Predictors of outcomes of patients ≥ 80 years old admitted to intensive care units in Poland - a post-hoc analysis of the VIP2 prospective observational study.

INTRODUCTION: Elderly patients pose a significant challenge to intensive care unit (ICU) clinicians. In this study we attempted to characterise the population of patients over 80 years old admitted to ICUs in Poland and identify associations between clinical features and short-term outcomes. MATERIAL AND METHODS: The study is a post-hoc analysis of the Polish cohort of the VIP2 European prospective observational study enrolling patients > 80 years old admitted to ICUs over a 6-month period. Data including clinical features, clinical frailty scale (CFS), geriatric scales, interventions within the ICU, and outcomes (30-day and ICU mortality and length of stay) were gathered. Univariate analyses comparing frail (CFS > 4) to non-frail patients and survivors to non-survivors were performed. Multivariable models with CFS, activities of daily living score (ADL), and the cognitive decline questionnaire IQCODE as predictors and ICU or 30-day mortality as outcomes were formed. RESULTS: A total of 371 patients from 27 ICUs were enrolled. Frail patients had significantly higher ICU (58% vs. 44.45%, P = 0.03) and 30-day (65.61% vs. 54.14%, P = 0.01) mortality compared to non-frail counterparts. The survivors had significantly lower SOFA score, CFS, ADL, and IQCODE than non-survivors. In multivariable analysis CFS (OR 1.15, 95% CI: 1.00-1.34) and SOFA score (OR 1.29, 95% CI: 1.19-1.41) were identified as significant predictors for ICU mortality; however, CFS was not a predictor for 30-day mortality ( P = 0.07). No statistical significance was found for ADL, IQCODE, polypharmacy, or comorbidities. CONCLUSIONS: We found a positive correlation between CFS and ICU mortality, which might point to the value of assessing the score for every patient admitted to the ICU. The older Polish ICU patients were characterised by higher mortality compared to the other European countries.

[Acute poisonings with carbon monoxide among the patients hospitalized in the Toxicology Unit during the period of 2006-2010]. / Zatrucia tlenkiem wegla w materiale Oddzialu Toksykologii Instytutu Medycyny Pracy w Lodzi w latach 2006-2010.

Acute poisonings with carbon monoxide pose real challenge in the clinical toxicology. Its importance is determined both by high frequency of immediate life threatening conditions and by the risk of complications leading to permanent organs damage. The main objective of this study is an identification of prognostic factors on the base of analysis the cohort of patients hospitalized due to intoxication with these agents in the Toxicology Unit during the period 2006-2010. During the search process 571 patients hospitalized due to carbon monoxide poisoning during the period 2006-2010 were identified within total number of 21 400 subjects hospitalized during studied period. Therefore intoxications with carbon monoxide accounted for 2.66% of total admissions to the unit. The main sources of exposure were faulty gas heaters. Patients condition on admission varied, with most cases described as the moderate and severe state. At the moment of admission to hospital, the most frequently noted pathologies were: vertigo, headeache and complains from the respiratory tract. The most commonly encountered complication were labyrinths' injuries, neurological abnormalities and pneumonia. Mean concentration of COHb measured on admission in this group was in the blood 21.50 +/- 10.96%. Poor prognosis may be associated with such clinical features on admission, as: respiratory and circulatory disturbances, cerebral sequelae and reported sequelae from labyrinths. Such parameters as: COHb level, lactate and troponine concentrations and BE values measured on admission should be considered as the prognostic factors, determining the course of the disease and the outcomes of treatment.

[Is it possible to predict the success of pharmacological closure of persistent ductus arteriosus in prematurely born neonates?]. / Czy mozna przewidziec skutecznosc farmakoterapii przetrwalego przewodu tetniczego u przedwczesnie urodzonych noworodków?

BACKGROUND: Haemodynamically significant persistent ductus arteriosus (PDA) with left-to-right shunting causes overload of the pulmonary circulation and results in prolonged mechanical ventilation and oxygen dependence. Among other options, pharmacological closure using cyclooxygenase inhibitors remains popular among neonatologists. The purpose of the study was to assess the importance of factors affecting the outcome of the aforementioned strategy. METHODS: Charts of neonates with respiratory failure treated with indomethacin for PDA were retrospectively analyzed. Patients with other heart abnormalities and those with delayed PDA therapy were excluded. RESULTS: 83 patients met the inclusion criteria. The median birth weight was 1000 g (interquartile range--IQR 800-1320), and gestational age was 27 weeks (IQR 26-30). The overall success rate of primary treatment with indomethacin was 57%. Surgical PDA ligation was performed in 32%. Factors which contributed significantly (p < 0.05) to the failure of indomethacin treatment were: each 10 mL kg(-1) of intravenous fluid administration that exceeded the total amount of 100 mL kg(-1) 24h(-1), odds ratio (OR) 1.12; a PDA diameter/body mass index (OR 1.93); and gestational age (OR 0.78). In a multivariate model, the following factors were found significant: gestational age OR 0.76 (95% confidence interval 0.61-0.95) and i.v. fluid excess OR 1.14 (95% CI 1.02-1.27). In patients with primary treatment failure a higher incidence of bronchopulmonary dysplasia (BPD) (67% vs. 36% p = 0.006), and combined BPD or death (72% vs 42.5% p = 0.01) were noted. CONCLUSIONS: Prediction of successful treatment with indomethacin is possible on the basis of gestational age and daily fluid intake. These factors should be considered when considering the risk/benefit of indomethacin therapy.