The Evaluation of Risk Factors for Vancomycin-Resistant Enterococcus Colonization and Infection Among Mixed Adult Intensive Care Unit Patients.

Background and objective Despite the adherence to strict infection control measures, vancomycin-resistant enterococcus (VRE) colonization and VRE infections are still important problems nowadays. However, there are only a limited number of studies examining the factors causing the transformation of VRE colonization to VRE infection in the intensive care unit (ICU). The aim of this study is to delineate the prevalence of VRE colonization and its transformation into infection and the risk factors leading to infection. Methods Patients admitted to the third-level mixed-type ICU from 2012 to 2015 for at least 24 hours and acquired VRE colonization and VRE infection, both during and after their admission, were included in the study, and their medical records were examined retrospectively. VRE rectal swabs were taken weekly from each patient on admission and discharge from the ICU. If the VRE-positive patient was detected negative for VRE on the rectal swap taken three times in total as a surveillance culture successively, this patient was accepted as VRE negative. Demographic data, Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores, invasive procedures, treatments (corticosteroid, antibiotic, etc.), nutrition types, laboratory results, and ICU results were recorded. Results Among 1730 patients admitted to ICU, 101 (5.8%) were found to carry VRE colonization. Twelve (11.8%) out of 101 patients colonized with VRE developed VRE infection. About 56.4% had urinary tract infections, 68.3% had pneumonia, 15.8% had surgical site infections, and 24.8% had catheter-associated infections among these infected patients. The most prevalent factor was Enterococcus faecium in patients with VRE colonization (64.3%) and infection (91%). VRE turned negative in 67% of patients with VRE colonization during their stay in ICU. Renal replacement therapy was statistically significant (p < 0.05) in the group with VRE infection (66.7%) compared to the VRE-colonized group (26.1%). Infection development risk among carriers of VRE for more than one week was again found statistically significant (p = 0.025). Demographic data, APACHE-II scores, treatments, nutrition type, previous antibiotic usage and types, invasive procedures, laboratory results, and ICU results were similar among the patients with VRE colonization and infection. Conclusion A longer duration of ICU stay in patients with colonization and previous renal replacement therapy increases the transformation of VRE colonization to VRE infection. Strategies toward decreasing VRE-colonized patients' period of stay in ICU is the main objective to control the rate of VRE infection.

Practical parameters that can be used for nutritional assessment in patients hospitalized in the intensive care unit with the diagnosis of chronic obstructive pulmonary disease: Prognostic nutritional index, neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-monocyte ratio.

ABSTRACT: Malnutrition is an important condition in patients diagnosed with chronic obstructive pulmonary disease (COPD). There is a need for practical and objective nutritional assessment methods in patients hospitalized in the intensive care unit with the diagnosis of COPD. In this study, it was aimed to determine the parameters that can practically evaluate the nutritional status of these patients. It was aimed to determine the relationship between prognostic nutritional index (PNI), and nutritional risk screening (NRS)-2002, nutrition risk in the critical ill (Nutric) Score and to determine a cut-off value for PNI, neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and other complete blood count parameters.Hemogram values, albumin values, NLR, PLR, LMR, NRS-2002, PNI and modified Nutric Score calculations of the patients hospitalized in the intensive care unit due to COPD were recorded. The relationship between PNI and NRS-2002 and modified Nutric Score, as well as the relationship between NLR, PLR, LMR, hemogram parameters and PNI were analyzed using statistical methods.The PNI cut-off value for nutritional assessment in patients hospitalized in the intensive care unit due to COPD was determined as 38.5 (area under curve = 0.891, sensitivity 80.8%, specificity 88.1%, positive predictive value 92.9%, negative predictive value 88%). High-risk group according to PNI compared to low-risk group, lymphocyte count (P < .001), basophil count (P = .004), red blood cell (P < .001), hemoglobin (P < .001), hematocrit (P < .001), and LMR (P = .001) were statistically significantly lower, while NLR (P < .001) and PLR (P = .001) were statistically significantly higher. Cut-off values for lymphocyte count, basophil count, NLR, PLR, and LMR were found to be 1.18, 0.035, 7.97, 291.10, and 2.606, respectively.Nutritional risk assessment can be made in a practical way by using PNI in patients hospitalized in intensive care unit due to COPD. For this, the PNI cut-off value was determined as 38.5 in our study. In addition, NLR, PLR, LMR, basophil and lymphocyte values, which can be calculated using complete blood count parameters, may also be useful in the evaluation of nutritional status in these patients. In our study, the cut-off values determined for NLR, PLR, LMR, basophil and lymphocyte were 7.97, 291.10 and 2.606, 0.035 and 1.18, respectively. We think that the results we have obtained can provide preliminary information for future research.

Are Neutrophil-Lymphocyte, Platelet-Lymphocyte, and Monocyte-Lymphocyte Ratios Prognostic Indicators in Patients With Chronic Obstructive Pulmonary Disease in Intensive Care Units?

Background and objective Chronic obstructive pulmonary disease (COPD) is a condition in which the expiratory airflow is restricted and is characterized by inflammation. Recently, inflammation-related biomarkers such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR) have been used to predict the prognosis in COPD. The aim of this study was to evaluate the role of biomarkers such as NLR, PLR, and MLR in COPD patients in intensive care and to examine the ability of these markers to predict the prognosis [length of stay in hospital (LOSH), duration of mechanical ventilation (MV), length of stay in ICU (LOS ICU), and mortality]. Methods A total of 562 patients who were treated in the ICU between 2018 and 2019 were retrospectively reviewed. Among them, 369 were patients with COPD. We evaluated clinical data including patient demographics, Charlson Comorbidity Index (CCI), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, LOS ICU, LOSH, duration of MV, as well as NLR, PLR, and MLR values. Data on patient deaths (30-day mortality) was obtained from the Death Notification System. Results Age, LOSH, CCI, and SOFA were found to predict mortality in COPD patients. In cases with mortality, age, inotropic use, MV duration, LOS ICU, APACHE II, CCI, SOFA, lymphocyte count, neutrophil count, platelet count, monocyte count, NLR, PLR, and MLR levels were statistically significantly higher than those in cases without mortality. There was a positive and low statistically significant relationship of NLR, PLR, and MLR with prognostic factors like MV duration, APACHE II scores, and SOFA scores. Conclusion The NLR, PLR, and MLR values may be used as prognostic indicators in COPD patients in intensive care. Although there are many studies endorsing the use of biomarkers such as NLR, PLR, and MLR as prognostic indicators, further comparative studies on this subject are still required to gain deeper insights into the topic.

Evaluation of Nutritional Status in Hospitalized Chronic Obstructive Pulmonary Disease Patients and Can C-reactive Protein-to-Albumin Ratio Be Used in the Nutritional Risk Assessment in These Patients.

Background Malnutrition is common in patients diagnosed with chronic obstructive pulmonary disease (COPD). CRP/albumin ratio (CAR) can be used as a parameter to evaluate the inflammatory process and nutritional status together. The aim of this study was to make a general evaluation of the nutritional status of hospitalized patients with COPD and to investigate whether CAR can predict nutritional status in these patients. Methods Patients who were hospitalized with COPD who were consulted to the nutrition department were included in the study. The patients' Nutritional Risk Score-2002 (NRS), demographic data, diagnoses, body mass indexes (BMI), nutritional support applied to the patients were recorded. CRP, Albumin, and CAR values of the patients were determined. Patients recommended nutritional follow-up, total parenteral nutrition (TPN) or enteral nutrition (EN) initiated, and oral nutritional supplement (ONS) support were identified. Results A total of 393 patients with COPD were analyzed. 88.55% of the patients were in the NRS ≥ 3 risk group. TPN treatment was started in 10.2% of the patients, EN in 10.9%, ONS in 76.3%, and nutritional follow-up was recommended in 2.5% of the patients. While albumin level was lower in patients with NRS ≥ 3, CRP and CAR were higher in patients with NRS ≥ 3 (p < 0.05). There was a negative correlation between NRS-2002 and albumin (p < 0.001). A positive correlation was observed between NRS-2002 and CRP and CAR (p < 0.001). Age and CAR were found to be effective in predicting those with NRS-2002 ≥ 3. The cut-off value for CAR was accepted as 3.26. Conclusions The need for nutritional support is high in patients hospitalized with COPD. It is important to evaluate nutritional support needs in these patients, regardless of NRS-2002 and BMI. In this respect, the clinician's observation and the decision are as valuable as the scoring that determines malnutrition. We think that the cut-off value of 3.26 determined for CAR can be used in the nutritional risk assessment in patients with COPD.

Determinants of prognosis in geriatric patients followed in respiratory ICU; either infection or malnutrition.

ABSTRACT: Severity of illness, age, malnutrition, and infection are the important factors determining intensive care unit (ICU) survival.The aim of the study is to determine the relations between Geriatric Nutritional Risk Index (GNRI), C-reactive protein/albumin (CAR), and prognosis-mortality of geriatric patients (age of ≥65 years) admitted to intensive care unit.The study with 10/15/2020, 697 approval date, and number retrospectively registered. Between January 1, 2018 and December 31, 2019, 413 geriatric patients admitted to ICU. The patients were divided into three groups according to their age.The age group, gender, Charlson comorbidity index, intensive care scores (Acute Physiology And Chronic Health Evaluation II and Sequential Organ Failure Assessment), the infection markers (white blood cell, procalcitonin, CAR levels), malnutrition tools for each patient (body mass index, Nutrition Risk in Critically ill score, and GNRI scores) were analyzed retrospectively. Also length of stay (LOS) ICU, length of stay hospital, and 30-day mortality were recorded.Geriatric patients number of 403 was included in the study. Forty-nine (12.3%) patients had a history of malignancy, 272 (67.5%) patients had Chronic Obstructive Pulmonary Disease comorbidity. There was no difference in mortality between age groups.In patients with mortality, body mass index, had being Chronic Obstructive Pulmonary Disease history, GNRI, length of stay hospital, and albumin were significantly lower; malignancy comorbidity rate, inotrope use, modified Nutrition Risk in Critically ill score, mechanical ventilation duration, LOS ICU, Sequential Organ Failure Assessment, Acute Physiology And Chronic Health Evaluation II, Charlson comorbidity index, C-reactive protein, procalcitonin, and CAR were significantly higher.Both malnutrition and infection affect mortality in geriatric patients in intensive care. The GNRI is better than CAR at predicting mortality.

What are the prognostic factors affecting 30-day mortality in geriatric patients with respiratory failure in the Intensive Care Unit?

OBJECTIVE: We aimed to investigate the prognostic factors related to 30 day mortality of elderly patients with respiratory failure in the intensive care unit (ICU). METHODS: We performed a single centre, retrospective study and analyzed the main variables and outcomes of 238 geriatric patients admitted to an ICU with ARF between December 2017- January 2019 in Chest Disease Hospital, were included and classified as survivors and nonsurvivors. Main characteristics, laboratory datas, severity and nutrition scores were evaluated and logistic regression analysis were used. RESULTS: The nonsurvivor group included 110 cases (40% female,) with a median age of 79, had higher scores in the followings; Acute Physiology Chronic Health Evaluation II score (APACHE-II) (p < 0.001), Charlson Comorbidity Index (CCI) (p < 0.001), Sequential Organ Failure Assessment score (p < 0.001). The inotropic support requirement was also higher in the nonsurvivor group (48,2%). As a comorbidity, malignancy and Type-I respiratory failure were higher in the nonsurvivor group (p=0.03, p < 0.001). The overall 30-day mortality was 46%. Blood urea nitrogen, procalsitonin, C-reactive protein and creatinine levels were higher in the nonsurvivor group (p < 0.001). However, albumin (p < 0.001), BMI (p=0.03) and longer hospital stay (p < 0.001) were higher in the survivor group. Inotropic support, APACHE-II score and CCI were independently related to increased mortality risk, whereas albumin was associated with decreased mortality risk. CONCLUSION: High APACHE II score, low CCI, low albumin levels and the requirement for inotropic support were found to be independently risk factors of 30-day mortality in the geriatric patients with respiratory failure in ICU.

The comparison of GNRI and other nutritional indexes on short-term survival in geriatric patients treated for respiratory failure.

BACKGROUND: There are several screening tools used in the detection of malnutrition to facilitate nutritional support and predict prognosis in the elderly. AIMS: We aimed to compare the prognostic predictive value of geriatric nutritional risk index (GNRI) with other nutritional indices on 1 month survival in geriatric patients hospitalized for respiratory failure in intensive care unit (ICU). METHODS: A total of 191 geriatric patients (> 65 years) admitted to a specialized chest hospital with respiratory failure between January 2018 and January 2019 were analyzed. Patients were classified into two category according to 30-day survival: Survivors and Non-survivors. Nutritional assesment was done via GNRI, OPNI, NRS 2002, Nutric Scores in ICU. RESULTS: Using GNRI, 146 (76.3%) geriatric patients found to be at risk of malnutrition (GNRI score: ≤ 92). GNRI < 86.9 showed significantly higher 30-day mortality rate and patients with malnutrition risk were older, had significantly lower BMI, OPNI, and higher SOFA score. The Age, NRS 2002, Nutric and SOFA score had negative correlation with GNRI. Nutric score, prealbumin and GNRI were detected as significant independent risk factors of 30-day mortality. GNRI had higher sensitivity (76.7%) but lower specificity (57.1%) compared to Nutric score and OPNI for the prediction of 30-day hospital mortality. CONCLUSIONS: Compared to others, Geriatric Nutritional Risk Index (GNRI) seems to be a good predictor of 30-day mortality and having a score of less than 86.9 increase the malnutrition risk in geriatric patients hospitalized for respiratory failure in ICU.

The relationship between magnesium levels and mortality in the respiratory intensive care unit.

ABSTRACT: Magnesium deficiency is defined as a pathophysiologic factor in numerous illnesses. This study aims to define the effects of magnesium levels on patients in the intensive care unit (ICU) regarding length of stay in the ICU, length of mechanical ventilation (MV), and 28-day mortality.The following data were collected during initial assessment of patients admitted to the ICU with acute respiratory failure (ARF). Demographic data, magnesium and potassium levels, Charlson's Comorbidity Index (CCI), Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores, length of MV, length of hospital stay in the ICU, 28-day mortality, and ICU discharge status.In the initial serum analysis prior to treatment of patients in the ICU, the mortality rate of the patient group with hypermagnesemia was found to be statistically significant when compared with other magnesium levels (P = .018). Apart from renal failure, ICU mortality is higher in the hypermagnesemia group than other groups.Hypermagnesemia is an electrolyte abnormality that is generally seen in older individuals and those with serious comorbidity and it can be used in mortality prediction.

How Effective are Intensive Care Unit Beds Used in Our Region?

OBJECTIVE: The demand for critical care facilities is also growing in our country. The aim of the present study was to investigate the incidence and causes of inappropriate admissions to adult intensive care units (ICUs) in our region to facilitate the planning of bed numbers. METHODS: A team of specialists made an unannounced visit to level 1, 2 and 3 adult ICUs in 12 hospitals in our region between June 2014 and January 2015. A total of 290 ICU patients were evaluated. RESULTS: The rate of inappropriate ICU admission was 55.9%, and the most common reason was the lack of a lower level ICU. Palliative patients comprised 35.5% of the ICU patients, 68% of whom should have been in home care. The rate of inappropriate admission was 16.7% higher in open ICUs than in closed ICUs. CONCLUSION: Our results indicate that instead of increasing the number of beds in level 2 and 3 ICUs, hospitals should increase the number of level 1 ICU beds. In addition, we believe that the existing beds could be utilised more effectively if all ICUs implemented a closed management style and if there was better coordination between ICUs.