Clinical nomogram prediction model to assess the risk of prolonged ICU length of stay in patients with diabetic ketoacidosis: a retrospective analysis based on the MIMIC-IV database.

BACKGROUND: The duration of hospitalization, especially in the intensive care unit (ICU), for patients with diabetic ketoacidosis (DKA) is influenced by patient prognosis and treatment costs. Reducing ICU length of stay (LOS) in patients with DKA is crucial for optimising healthcare resources utilization. This study aimed to establish a nomogram prediction model to identify the risk factors influencing prolonged LOS in ICU-managed patients with DKA, which will serve as a basis for clinical treatment, healthcare safety, and quality management research. METHODS: In this single-centre retrospective cohort study, we performed a retrospective analysis using relevant data extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Clinical data from 669 patients with DKA requiring ICU treatment were included. Variables were selected using the Least Absolute Shrinkage and Selection Operator (LASSO) binary logistic regression model. Subsequently, the selected variables were subjected to a multifactorial logistic regression analysis to determine independent risk factors for prolonged ICU LOS in patients with DKA. A nomogram prediction model was constructed based on the identified predictors. The multivariate variables included in this nomogram prediction model were the Oxford acute severity of illness score (OASIS), Glasgow coma scale (GCS), acute kidney injury (AKI) stage, vasoactive agents, and myocardial infarction. RESULTS: The prediction model had a high predictive efficacy, with an area under the curve value of 0.870 (95% confidence interval [CI], 0.831-0.908) in the training cohort and 0.858 (95% CI, 0.799-0.916) in the validation cohort. A highly accurate predictive model was depicted in both cohorts using the Hosmer-Lemeshow (H-L) test and calibration plots. CONCLUSION: The nomogram prediction model proposed in this study has a high clinical application value for predicting prolonged ICU LOS in patients with DKA. This model can help clinicians identify patients with DKA at risk of prolonged ICU LOS, thereby enhancing prompt intervention and improving prognosis.

Analysis of Influencing Factors of Sepsis after Prostate Biopsy: A Meta-Analysis.

OBJECTIVE: This study aimed to conduct a systematic review of studies investigating the influencing factors of sepsis in patients following prostate biopsy and to provide clinical references for the prevention and reduction of sepsis occurrence. METHODS: A comprehensive computer search was performed on multiple databases, including PubMed, Web of Science, Embase, and Scope. The search period extended from the inception of each database to September 2023. Two independent researchers screened the literature, extracted data, evaluated the risk of bias, and conducted a meta-analysis using R software. The included studies comprised cohort and case-control studies, and the inverse variance method was utilized to combine odds ratio (OR) values with corresponding 95% confidence intervals (CIs). RESULTS: The analysis included a total of 22 studies involving 374,021 patients. Meta-analysis results indicated that targeted prophylactic antibiotics (OR = 0.48, 95% CI [0.23, 0.98]), combined use of antibiotics (OR = 0.44, 95% CI [0.25, 0.76]), history of antibiotic use (OR = 2.54, 95% CI [1.49, 4.31]), and diabetes (OR = 2.95, 95% CI [1.25, 6.98]) may be influential factors for sepsis after prostate biopsy. However, factors such as biopsy procedure, positive biopsy, and previous biopsy did not exhibit a significant association with sepsis after prostate biopsy. CONCLUSIONS: Targeted prophylactic antibiotics, combined use of antibiotics, history of antibiotic use, and diabetes are identified as influential factors for sepsis in patients after prostate biopsy. However, due to limitations in the quantity and quality of the included studies, further high-quality research is necessary to validate these findings.

Neurological outcomes in adult drowning patients in China.

BACKGROUND: Drowning is the third leading cause of unintentional death worldwide. The epidemiological characteristics of adult drownings are rarely reported. OBJECTIVE: Investigate factors associated with neurological prognosis in adult drowning inpatients. DESIGN: Multicenter medical record review. SETTING: Tertiary health care institutions. PATIENTS AND METHODS: We collected demographic and clinical data on patients who drowned but survived between September 2006 and January 2020. Neurological prognosis was compared in patients with and without cardiac arrest. MAIN OUTCOME MEASURES: Neurological outcomes. SAMPLE SIZE AND CHARACTERISTICS: 142 patients with mean age of 50.6 (19.8) years, male/female ratio of 1.54:1. RESULT: Forty-five patients (31.7%) received CPR, 90 patients (63.4%) experienced unconsciousness, and 59 patients (41.5%) received endotracheal intubation and mechanical ventilation. Multivariate logistic regression analysis showed that the initial blood lactic acid level (OR: 7.67, 95%CI: 1.23-47.82, P=.029) was associated with a poor neurological prognosis in patients without cardiac arrest. The incidence of ICU admission (OR: 16.604, 95%CI: 1.15-239.49, P=.039) was associated with a poor neurologic prognosis in patients with cardiac arrest. CONCLUSIONS: For the drowning patients with cardiac arrest, ICU admission was associated with neurological function prognosis in these patients. Among the patients without cardiac arrest, the initial lactate value was associated with neurological function prognosis of these patients. LIMITATIONS: Retrospective. CONFLICT OF INTEREST: None.

Role of electrocardiograms in assessment of severity and analysis of the characteristics of ST elevation in acute myocarditis: A two-centre study.

Acute myocarditis is a severe disease with a high mortality rate and various dynamic changes visible on electrocardiograms (ECGs). The purpose of the present study was to investigate ECG findings of patients with acute myocarditis, ECG findings associated with fulminant myocarditis (FM) and the characteristics of ST elevation on admission. A retrospective analysis of 1,814 ECGs of 274 consecutive patients with acute myocarditis aged ≥13 years, who were hospitalized in two centres between August 2007 and November 2019, was performed. A total of 251 patients with myocarditis (91.6%) presented with ECG abnormalities. The most common ECG findings were T-wave inversion and ST elevation. Univariate logistic regression analysis demonstrated that 12 ECG findings were associated with FM. Multivariate regression analysis revealed that the independent predictive factors for FM included ventricular tachycardia, high-degree atrioventricular block, sinus tachycardia, low voltage and QRS duration of ≥120 msec (all P<0.05). A total of 112 cases displayed ST elevation at admission. Of these, ST elevation without T-wave inversion (n=87) was associated with a shorter duration of cardiac symptoms (1.5 vs. 3.1 days; P<0.001) compared with ST elevation with T-wave inversion (n=25). Of the aforementioned 87 patients, 71 (81.6%) presented with T-wave inversion at the hospital. The median time from the onset of cardiac symptoms to T-wave inversion was 4.0 days. In conclusion, patients with acute myocarditis exhibited various dynamic changes on ECG. Thus, ECGs should be widely used for the assessment of severity and the characteristics of ST elevation on admission.