Optimal timing for hospice-shared care initiation in terminal cancer patients.

PURPOSE: The existing concept suggests early palliative and hospice therapy for a better quality of care (QOC) and less medical expense in terminal cancer patients, but the time points of "early" initiation were defined by pre-set study protocol rather than the real-world data. The study aimed to determine the optimal timing of initiating palliative care for patients with terminal cancer. METHODS: This retrospective population-based study was conducted using a nationwide database. We extracted patients with cancer who were in their last year of lives in the period from 1 January 2010 to 31 December 2013 and categorized them into two groups ("hospice-shared care" (HSC) group and "usual care" (UC) group) after a matching process. Subsequently, we used a generalized linear mixed-effects model to compare the QOC and medical expenses between groups. RESULTS: After the selection and matching process, we enrolled 1714 patients (67.7 ± 13.2 years, 62.7% male) categorized into the HSC and UC groups (n = 857 in each group). The HSC groups showed generally better QOC in the four indices (with emergency room visit, hospitalization, intensive care unit admission, and receiving chemotherapy) than the UC group in those who initiated HSC 8-60 days before death. The HSC group also had significantly lower medical expenses than the UC group in those who initiated HSC 15-90 days before death. CONCLUSIONS: Among patients with terminal cancer, HSC initiation before the last 8 days and 15 days of lives can effectively improve QOC and save medical expenses, respectively.

A novel procalcitonin-based score for detecting sepsis among critically ill patients.

BACKGROUND: Procalcitonin (PCT) has been widely investigated as an infection biomarker. The study aimed to prove that serum PCT, combining with other relevant variables, has an even better sepsis-detecting ability in critically ill patients. METHODS: We conducted a retrospective cohort study in a regional teaching hospital enrolling eligible patients admitted to intensive care units (ICU) between July 1, 2016, and December 31, 2016, and followed them until March 31, 2017. The primary outcome measurement was the occurrence of sepsis. We used multivariate logistic regression analysis to determine the independent factors for sepsis and constructed a novel PCT-based score containing these factors. The area under the receiver operating characteristics curve (AUROC) was applied to evaluate sepsis-detecting abilities. Finally, we validated the score using a validation cohort. RESULTS: A total of 258 critically ill patients (70.9±16.3 years; 55.4% man) were enrolled in the derivation cohort and further subgrouped into the sepsis group (n = 115) and the non-sepsis group (n = 143). By using the multivariate logistic regression analysis, we disclosed five independent factors for detecting sepsis, namely, "serum PCT level," "albumin level" and "neutrophil-lymphocyte ratio" at ICU admission, along with "diabetes mellitus," and "with vasopressor." We subsequently constructed a PCT-based score containing the five weighted factors. The PCT-based score performed well in detecting sepsis with the cut-points of 8 points (AUROC 0.80; 95% confidence interval (CI) 0.74-0.85; sensitivity 0.70; specificity 0.76), which was better than PCT alone, C-reactive protein and infection probability score. The findings were confirmed using an independent validation cohort (n = 72, 69.2±16.7 years, 62.5% men) (cut-point: 8 points; AUROC, 0.79; 95% CI 0.69-0.90; sensitivity 0.64; specificity 0.87). CONCLUSIONS: We proposed a novel PCT-based score that performs better in detecting sepsis than serum PCT levels alone, C-reactive protein, and infection probability score.

Independent Predictive Ability of Procalcitonin of Acute Kidney Injury among Critically Ill Patients.

It is unclear whether serum procalcitonin (PCT) levels rise in patients with acute kidney injury (AKI), and it is also unclear whether the elevation of PCT levels in this setting is independent of the existence of infection and impaired renal clearance. We conducted a retrospective study in a regional teaching hospital in Taiwan to evaluate the AKI-predictive ability of serum PCT among critically ill patients. We enrolled 330 patients (mean age, 70.5 ± 16.4 years; 57.0% men) who were admitted to the intensive care unit (ICU) from 1 July 2016, to 31 December 2016, and who had serum PCT measurement performed within 24 h after ICU admission. We used the generalized additive model and generalized linear model to evaluate the association of serum PCT levels and renal function variables. In addition, we used the multivariate logistic regression method to demonstrate serum PCT level as an independent predictor of AKI in both the non-infected patients (odds ratio (OR) = 1.38, 95% confidence interval (CI) = 1.12-1.71, p = 0.003) and the infected patients (OR = 1.23, 95% CI = 1.03-1.46, p = 0.020). In conclusion, serum PCT level at ICU admission is an independent predictor of developing AKI irrespective of infection among critically ill patients.

The Predictivity of N-Terminal Pro b-Type Natriuretic Peptide for All-Cause Mortality in Various Follow-Up Periods among Heart Failure Patients.

Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) is an excellent prognostic⁻predictive tool in heart failure (HF) patients, but its plasma level changes following therapy. The comparison of prognosis⁻predictivity of a single measurement of plasma NT-pro BNP in different follow-up periods in acute HF patients has been less studied. This study aimed to evaluate whether the association between initial plasma NT-proBNP levels and all-cause mortality would decrease along with an increased follow-up period in patients with acute HF. The retrospective study was carried out, enrolling adult patients with hospitalization-requiring acute HF who fulfilled the predefined criteria from January 1, 2011, to December 31, 2013. We evaluated the independent predictors of 12-month mortality, and subsequently compared the predictivity of NT-proBNP level at initial presentation for 1-, 3-, 6-, 9- and 12-month mortality. In total, 269 patients (mean age, 74.45 ± 13.59 years; female, 53.9%) were enrolled. The independent predictors of 12-month mortality included higher "Charlson Comorbidity Index" (adjusted hazard ratio (aHR) = 1.22; 95% confidence interval (CI), 1.10⁻1.34), increased "age" (aHR = 1.07; 95% CI, 1.04⁻1.10), "administration of vasopressor" (aHR = 3.43; 95% CI, 1.76⁻6.71), "underwent cardiopulmonary resuscitation" (aHR = 4.59; 95% CI, 1.76⁻6.71), and without "angiotensin-converting enzyme inhibitors/angiotensin receptor blocker" (aHR = 0.41; 95% CI, 1.86⁻11.31) (all p <0.001). "Plasma NT-pro BNP level ≧11,755 ng/L" was demonstrated as an independent predictor in 1-month (aHR = 2.37; 95% CI, 1.10⁻5.11; p = 0.028) and 3-month mortality (aHR = 1.98; 95% CI, 1.02⁻3.86; p = 0.045) but not in more extended follow-up. The outcome predictivity of plasma NT-proBNP levels diminished in a longer follow-up period in hospitalized acute HF patients. In conclusion, these findings remind physicians to act with caution when using a single plasma level of NT-proBNP to predict patient outcomes with a longer follow-up period.

Predicting cardiogenic pulmonary edema in heart failure patients by using an N-terminal pro-b-type natriuretic peptide (NT-pro BNP) -based score.

BACKGROUND: Cardiogenic pulmonary edema (CPE) is a life-threatening emergency necessitating aggressive management. We conducted this study to test the hypothesis that a combination of N-terminal pro-b-type natriuretic peptide (NT-pro-BNP) and some relevant clinical factors may provide better predictability for CPE in heart failure (HF) patients. METHODS: This retrospective study enrolled adult HF patients hospitalized during January 2011 to December 2013. After determining the independent predictors for the occurrence of CPE, a novel NT-pro BNP-based diagnostic score for predicting CPE was established. RESULTS: A total of 269 patients (mean age, 74.5 ±â€¯13.6 years; female, 53.9%) were enrolled, and categorized into CPE group (n = 80, 29.7%) and non-CPE group (n = 189, 70.3%). Several factors such as "Serum NT-pro-BNP level > 6980 mg/dl," "systemic blood pressure > 170 mm Hg," "heart rate > 120 bpm," "with rales in breathing sound," "with jugular vein engorgement," "with NYHA Fc III/IV," "with chronic lung disease" and "with angiotensin converting enzyme inhibitors/angiotensin receptor blocker" were found to be associated with the existence of CPE. A novel NT-pro BNP based scoring system containing these risk factors was proposed and proven excellent in predicting CPE. CONCLUSIONS: The NT-pro-BNP scoring system could predict CPE in HF patients.

Corrigendum: N-terminal pro b-type natriuretic peptide (NT-pro-BNP) -based score can predict in-hospital mortality in patients with heart failure.

This corrects the article DOI: 10.1038/srep29590.

N-terminal pro b-type natriuretic peptide (NT-pro-BNP) -based score can predict in-hospital mortality in patients with heart failure.

Serum N-terminal pro b-type natriuretic peptide (NT-pro-BNP) testing is recommended in the patients with heart failure (HF). We hypothesized that NT-pro-BNP, in combination with other clinical factors in terms of a novel NT-pro BNP-based score, may provide even better predictive power for in-hospital mortality among patients with HF. A retrospective study enrolled adult patients with hospitalization-requiring HF who fulfilled the predefined criteria during the period from January 2011 to December 2013. We proposed a novel scoring system consisting of several independent predictors including NT-pro-BNP for predicting in-hospital mortality, and then compared the prognosis-predictive power of the novel NT-pro BNP-based score with other prognosis-predictive scores. A total of 269 patients were enrolled in the current study. Factors such as "serum NT-pro-BNP level above 8100 mg/dl," "age above 79 years," "without taking angiotensin converting enzyme inhibitors/angiotensin receptor blocker," "without taking beta-blocker," "without taking loop diuretics," "with mechanical ventilator support," "with non-invasive ventilator support," "with vasopressors use," and "experience of cardio-pulmonary resuscitation" were found as independent predictors. A novel NT-pro BNP-based score composed of these risk factors was proposed with excellent predictability for in-hospital mortality. The proposed novel NT-pro BNP-based score was extremely effective in predicting in-hospital mortality in HF patients.