PSM) was used to balance baseline characteristics, 458 RRT patients and an equal number of non-RRT patients were enrolled for further research. After PSM, 28-day mortality of RRT and non-RRT groups were 32.3% vs. 39.3%, P = 0.033. Using uplift modeling, we found that urine output, fluid input, mean blood pressure, body temperature, and lactate were the top 5 factors that had the most influence on RRT effect. The area under the uplift curve (AUUC) of the class transformation model was 0.068, the AUUC of SOFA was 0.018, and the AUUC of Kdigo-stage was 0.050. The class transformation model was more efficient in predicting individual treatment effect. A logistic regression model was developed, and a nomogram was drawn to predict whether an S-AKI patient can benefit from RRT. Six factors were taken into account (urine output, creatinine, lactate, white blood cell count, glucose, respiratory rate). Uplift modeling can better predict the ITE of RRT on S-AKI patients than conventional score systems such as Kdigo and SOFA. We also found that white blood cell count is related to the benefits of RRT, suggesting that changes in inflammation levels may be associated with the effects of RRT on S-AKI patients.


Assuntos
Injúria Renal Aguda , Sepse , Humanos , Estudos Retrospectivos , Prognóstico , Terapia de Substituição Renal/efeitos adversos , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Sepse/complicações , Sepse/terapia , Lactatos , Unidades de Terapia Intensiva
11.
Einstein (Sao Paulo) ; 22(spe1): eRW0352, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38477798

RESUMO

OBJECTIVE: To review the long-term outcomes (functional status and psychological sequelae) of survivors of critical illnesses due to epidemic viral pneumonia before the COVID-19 pandemic and to establish a benchmark for comparison of the COVID-19 long-term outcomes. METHODS: This systematic review of clinical studies reported the long-term outcomes in adults admitted to intensive care units who were diagnosed with viral epidemic pneumonia. An electronic search was performed using databases: MEDLINE®, Web of Science™, LILACS/IBECS, and EMBASE. Additionally, complementary searches were conducted on the reference lists of eligible studies. The quality of the studies was assessed using the Newcastle-Ottawa Scale. The results were grouped into tables and textual descriptions. RESULTS: The final analysis included 15 studies from a total of 243 studies. This review included 771 patients with Influenza A, Middle East Respiratory Syndrome, and Severe Acute Respiratory Syndrome. It analyzed the quality of life, functionality, lung function, mortality, rate of return to work, rehospitalization, and psychiatric symptoms. The follow-up periods ranged from 1 to 144 months. We found that the quality of life, functional capacity, and pulmonary function were below expected standards. CONCLUSION: This review revealed great heterogeneity between studies attributed to different scales, follow-up time points, and methodologies. However, this systematic review identified negative long-term effects on patient outcomes. Given the possibility of future pandemics, it is essential to identify the long-term effects of viral pneumonia outbreaks. This review was not funded. Prospero database registration: (www.crd.york.ac.uk/prospero) under registration ID CRD42021190296.


Assuntos
COVID-19 , Pneumonia Viral , Adulto , Humanos , Alta do Paciente , Pandemias , Qualidade de Vida , Unidades de Terapia Intensiva
12.
BMC Infect Dis ; 24(1): 306, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38481153

RESUMO

BACKGROUND: Bloodstream infections (BSI) are highly prevalent in hospitalized patients requiring intensive care. They are among the most serious infections and are highly associated with sepsis or septic shock, which can lead to prolonged hospital stays and high healthcare costs. This study aimed at establishing an easy-to-use nomogram for predicting the prognosis of patients with BSI. METHODS: In retrospective study, records of patients with BSI admitted to the intensive care unit (ICU) over the period from Jan 1st 2016 to Dec 31st 2021 were included. We used data from two different China hospitals as development cohort and validation cohort respectively. The demographic and clinical data of patients were collected. Based on all baseline data, k-means algorithm was applied to discover the groups of BSI phenotypes with different prognostic outcomes, which was confirmed by Kaplan-Meier analysis and compared using log-rank tests. Univariate Cox regression analyses were used to estimate the risk of clusters. Random forest was used to identified discriminative predictors in clusters, which were utilized to construct nomogram based on multivariable logistic regression in the discovery cohort. For easy clinical applications, we developed a bloodstream infections clustering (BSIC) score according to the nomogram. The results were validated in the validation cohort over a similar period. RESULTS: A total of 360 patients in the discovery cohort and 310 patients in the validation cohort were included in statistical analyses. Based on baseline variables, two distinct clusters with differing prognostic outcomes were identified in the discovery cohort. Population in cluster 1 was 211 with a ICU mortality of 17.1%, while population in cluster 2 was 149 with an ICU mortality of 41.6% (p < 0.001). The survival analysis also revealed a higher risk of death for cluster 2 when compared with cluster 1 (hazard ratio: 2.31 [95% CI, 1.53 to 3.51], p < 0.001), which was confirmed in validation cohort. Four independent predictors (vasoconstrictor use before BSI, mechanical ventilation (MV) before BSI, Deep vein catheterization (DVC) before BSI, and antibiotic use before BSI) were identified and used to develop a nomogram. The nomogram and BSIC score showed good discrimination with AUC of 0.96. CONCLUSION: The developed score has potential applications in the identification of high-risk critically ill BSI patients.


Assuntos
Bacteriemia , Sepse , Choque Séptico , Humanos , Estudos Retrospectivos , Estado Terminal , Bacteriemia/epidemiologia , Sepse/epidemiologia , Unidades de Terapia Intensiva
13.
Clin Nutr ESPEN ; 60: 234-239, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38479915

RESUMO

INTRODUCTION: The Coronavirus disease 2019 (COVID-19) spread rapidly, with 37 million cases and more than 699,000 deaths. Among intensive care unit (ICU) patients with COVID-19, a high incidence of acute kidney injury (AKI) has been observed, ranging from 50 to 80%; furthermore, 85.9% were calculated to have high nutritional risk, which doubled their odds of death. The aim of the present study was to evaluate possible associations between nutritional risk, acute kidney injury, and morbidity and mortality in patients with COVID-19 admitted to an ICU. METHODS: Retrospective cohort study of adult and older-adult patients hospitalized for >24 h in an ICU. The exposure was diagnosis of COVID-19, while the outcomes were mortality, acute kidney injury, dialysis, mechanical ventilation, and vasopressor use. The association of nutritional risk with outcomes was evaluated. The sample consisted of two secondary datasets. Individuals aged <18 years, those with dialytic chronic kidney disease, pregnant women, and those diagnosed with brain death were excluded. RESULTS: The sample consisted of 192 patients: 101 in the exposure group (positive for COVID-19) and 91 in the control group (no COVID-19 diagnosis). The COVID-19 and non-COVID-19 groups differed significantly in the variables weight, body mass index (BMI), nutritional risk, mNUTRIC-S score, and length of ICU stay. Our results suggest that the optimal mNUTRIC-S score cutoff to predict nutritional risk is <5 points. CONCLUSION: COVID-19 has a significant impact on patients' kidney function, increasing the incidence of AKI and the likelihood of death. Nutritional risk is a major factor in the mortality of patients with COVID-19. Therefore, use of the mNUTRIC-S scale could contribute to assessment of prognosis in this patient population.


Assuntos
Injúria Renal Aguda , COVID-19 , Gravidez , Adulto , Humanos , Feminino , COVID-19/complicações , Estudos Retrospectivos , Unidades de Terapia Intensiva , Incidência , Injúria Renal Aguda/diagnóstico
14.
Crit Care Med ; 52(4): e208, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38483232
16.
PLoS One ; 19(3): e0298617, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38470900

RESUMO

BACKGROUND: The understanding of shock indices in patients with septic shock is limited, and their values may vary depending on cardiac function. METHODS: This prospective cohort study was conducted across 20 university-affiliated hospitals (21 intensive care units [ICUs]). Adult patients (≥19 years) with septic shock admitted to the ICUs during a 29-month period were included. The shock index (SI), diastolic shock index (DSI), modified shock index (MSI), and age shock index (Age-SI) were calculated at sepsis recognition (time zero) and ICU admission. Left ventricular (LV) function was categorized as either normal LV ejection fraction (LVEF ≥ 50%) or decreased LVEF (<50%). RESULTS: Among the 1,194 patients with septic shock, 392 (32.8%) who underwent echocardiography within 24 h of time zero were included in the final analysis (normal LVEF: n = 246; decreased LVEF: n = 146). In patients with normal LVEF, only survivors demonstrated significant improvement in SI, DSI, MSI, and Age-SI values from time zero to ICU admission; however, no notable improvements were found in all patients with decreased LVEF. The completion of vasopressor or fluid bundle components was significantly associated with improved indices in patients with normal LVEF, but not in those with decreased LVEF. In multivariable analysis, each of the four indices at ICU admission was significantly associated with in-hospital mortality (P < 0.05) among patients with normal LVEF; however, discrimination power was better in the indices for patients with lower lactate levels (≤ 4.0 mmol/L), compared to those with higher lactate levels. CONCLUSIONS: The SI, DSI, MSI, and Age-SI at ICU admission were significantly associated with in-hospital mortality in patients with septic shock and normal LVEF, which was not found in those with decreased LVEF. Our study emphasizes the importance of interpreting shock indices in the context of LV function in septic shock.


Assuntos
Choque Séptico , Adulto , Humanos , Volume Sistólico , Função Ventricular Esquerda , Estudos Prospectivos , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Lactatos
17.
Artigo em Inglês | MEDLINE | ID: mdl-38464562

RESUMO

Purpose: Acute kidney injury (AKI) is a common complication of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and inflammation is the potential link between AKI and AECOPD. However, little is known about the incidence and risk stratification of AKI in critically ill AECOPD patients. In this study, we aimed to establish risk model based on white blood cell (WBC)-related indicators to predict AKI in critically ill AECOPD patients. Material and Methods: For the training cohort, data were taken from the Medical Information Mart for eICU Collaborative Research Database (eICU-CRD) database, and for the validation cohort, data were taken from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The study employed logistic regression analysis to identify the major predictors of WBC-related biomarkers on AKI prediction. Subsequently, a risk model was developed by multivariate logistic regression, utilizing the identified significant indicators. Results: Finally, 3551 patients were enrolled in training cohort, 926 patients were enrolled in validation cohort. AKI occurred in 1206 (33.4%) patients in training cohort and 521 (56.3%) patients in validation cohort. According to the multivariate logistic regression analysis, four WBC-related indicators were finally included in the novel risk model, and the risk model had a relatively good accuracy for AKI in the training set (C-index, 0.764, 95% CI 0.749-0.780) as well as in the validation set (C-index, 0.738, 95% CI: 0.706-0.770). Even after accounting for other models, the critically ill AECOPD patients in the high-risk group (risk score > 3.44) still showed an increased risk of AKI (odds ratio: 4.74, 95% CI: 4.07-5.54) compared to those in low-risk group (risk score ≤ 3.44). Moreover, the risk model showed outstanding calibration capability as well as therapeutic usefulness in both groups for AKI and ICU mortality and in-hospital mortality of critical ill AECOPD patients. Conclusion: The novel risk model showed good AKI prediction performance. This risk model has certain reference value for the risk stratification of AECOPD complicated with AKI in clinically.


Assuntos
Injúria Renal Aguda , Doença Pulmonar Obstrutiva Crônica , Humanos , Prognóstico , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Estado Terminal/epidemiologia , Unidades de Terapia Intensiva , Estudos Retrospectivos , Leucócitos , Injúria Renal Aguda/epidemiologia
19.
J Clin Neurophysiol ; 41(3): 230-235, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38436390

RESUMO

PURPOSE: There is frequent delay between ordering and placement of conventional EEG. Here we estimate how many patients had seizures during this delay. METHODS: Two hundred fifty consecutive adult patients who underwent conventional EEG monitoring at the University of Wisconsin Hospital were retrospectively chart reviewed for demographics, time of EEG order, clinical and other EEG-related information. Patients were stratified by use of anti-seizure medications before EEG and into low-risk, medium-risk, and high-risk groups based on 2HELPS2B score (0, 1, or >1). Monte Carlo simulations (500 trials) were performed to estimate seizures during delay. RESULTS: The median delay from EEG order to performing EEG was 2.00 hours (range of 0.5-8.00 hours) in the total cohort. For EEGs ordered after-hours, it was 2.00 hours (range 0.5-8.00 hours), and during business hours, it was 2.00 hours (range 0.5-6.00 hours). The place of EEG, intensive care unit, emergency department, and general floor, did not show significant difference (P = 0.84). Anti-seizure medication did not affect time to first seizure in the low-risk (P = 0.37), medium-risk (P = 0.44), or high-risk (P = 0.12) groups. The estimated % of patients who had a seizure in the delay period for low-risk group (2HELPS2B = 0) was 0.8%, for the medium-risk group (2HELPS2B = 1) was 10.3%, and for the high-risk group (2HELPS2B > 1) was 17.6%, and overall risk was 7.2%. CONCLUSIONS: The University of Wisconsin Hospital with 24-hour in-house EEG technologists has a median delay of 2 hours from order to start of EEG, shorter than published reports from other centers. Nonetheless, seizures were likely missed in about 7.2% of patients.


Assuntos
Eletroencefalografia , Serviço Hospitalar de Emergência , Adulto , Humanos , Estudos Retrospectivos , Unidades de Terapia Intensiva , Convulsões/diagnóstico
20.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 36(2): 178-182, 2024 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-38442935

RESUMO

OBJECTIVE: To establish a predictive model for the progression of acute kidney injury (AKI) to stage 3 AKI (renal failure) in the intensive care unit (ICU), so as to assist physicians to make early and timely decisions on whether to intervene in advance. METHODS: A retrospective analysis was conducted. Thirty-eight patients with AKI admitted to the intensive care medicine of the Third People's Hospital of Henan Province from January 2018 to May 2023 were enrolled. Patient data including acute physiology and chronic health evaluation II (APACHE II) upon admission, serum creatinine (SCr), blood urea nitrogen (BUN), daily urine output during hospitalization, and the timing of continuous renal replacement therapy (CRRT) intervention were recorded. Based on clinically collected pathological data, standardized creatinine value ratio mean polynomial fitting models were established as the first criterion for judging the progression to stage 3 AKI after data cleansing, screening, and normalization. Additionally, standardized creatinine value ratio index fitting models were established as the second criterion for predicting progression to stage 3 AKI. RESULTS: A total of 38 AKI patients were included, including 25 males and 13 females. The average age was (58.45±12.94) years old. The APACHE II score was 24.13±4.17 at admission. The intervention node was (4.42±0.95) days. Using a dual regression model approach, statistical modeling was performed with a relatively small sample size of statistical data samples, yielding a scatter index non-linear regression model for standardized creatinine value ratio data relative to day "n", with y = 1.246 2x1.164 9 and an R2 of 0.860 1, indicating reasonable statistical fitting. Additionally, a quadratic non-linear regression model was obtained for the mean standardized creatinine value ratio relative to day "n", with y = -0.260 6x2+3.010 7x-1.612 and an R2 of 0.998 9, indicating an excellent statistical fit. For example, using a baseline SCr value of 66 µmol/L for a healthy individual, the dual regression model predicted that the patient would progress to stage 3 AKI within 3-5 days. This prediction was consistent when applied to other early intervention renal injury patients. CONCLUSIONS: The established model effectively predicts the time interval of the progression of AKI to stage 3 AKI (renal failure), which assist intensive care physicians to intervene AKI as early as possible to prevent disease progression.


Assuntos
Injúria Renal Aguda , Feminino , Masculino , Humanos , Pessoa de Meia-Idade , Idoso , Creatinina , Estudos Retrospectivos , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/terapia , Unidades de Terapia Intensiva , Prognóstico
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