Characteristics of patients readmitted to intensive care unit: a nested case-control study.

OBJECTIVES: To evaluate the pattern of unplanned readmissions to the intensive care unit and identify patients at risk of readmission. DESIGN: Nested case-referent study. SETTING: Tertiary hospital, Hong Kong. PATIENTS: A total of 146 patients with unplanned intensive care unit readmission were compared with 292 control patients who were discharged from the intensive care unit alive and never readmitted. Cases and controls were matched for age, gender, and disease severity. MAIN OUTCOME MEASURES: Patient demographics, initial and pre-discharge clinical parameters, reasons for readmission, and outcomes were studied. RESULTS: During the 30-month study period, the readmission rate was 5.1%. Readmitted patients had significantly higher mortality and longer mean hospital lengths of stay (both P<0.001). Most patients in this cohort (36.3%) were readmitted for a respiratory cause. Based on classification tree analysis, postoperative patients with sepsis (adjusted P=0.043), non-operative septic patients with fluid gain 24 hours pre-discharge (adjusted P=0.013), and non-septic patients with increased sputum quantity on discharge (adjusted P=0.006) were significantly associated with intensive care unit readmission. CONCLUSION: Incomplete resolution of respiratory conditions remained an important reason for potentially preventable intensive care unit readmission. Attention to fluid balance and sputum quantity before intensive care unit discharge might prevent unplanned intensive care unit readmission.

In-house human immunodeficiency virus-1 genotype resistance testing to determine highly active antiretroviral therapy resistance mutations in Hong Kong.

OBJECTIVE: To determine the frequency of highly active antiretroviral therapy resistance mutations in the viral pol gene of human immunodeficiency virus-1 (HIV-1) genotypes that circulate in Hong Kong, by means of an in-house HIV-1 genotyping system. DESIGN: Retrospective study. SETTING: Two HIV clinics in Hong Kong. PATIENTS: A modified in-house genotyping resistance test was used to sequence the partial pol gene in 1165 plasma samples from 965 patients. The performance of our test was cross-compared with the US Food and Drug Administration-approved ViroSeq HIV-1 genotyping system. The results of genotyping were submitted to the Stanford HIV-1 drug resistance database for analysis. RESULTS: The cost-effective in-house genotypic resistance test (US$40) demonstrated comparable performance to the US Food and Drug Administration-approved ViroSeq system. The detection limit of this in-house genotypic resistance test could reach 400 copies/mL for both HIV-1 subtype B and CRF01_AE, which were the predominant genotypes in Hong Kong. Drug resistance mutations were detected only in post-treatment samples from treatment-failure patients. However, there was no significant difference in the frequency of drug resistance mutations between subtype B and CRF01_AE. CONCLUSION: Our cost-effective in-house genotypic resistance test detected no significant difference in drug resistance-related mutations frequencies between HIV-1 subtype B and CRF01_AE in Hong Kong. A drug resistance-related mutations database for different HIV-1 genotypes should be established in Hong Kong to augment guidance for HIV treatment.

Star fruit intoxication successfully treated by charcoal haemoperfusion and intensive haemofiltration.

We report on a case of an elderly woman with chronic renal impairment, secondary to diabetic nephropathy, who developed a deep coma and seizure shortly after consumption of star fruit. She was managed in the intensive care unit, and her consciousness level improved dramatically after an 8-hour charcoal haemoperfusion and 30 hours of continuous haemofiltration. There were no long-term neurological or renal sequelae 9 months later. Early recognition of this condition, intensive dialytic therapy and supportive measures, as well as early initiation of charcoal haemoperfusion may improve the management of this potentially treatable condition.