Journal articles on the topic 'Poor outcomes after hospital admission'
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Kim, Hyo Joon, Kurz Michael, Jung Hee Wee, Joo Suk Oh, Won Young Kim, In Soo Cho, Mi Jin Lee, Dong Hun Lee, Yong Hwan Kim, and Chun Song Youn. "Coagulation measures after cardiac arrest (CMACA)." PLOS ONE 18, no. 1 (January 6, 2023): e0279653. http://dx.doi.org/10.1371/journal.pone.0279653.
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Background During cardiac arrest (CA) and after cardiopulmonary resuscitation, activation of blood coagulation and inadequate endogenous fibrinolysis occur. The aim of this study was to describe the time course of coagulation abnormalities after out-of-hospital CA (OHCA) and to examine the association with clinical outcomes in patients undergoing targeted temperature management (TTM) after OHCA. Methods This prospective, multicenter, observational cohort study was performed in eight emergency departments in Korea between September 2018 and September 2019. Laboratory findings from hospital admission and 24 hours after return of spontaneous circulation (ROSC) were analyzed. The primary outcome was cerebral performance category (CPC) at discharge, and the secondary outcome was in-hospital mortality. Results A total of 170 patients were included in this study. The lactic acid, prothrombin time (PT), activated partial thrombin time (aPTT), international normalized ratio (INR), and D-dimer levels were higher in patients with poor neurological outcomes at admission and 24 h after ROSC. The lactic acid and D-dimer levels decreased over time, while fibrinogen increased over time. PT, aPTT, and INR did not change over time. The PT at admission and D-dimer levels 24 h after ROSC were associated with neurological outcomes at hospital discharge. Coagulation-related factors were moderately correlated with the duration of time from collapse to ROSC. Conclusion The time-dependent changes in coagulation-related factors are diverse. Among coagulation-related factors, PT at admission and D-dimer levels 24 h after ROSC were associated with poor neurological outcomes at hospital discharge in patients treated with TTM.
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Guo, Rui, Ruiqi Chen, Chao You, Lu Ma, Hao Li, and Yuan Fang. "Glucose Levels and Outcome After Primary Intraventricular Hemorrhage." Current Neurovascular Research 16, no. 1 (May 13, 2019): 40–46. http://dx.doi.org/10.2174/1567202616666190131164108.
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Background and Purpose: Hyperglycemia is reported to be associated with poor outcome in patients with spontaneous Intracerebral Hemorrhage (ICH), but the association between blood glucose level and outcomes in Primary Intraventricular Hemorrhage (PIVH) remains unclear. We sought to identify the parameters associated with admission hyperglycemia and analyze the impact of hyperglycemia on clinical outcome in patients with PIVH. Methods: Patients admitted to Department of Neurosurgery, West China Hospital with PIVH between 2010 and 2016 were retrospectively included in our study. Clinical, radiographic, and laboratory data were collected. Univariate and multivariate logistic regression analyses were used to identify independent predictors of poor outcomes. Results: One hundred and seventy patients were included in the analysis. Mean admission blood glucose level was 7.78±2.73 mmol/L and 10 patients (5.9%) had a history of diabetes mellitus. History of diabetes mellitus (P = 0.01; Odds Ratio [OR], 9.10; 95% Confidence Interval [CI], 1.64 to 50.54) was independent predictor of admission critical hyperglycemia defined at 8.17 mmol/L. Patients with admission critical hyperglycemia poorer outcome at discharge (P < 0.001) and 90 days (P < 0.001). After adjustment, admission blood glucose was significantly associated with discharge (P = 0.01; OR, 1.30; 95% CI, 1.06 to 1.59) and 90-day poor outcomes (P = 0.03; OR, 1.27; 95% CI, 1.03 to 1.58), as well as mortality at 90 days (P = 0.005; OR, 1.41; 95% CI, 1.11 to 1.78). In addition, admission critical hyperglycemia showed significantly increased the incidence rate of pneumonia in PIVH (P = 0.02; OR, 6.04; 95% CI 1.27 to 28.80) even after adjusting for the confounders. Conclusion: Admission blood glucose after PIVH is associated with discharge and 90-day poor outcomes, as well as mortality at 90 days. Admission hyperglycemia significantly increases the incidence rate of pneumonia in PIVH.
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Song, Yue, Changqiang Yang, and Hua Wang. "Free Triiodothyronine Is Associated with Poor Outcomes after Acute Ischemic Stroke." International Journal of Clinical Practice 2022 (February 3, 2022): 1–6. http://dx.doi.org/10.1155/2022/1982193.
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Aims. It is unclear whether thyroid hormones are associated with functional outcomes after ischemic stroke. We aimed to investigate the impact of serum levels of thyroid hormones at admission on functional outcomes at 3 months after acute ischemic stroke. Methods. A total of 480 consecutive patients with ischemic stroke who were admitted to our hospital within 48 h of onset were enrolled. The levels of thyroid hormones, including thyroid-stimulating hormone, free triiodothyronine (FT3), and free thyroxine, were measured at admission, and functional outcomes were assessed at 3 months using the modified Rankin Scale (mRS), with scores ranging from 0 to 6. Poor outcome was defined as mRS score ≥3. Results. FT3 levels at admission were considerably lower in patients with poor outcomes than in those with good outcomes at 3 months (3.53 ± 0.70 pmol/L vs. 4.04 ± 0.68 pmol/L; P < 0.001 ). Lower FT3 levels were observed in patients with higher mRS scores. Multivariable logistic regression analysis revealed that FT3 levels were significantly associated with a risk of poor outcomes at 3 months, independent of conventional risk factors such as age, National Institutes of Health Stroke Scale score, and recanalized therapy. In addition, patients in FT3 levels in the lowest quartile had a 2.56-fold higher risk of poor outcomes than those with FT3 levels in the highest quartile (odds ratio = 2.56, 95% confidence interval = 1.15–5.69, P = 0.021 ). The sensitivity and specificity of FT3 level ≤3.69 pmol/L for predicting poor outcomes were 62.70% and 72.03%, respectively. Conclusion. Our study suggests that FT3 levels at admission are significantly and independently associated with a risk of poor outcomes after ischemic stroke and that lower FT3 levels can be considered as a prognostic biomarker for poor outcomes at 3 months.
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Keeble, Eilís, Helen C. Roberts, Christopher D. Williams, James Van Oppen, and Simon Paul Conroy. "Outcomes of hospital admissions among frail older people: a 2-year cohort study." British Journal of General Practice 69, no. 685 (July 15, 2019): e555-e560. http://dx.doi.org/10.3399/bjgp19x704621.
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Background‘Frailty crises’ are a common cause of hospital admission among older people and there is significant focus on admission avoidance. However, identifying frailty before a crisis occurs is challenging, making it difficult to effectively target community services. Better longer-term outcome data are needed if services are to reflect the needs of the growing population of older people with frailty.AimTo determine long-term outcomes of older people discharged from hospital following short (<72 hours) and longer hospital admissions compared by frailty status.Design and settingTwo populations aged ≥70 years discharged from hospital units: those following short ‘ambulatory’ admissions (<72 hours) and those following longer inpatient stays.MethodData for 2-year mortality and hospital use were compared using frailty measures derived from clinical and hospital data.ResultsMortality after 2 years was increased for frail compared with non-frail individuals in both cohorts. Patients in the ambulatory cohort classified as frail had increased mortality (Rockwood hazard ratio 2.3 [95% confidence interval {CI} = 1.5 to 3.4]) and hospital use (Rockwood rate ratio 2.1 [95% CI = 1.7 to 2.6]) compared with those patients classified as non-frail.ConclusionIndividuals with frailty who are discharged from hospital experience increased mortality and resource use, even after short ‘ambulatory’ admissions. This is an easily identifiable group that is at increased risk of poor outcomes. Health and social care systems might wish to examine their current care response for frail older people discharged from hospital. There may be value in a ‘secondary prevention’ approach to frailty crises targeting individuals who are discharged from hospital.
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Gielen, Anneke, Kristine Koekkoek, Marijke van der Steen, Martijn-Looijen Looijen, and Arthur van Zanten. "Evaluation of the Initial General Ward Early Warning Score and ICU Admission, Hospital Length of Stay and Mortality." Western Journal of Emergency Medicine 22, no. 5 (September 2, 2021): 1132–38. http://dx.doi.org/10.5811/westjem.2021.6.50657.
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Introduction: Despite widespread implementation of the Early Warning Score (EWS) in hospitals, its effect on patient outcomes remains mostly unknown. We aimed to evaluate associations between the initial EWS and in-hospital mortality, intensive care unit (ICU) admission, and hospital length of stay (LOS). Methods: We performed a retrospective cohort study of adult patients admitted to a general hospital ward between July 1, 2014–December 31, 2017. Data were obtained from electronic health records (EHR). The primary outcome was in-hospital mortality. Secondary outcomes were ICU admission and hospital LOS. We categorized patients into three risk groups (low, medium or high risk of clinical deterioration) based on EWS. Descriptive analyses were used. Results: After applying inclusion and exclusion criteria, we included 53,180 patients for analysis. We found that the initial (low- vs high-risk) EWS was associated with an increased in-hospital mortality (1.5% vs 25.3%, P <0.001), an increased ICU admission rate (3.1% vs 17.6%, P <0.001), and an extended hospital LOS (4.0 days vs 8.0 days, P <0.001). Conclusion: Our findings suggest that an initial high-risk EWS in patients admitted to a general hospital ward was associated with an increased risk of in-hospital mortality, ICU admission, and prolonged hospital LOS. Close monitoring and precise documentation of the EWS in the EHR may facilitate predicting poor outcomes in individual hospitalized patients and help to identify patients for whom timely and adequate management may improve outcomes.
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de Carvalho, João José Freitas, Monique Bueno Alves, Georgiana Álvares Andrade Viana, Cícera Borges Machado, Bento Fortunato Cardoso dos Santos, Alberto Hideki Kanamura, Claudio Luiz Lottenberg, Miguel Cendoroglo Neto, and Gisele Sampaio Silva. "Stroke Epidemiology, Patterns of Management, and Outcomes in Fortaleza, Brazil." Stroke 42, no. 12 (December 2011): 3341–46. http://dx.doi.org/10.1161/strokeaha.111.626523.
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Background and Purpose— Little information exists on the epidemiology and patterns of treatment of patients admitted to Brazilian hospitals with stroke. Our objective was to describe the frequency of risk factors, patterns of management, and outcome of patients admitted with stroke in Fortaleza, the fifth largest city in Brazil. Methods— Data were prospectively collected from consecutive patients admitted to 19 hospitals in Fortaleza with a diagnosis of stroke or transient ischemic attack from June 2009 to October 2010. Results— We evaluated 2407 consecutive patients (mean age, 67.7±14.4 years; 51.8% females). Ischemic stroke was the most frequent subtype (72.9%) followed by intraparenchymal hemorrhage (15.2%), subarachnoid hemorrhage (6.0%), transient ischemic attack (3%), and undetermined stroke (2.9%). The median time from symptoms onset to hospital admission was 12.9 (3.8–32.5) hours. Hypertension was the most common risk factor. Only 1.1% of the patients with ischemic stroke received thrombolysis. The median time from hospital admission to neuroimaging was 3.4 (1.2–26.5) hours. In-hospital mortality was 20.9% and the frequency of modified Rankin Scale score ≤2 at discharge was less than 30%. Older age, prestroke disability, and having a depressed level of consciousness at admission were independent predictors of poor outcome; conversely, male gender was a predictor of good outcome. Conclusions— The prevalence of stroke risk factors and clinical presentation in our cohort were similar to previous series. Treatment with thrombolysis and functional independency after a stroke admission were infrequent. We also found long delays in hospital admission and in evaluation with neuroimaging and high in-hospital mortality.
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Zewudie, Ameha Zeleke, Tolcha Regasa, Solomon Hambisa, Dejen Nureye, Yitagesu Mamo, Temesgen Aferu, Desalegn Feyissa, and Tewodros Yosef. "Treatment Outcome and Its Determinants among Patients Admitted to Stroke Unit of Jimma University Medical Center, Southwest Ethiopia." Stroke Research and Treatment 2020 (December 30, 2020): 1–8. http://dx.doi.org/10.1155/2020/8817948.
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Background. Stroke is a public health problem in Ethiopia. Despite the high prevalence of stroke in Ethiopia, there is a paucity of data with regard to drug treatment, treatment outcome, and risk factors of poor treatment outcome of stroke. Hence, this study is aimed at assessing treatment outcome and its determinants among patients admitted to stroke unit of Jimma University Medical Center (JUMC). Methods. A two-year hospital-based retrospective cross-sectional study was employed to analyze the medical records of patients admitted with stroke to stroke unit of Jimma University Medical Centre from February 1st, 2016 to March 30th, 2018. Data was entered by Epidata manager version 4.0.2 and analyzed by SPSS version 24. Multivariable logistic regression analysis with the backward stepwise approach was done to identify independent predictors of poor treatment outcome of stroke. Variables with P value less than 0.05 were considered as statically significant determinants of poor treatment outcome. Results. Of 220 patients with stroke admitted to the Jimma University, 67.30% were male. Nearly two thirds (63.18%) of them had poor treatment outcomes. Dyslipidimics were administered to 60% of the patients, and the most popular antiplatelet used was aspirin, which was prescribed to 67.3% the patients. Age ≥ 65 adjusted odd ratio ((AOR): 2.56; 95% CI: 1.95-9.86, P = 0.001 ), presence of comorbidity (AOR: 5.25; 95% CI: 1.08-17.69, P < 0.001 ), admission with hemorrhagic stroke (AOR: 18.99; 95% CI: 7.05-42.07, P < 0.001 ), and admission to the hospital after 24 hour of stroke onset (AOR: 4.98; 95% CI: 1.09-21.91, P = 0.03 ) were independent predictors of poor treatment outcomes. Conclusion. Substantial numbers of stroke patients had poor treatment outcomes. Elderly patients, patients diagnosed with hemorrhagic stroke, patients with comorbidity, and those with delayed hospital admission were more likely to have poor treatment outcome. Hence, frequent monitoring and care should be given for the aforementioned patients. Awareness creation on the importance of early admission should be delivered particularly for patients who have risk factors of stroke (cardiovascular diseases).
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Bacha, Lensa Tamiru, Wase Benti Hailu, and Edosa Tesfaye Geta. "Clinical outcome and associated factors of respiratory distress syndrome among preterm neonates admitted to the neonatal intensive care unit of Adama Hospital and Medical College." SAGE Open Medicine 10 (January 2022): 205031212211460. http://dx.doi.org/10.1177/20503121221146068.
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Objective: Aim of the study was to assess the clinical outcome and associated factors of respiratory distress syndrome among preterm neonates admitted to the neonatal intensive care unit of Adama Hospital and Medical College. Methods: Hospital-based cross-sectional study was conducted using 242 randomly selected medical records of preterm neonates admitted to Adama comprehensive specialized hospital. Clinical outcome was categorized as poor if the neonate died or left against advice and good if discharged after improvement. Data were coded, entered into Epidata v.7.4.2 and exported to SPSS v.27 for analysis. After initial bi-variable logistic regression analysis, predictor variables with p-value of <0.2 were included in multivariable analysis. Significant association of factors with clinical outcome was claimed at p-value <0.05 and calculated 95% adjusted odds ratio. Results: Majority of admissions were male (63.2%), mean birth weight of 1440.3 g (+321.2 SD) and sepsis (82%), hypothermia (73%), and apnea (21.5%) were leading comorbidities. One hundred fifty-two (62.8%) of preterm neonates had poor outcomes. Neonates born singleton were 47% less likely to develop poor clinical outcomes (adjusted odds ratio 0.53 (0.48–0.94). The odds of poor clinical outcomes were higher during the first 3 days of admission (adjusted odds ratio 3.83 (3.28–14.77). Extremely preterm neonates (adjusted odds ratio 4.16 (4.01–12.97), extremely low birth weight preterm neonates had higher odds of poor clinical outcome. Conclusion: The study found higher poor clinical outcome among preterm neonates admitted with respiratory distress syndrome. Poor outcome was higher in lower gestational age, lower birth weight, twins and majority of it happened during 3 days of their life. Effective preventive care and initiation of low-cost, life-saving interventions including heated humidified high-flow nasal cannula and surfactant administration could significantly improve the clinical outcome of the neonates.
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Singh, Bhagteshwar, Suzannah Lant, Sofia Cividini, Jonathan W. S. Cattrall, Lynsey C. Goodwin, Laura Benjamin, Benedict D. Michael, et al. "Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis." PLOS ONE 17, no. 6 (June 2, 2022): e0263595. http://dx.doi.org/10.1371/journal.pone.0263595.
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Background Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. Methods We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. Results We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67–82]), than encephalopathy (54% [42–65]). Intensive care use was high (38% [35–41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27–32]. The hazard of death was comparatively lower for patients in the WHO European region. Interpretation Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.
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Akram, Muhammad Junaid, Xinni Lv, Lan Deng, Zuoqiao Li, Tiannan Yang, Hao Yin, Xiaofang Wu, et al. "Off-Hour Admission Is Associated with Poor Outcome in Patients with Intracerebral Hemorrhage." Journal of Clinical Medicine 12, no. 1 (December 21, 2022): 66. http://dx.doi.org/10.3390/jcm12010066.
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The mortality of stroke increases on weekends and during off-hour periods. We investigated the effect of off-hour admission on the outcomes of intracerebral hemorrhage (ICH) patients. We retrospectively analyzed a prospective cohort of ICH patients, admitted between January 2017 and December 2019 at the First Affiliated Hospital of Chongqing Medical University. Acute ICH within 72 h after onset with a baseline computed tomography and 3-month follow-up were included in our study. Multivariable logistic regression analysis was performed for calculating the odds ratios (OR) and 95% confidence interval (CI) for the outcome measurements. Of the 656 participants, 318 (48.5%) were admitted during on-hours, whereas 338 (51.5%) were admitted during off-hours. Patients with a poor outcome had a larger median baseline hematoma volume, of 27 mL (interquartile range 11.1–53.2 mL), and a lower median time from onset to imaging, of 2.8 h (interquartile range 1.4–9.6 h). Off-hour admission was significantly associated with a poor functional outcome at 3 months, after adjusting for cofounders (adjusted OR 2.17, 95% CI 1.35–3.47; p = 0.001). We found that patients admitted during off-hours had a higher risk of poor functional outcomes at 3 months than those admitted during working hours.
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Ryczek, Robert, Przemysław J. Kwasiborski, Agnieszka Rzeszotarska, Jolanta Dymus, Agata Galas, Anna Kaźmierczak-Dziuk, Anna M. Karasek, et al. "Neuron-Specific Enolase and S100B: The Earliest Predictors of Poor Outcome in Cardiac Arrest." Journal of Clinical Medicine 11, no. 9 (April 22, 2022): 2344. http://dx.doi.org/10.3390/jcm11092344.
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Background: Proper prognostication is critical in clinical decision-making following out-of-hospital cardiac arrest (OHCA). However, only a few prognostic tools with reliable accuracy are available within the first 24 h after admission. Aim: To test the value of neuron-specific enolase (NSE) and S100B protein measurements at admission as early biomarkers of poor prognosis after OHCA. Methods: We enrolled 82 consecutive patients with OHCA who were unconscious when admitted. NSE and S100B levels were measured at admission, and routine blood tests were performed. Death and poor neurological status at discharge were considered as poor clinical outcomes. We evaluated the optimal cut-off levels for NSE and S100B using logistic regression and receiver operating characteristic (ROC) analyses. Results: High concentrations of both biomarkers at admission were significantly associated with an increased risk of poor clinical outcome (NSE: odds ratio [OR] 1.042 per 1 ng/dL, [1.007–1.079; p = 0.004]; S100B: OR 1.046 per 50 pg/mL [1.004–1.090; p < 0.001]). The dual-marker approach with cut-off values of ≥27.6 ng/mL and ≥696 ng/mL for NSE and S100B, respectively, identified patients with poor clinical outcomes with 100% specificity. Conclusions: The NSE and S100B-based dual-marker approach allowed for early discrimination of patients with poor clinical outcomes with 100% specificity. The proposed algorithm may shorten the time required to establish a poor prognosis and limit the volume of futile procedures performed.
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Lopez Ramos, Christian, Michael G. Brandel, Robert C. Rennert, Brian R. Hirshman, Arvin R. Wali, Jeffrey A. Steinberg, David R. Santiago-Dieppa, et al. "The Potential Impact of “Take the Volume Pledge” on Outcomes After Carotid Artery Stenting." Neurosurgery 86, no. 2 (March 15, 2019): 241–49. http://dx.doi.org/10.1093/neuros/nyz053.
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Abstract BACKGROUND The “Volume Pledge” aims to centralize carotid artery stenting (CAS) to hospitals and surgeons performing ≥10 and ≥5 procedures annually, respectively. OBJECTIVE To compare outcomes after CAS between hospitals and surgeons meeting or not meeting the Volume Pledge thresholds. METHODS We queried the Nationwide Inpatient Sample for CAS admissions. Hospitals and surgeons were categorized as low volume and high volume (HV) based on the Volume Pledge. Multivariable hierarchical regression models were used to examine the impact of hospital volume (2005-2011) and surgeon volume (2005-2009) on perioperative outcomes. RESULTS Between 2005 and 2011, 22 215 patients were identified. Most patients underwent CAS by HV hospitals (86.4%). No differences in poor outcome (composite endpoint of in-hospital mortality, postoperative neurological or cardiac complications) were observed by hospital volume but HV hospitals did decrease the likelihood of other complications, nonroutine discharge, and prolonged hospitalization. From 2005 to 2009, 9454 CAS admissions were associated with physician identifiers. Most patients received CAS by HV surgeons (79.2%). On multivariable analysis, hospital volume was not associated with improved outcomes but HV surgeons decreased odds of poor outcome (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.59-0.97; P = .028), complications (OR 0.56, 95% CI 0.46-0.71, P < .001), nonroutine discharge (OR 0.70, 95% CI 0.57-0.87; P = .001), and prolonged hospitalization (OR 0.52, 95% 0.44-0.61, P < .001). CONCLUSION Most patients receive CAS by hospitals and providers meeting the Volume Pledge threshold for CAS. Surgeons but not hospitals who met the policy's volume standards were associated with superior outcomes across all measured outcomes.
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Jankowski, K., and DC Bryden. "Using a CriSTAL scoring system to identify pre-morbid conditions associated with a poor outcome after admission to intensive care in people 70 years or older." Journal of the Intensive Care Society 20, no. 3 (October 9, 2018): 231–36. http://dx.doi.org/10.1177/1751143718804678.
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Older people admitted to intensive care are considered to have lower physiological reserves, an increased susceptibility to infection and longer recovery times, resulting in generally poorer outcomes after intensive care treatment. However, biological heterogeneity makes identification of those with the best chances of survival within their group difficult and risks subjecting those at the end of their lives to unsuccessful treatments. There is no fit-for-purpose outcome prediction tool capable of identifying patients most at risk of these poor outcomes at the point of admission to intensive care. This retrospective study sought to identify factors associated with mortality in older patients (≥70 years) admitted to a teaching hospital critical care unit using objective variables readily available at the point of admission. A total of 15 variables were tested for a significant association with mortality. Of these, eight were identified as significant variables (myocardial infarction within 6 months, an abnormal ECG, congestive cardiac failure (NYHA ≥2), chronic pulmonary disease, chronic liver disease, metastatic cancer, a stay in hospital ≥5 days preceding ICU admission, and frailty (Clinical Frailty Score ≥4)). These variables were used from the basis of a novel outcome prediction model. The aim of such a model would be that it could be used at the point of referral to intensive care to inform considerations regarding admission, and to facilitate conversations with the patient and family regarding realistic treatment expectations.
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Cromhout, Pernille Fevejle, Lau Caspar Thygesen, Philip Moons, Samer Nashef, Sune Damgaard, and Selina Kikkenborg Berg. "Social and emotional factors as predictors of poor outcomes following cardiac surgery." Interactive CardioVascular and Thoracic Surgery 34, no. 2 (October 4, 2021): 193–200. http://dx.doi.org/10.1093/icvts/ivab261.
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Abstract OBJECTIVES Existing risk prediction models in cardiac surgery stratify individuals based on their predicted risk, including only medical and physiological factors. However, the complex nature of risk assessment and the lack of parameters representing non-medical aspects of patients’ lives point towards the need for a broader paradigm in cardiac surgery. Objectives were to evaluate the predictive value of emotional and social factors on 4 outcomes; death within 90 days, prolonged stay in intensive care (≥72 h), prolonged hospital admission (≥10 days) and readmission within 90 days following cardiac surgery, as a supplement to traditional risk assessment by European System for Cardiac Operative Risk Evaluation (EuroSCORE). METHODS The study included adults undergoing cardiac surgery in Denmark 2014–2017 including information on register-based socio-economic factors, and, in a nested subsample, self-reported symptoms of anxiety and depression. Logistic regression analyses were conducted, adjusted for EuroSCORE, of variables reflecting social and emotional factors. RESULTS Amongst 7874 included patients, lower educational level (odds ratio 1.33; 95% confidence interval 1.17–1.51) and living alone (1.25; 1.14–1.38) were associated with prolonged hospital admission after adjustment for EuroSCORE. Lower educational level was also associated with prolonged intensive care unit stay (1.27; 1.00–1.63). Having a high income was associated with decreased odds of prolonged hospital admission (0.78; 0.70–0.87). No associations or predictive value for symptoms of anxiety or depression were found on any outcomes. CONCLUSIONS Social disparity is predictive of poor outcomes following cardiac surgery. Symptoms of anxiety and depression are frequent especially amongst patients with a high-risk profile according to EuroSCORE. Subj collection 105, 123
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Sato, Shoichiro, Hisatomi Arima, Emma Heeley, Yoichiro Hirakawa, Candice Delcourt, Richard I. Lindley, Thompson Robinson, et al. "Off-Hour Admission and Outcomes in Patients with Acute Intracerebral Hemorrhage in the INTERACT2 Trial." Cerebrovascular Diseases 40, no. 3-4 (2015): 114–20. http://dx.doi.org/10.1159/000434690.
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Background: Conflicting data exist of an association between off-hour (weekend, holiday, or night-time) hospital admission and adverse outcome in intracerebral hemorrhage (ICH). We determined the association between off-hour admissions and poor clinical outcome, and of any differential effect of early intensive blood pressure (BP) lowering treatment between off- and on-hour admissions, among participants of the Intensive BP Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). Methods: Subsidiary analysis of INTERACT2, a multinational, multicenter, clinical trial of patients with spontaneous ICH with elevated systolic BP, randomly assigned to intensive (target systolic BP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. Primary outcome was death or major disability (modified Rankin scale of 3-6) at 90 days. Off-hour admission was defined as night-time (4:30 p.m. to 8:30 a.m.) on weekdays, weekends (Saturday and Sunday), and public holidays in each participating country. Results: Of 2,794 patients with information on the primary outcome, 1,770 (63%) were admitted to study centers during off-hours. Off-hour admission was not associated with risk of poor outcome at 90 days (53% off-hour vs. 55% on-hour; p = 0.49), even after adjustment for comorbid risk factors (odds ratio 0.92; 95% CI 0.76-1.12). Consistency exists in the effects of intensive BP lowering between off- and on-hour admission (p = 0.85 for homogeneity). Conclusions: Off-hour admission was not associated with increased risks of death or major disability among trial protocol participants with acute ICH. Intensive BP lowering can provide similar treatment effect irrespective of admission hours.
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Jaraković, Milana, Vesna Aleksić, Snežana Bjelica, Sonja Dimić, Mila Kovačević, Milovan Petrović, Stevan Keča, Srđan Maletin, and Dragan Ivanišević. "Survival and neurologic recovery after out-of-hospital cardiac arrest." Halo 194 28, no. 2 (2022): 45–52. http://dx.doi.org/10.5937/halo28-36844.
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Introduction/Objective: Survival and neurologic recovery after out-of-hospital cardiac arrest remain poor despite significant advances in the therapeutic approach. The study aimed to evaluate predictors of intrahospital survival and neurologic outcome among patients after outof-hospital cardiac arrest as well as to evaluate the influence of mild therapeutic hypothermia introduction on intrahospital survival and neurologic outcome among comatose patients after out-of-hospital cardiac arrest. Methods The research was conducted as a retrospective observational study among patients hospitalized at the Cardiac Intensive Care Unit of the Institute for Cardiovascular Diseases of Vojvodina from January 2007 until November 2019 as a result of an out-of-hospital cardiac arrest. Results. The research included 506 survivors of OHCA. Multivariate regression analysis showed that initial shockable rhythm, cardiopulmonary resuscitation efforts lasting no longer than 20 minutes and a Glasgow Coma Score above 8 at admission, were predictors of intrahospital survival and good neurological outcome. Introduction of mild therapeutic hypothermia improved intrahospital survival (54.1% vs. 24.4%; p < 0.0005) and neurological outcome (42.9% vs. 18.3%; p < 0.0005) in comatose patients with initial shockable rhythm. Conclusion. In our study group of out-of-hospital cardiac arrest patients, initial shockable rhythm, cardiopulmonary resuscitation efforts lasting no longer than 20min and a Glasgow Coma Score above 8 at admission were predictors of intrahospital survival and favourable neurological outcome. The introduction of mild therapeutic hypothermia significantly improved survival and neurological outcomes in comatose patients with initial shockable rhythms.
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McGirt, Matthew J., Graeme F. Woodworth, Mohammed Ali, Khoi D. Than, Rafael J. Tamargo, and Richard E. Clatterbuck. "Persistent perioperative hyperglycemia as an independent predictor of poor outcome after aneurysmal subarachnoid hemorrhage." Journal of Neurosurgery 107, no. 6 (December 2007): 1080–85. http://dx.doi.org/10.3171/jns-07/12/1080.
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Object The authors of previous studies have shown that admission hyperglycemia or perioperative hyperglycemic events may predispose a patient to poor outcome after aneurysmal subarachnoid hemorrhage (SAH). The results of experimental evidence have suggested that hyperglycemia may exacerbate ischemic central nervous system injury. It remains to be clarified whether a single hyperglycemic event or persistent hyperglycemia is predictive of poor outcome after aneurysmal SAH. Methods Ninety-seven patients undergoing treatment for aneurysmal SAH were observed, and all perioperative variables were entered into a database of prospectively recorded data. Daily serum glucose values were retrospectively added. Patients were examined at hospital discharge (14–21 days after SAH onset), and Glasgow Outcome Scale (GOS) scores were prospectively documented. The GOS score at last follow-up was retrospectively determined. Serum glucose greater than 200 mg/dl for 2 or more consecutive days was defined as persistent hyperglycemia. Outcome was categorized as “poor” (dependent function [GOS Score 1–3]) or “good” (independent function [GOS Score 4 or 5]) at discharge. The independent association of 2-week and final follow-up outcome (GOS score) with the daily serum glucose levels was assessed using a multivariate analysis. Results In the univariate analysis, increasing age, increasing Hunt and Hess grade, hypertension, ventriculomegaly on admission computed tomography scan, Caucasian race, and higher mean daily glucose levels were associated with poor (dependent) 2-week outcome after aneurysmal SAH. In the multivariate analysis, older age, the occurrence of symptomatic cerebral vasospasm, increasing admission Hunt and Hess grade, and persistent hyperglycemia were independent predictors of poor (dependent) outcome 2 weeks after aneurysmal SAH. Admission Hunt and Hess grade and persistent hyperglycemia were independent predictors of poor outcome at last follow-up examination a mean 10 ± 3 months after aneurysmal SAH. Isolated hyperglycemic events did not predict poor outcome. Patients with persistent hyperglycemia were 10-fold more likely to have a poor (dependent) 2-week outcome and sevenfold more likely to have a poor outcome a mean 10 months after aneurysmal SAH independent of admission Hunt and Hess grade, occurrence of cerebral vasospasm, or all comorbidities. Conclusions Patients with persistent hyperglycemia were seven times more likely to have a poor outcome at a mean of 10 months after aneurysmal SAH. Isolated hyperglycemic events were not predictive of poor outcome. Serum glucose levels in the acute setting of aneurysmal SAH may help predict outcomes months after surgery.
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Kim, Jae-Guk, Hyungoo Shin, Tae-Ho Lim, Wonhee Kim, Youngsuk Cho, Bo-Hyoung Jang, Kyu-Sun Choi, Min-Kyun Na, Chiwon Ahn, and Juncheol Lee. "Efficacy of Quantitative Pupillary Light Reflex for Predicting Neurological Outcomes in Patients Treated with Targeted Temperature Management after Cardiac Arrest: A Systematic Review and Meta-Analysis." Medicina 58, no. 6 (June 15, 2022): 804. http://dx.doi.org/10.3390/medicina58060804.
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Background and objectives: This study aims to evaluate the usefulness of the quantitative pupillary light reflex as a prognostic tool for neurological outcomes in post-cardiac arrest patients treated with targeted temperature management (TTM). Material and Methods: We systematically searched MEDLINE, EMBASE, and the Cochrane Library (search date: 9 July 2021) for studies on post-cardiac arrest patients treated with TTM that had measured the percent constriction of pupillary light reflex (%PLR) with quantitative pupillometry as well as assessed the neurological outcome. For an assessment of the methodological quality of the included studies, two authors utilized the prognosis study tool independently. Results: A total of 618 patients from four studies were included in this study. Standardized mean differences (SMDs) were calculated to compare patients with good or poor neurological outcomes. A higher %PLR measured at 0–24 h after hospital admission was related to good neurological outcomes at 3 months in post-cardiac arrest patients treated with TTM (SMD 0.87; 95% confidence interval 0.70–1.05; I2 = 0%). A higher %PLR amplitude measured at 24–48 h after hospital admission was also associated with a good neurological outcome at 3 months in post-cardiac arrest patients treated with TTM, but with high heterogeneity (standardized mean difference 0.86; 95% confidence interval 0.40–1.32; I2 = 70%). The evidence supporting these findings was of poor quality. For poor neurological outcome, the prognosis accuracy of %PLR was 9.19 (pooled diagnostic odds ratio, I2 = 0%) and 0.75 (area under the curve). Conclusions: The present meta-analysis could not reveal that change of %PLR was an effective tool in predicting neurological outcomes for post-cardiac arrest patients treated with TTM owing to a paucity of included studies and the poor quality of the evidence.
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Lin, Chun-Fu, Yi-Syun Huang, Ming-Ta Tsai, Kuan-Han Wu, Chien-Fu Lin, and I.-Min Chiu. "In-Hospital Outcomes in Patients Admitted to the Intensive Care Unit after a Return Visit to the Emergency Department." Healthcare 9, no. 4 (April 7, 2021): 431. http://dx.doi.org/10.3390/healthcare9040431.
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Background: Intensive care unit (ICU) admission following a short-term emergency department (ED) revisit has been considered a particularly undesirable outcome among return-visit patients, although their in-hospital prognosis has not been discussed. We aimed to compare clinical outcomes between adult patients admitted to the ICU after unscheduled ED revisits and those admitted during index ED visits. Method: This retrospective study was conducted at two tertiary medical centers in Taiwan from 1 January 2016 to 31 December 2017. All adult non-trauma patients admitted to the ICU directly via the ED during the study period were included and divided into two comparison groups: patients admitted to the ICU during index ED visits and those admitted to the ICU during return ED visits. The outcomes of interest included in-hospital mortality, mechanical ventilation (MV) support, profound shock, hospital length of stay (HLOS), and total medical cost. Results: Altogether, 12,075 patients with a mean (standard deviation) age of 64.6 (15.7) years were included. Among these, 5.3% were admitted to the ICU following a return ED visit within 14 days and 3.1% were admitted following a return ED visit within 7 days. After adjusting for confounding factors for multivariate regression analysis, ICU admission following an ED revisit within 14 days was not associated with an increased mortality rate (adjusted odds ratio (aOR): 1.08, 95% confidence interval (CI): 0.89 to 1.32), MV support (aOR: 1.06, 95% CI: 0.89 to 1.26), profound shock (aOR: 0.99, 95% CI: 0.84 to 1.18), prolonged HLOS (difference: 0.04 days, 95% CI: −1.02 to 1.09), and increased total medical cost (difference: USD 361, 95% CI: −303 to 1025). Similar results were observed after the regression analysis in patients that had a 7-day return visit. Conclusion: ICU admission following a return ED visit was not associated with major in-hospital outcomes including mortality, MV support, shock, increased HLOS, or medical cost. Although ICU admissions following ED revisits are considered serious adverse events, they may not indicate poor prognosis in ED practice.
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Withall, A., L. M. Harris, and S. R. Cumming. "The relationship between cognitive function and clinical and functional outcomes in major depressive disorder." Psychological Medicine 39, no. 3 (June 4, 2008): 393–402. http://dx.doi.org/10.1017/s0033291708003620.
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BackgroundAlthough cognitive variables have been shown to be useful in predicting outcomes in late-life depression, there has not yet been a comprehensive study in younger persons with depression.MethodThe clinical symptoms and cognitive performance of participants were evaluated at admission to one of two university teaching hospitals and again at 3 months after remission and discharge. A total of 52 participants with a DSM-IV diagnosis of major depressive disorder, aged between 20 and 60 years and with a Hamilton Depression Rating Scale score ⩾17 entered the study. The sample for this paper comprises the 48 subjects (mean age 37.9 years, s.d.=10.7) who received admission and follow-up assessments; an attrition rate of 7.7%.ResultsMore perseverative errors on the shortened Wisconsin Card Sorting Test at admission predicted a worse clinical outcome at follow-up. Poor event-based prospective memory and more perseverative errors on the shortened Wisconsin Card Sorting Test at admission predicted worse social and occupational outcome at follow-up.ConclusionsThese results suggest that a brief cognitive screen at hospital admission, focusing on executive function, would have a useful prognostic value in depression. Determining early predictors of individuals at risk of poorer outcomes is important for identifying those who may need altered or additional treatment approaches.
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Li, Kin Chio, Catherine Wing Yan Tam, Hoi-Ping Shum, and Wing Wa Yan. "Impact of Hyperoxia and Hypocapnia on Neurological Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Retrospective Study." Critical Care Research and Practice 2019 (December 6, 2019): 1–8. http://dx.doi.org/10.1155/2019/7584573.
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In recent decades, there is increasing evidence suggesting that hyperoxia and hypocapnia are associated with poor outcomes in critically ill patients with cardiac arrest or traumatic brain injury. Yet, the impact of hyperoxia and hypocapnia on neurological outcome in patients with subarachnoid hemorrhage (SAH) has not been well studied. In the present study, we evaluated the impact of hyperoxia and hypocapnia on neurological outcomes in patients with aneurysmal SAH (aSAH). Patients with aSAH who were admitted to the intensive care unit (ICU) of a tertiary hospital in Hong Kong between January 2011 and December 2016 were retrospectively recruited. Patients’ demographics, comorbidities, radiological findings, clinical grades of SAH, PO2, and PCO2 within 24 hours of ICU admission, and Glasgow Outcome Scale (GOS) at 3 months after admission were recorded. Patients with a GOS score of 3 or less were considered having poor neurological outcomes. Among the 244 patients with aSAH, 122 of them (50%) had poor neurological outcomes at 3 months. Early hyperoxia (PO2 > 200 mmHg) and hypercapnia (PCO2 > 45 mmHg) were more common among patients with poor neurological outcomes. Logistic regression analysis indicated that hyperoxia independently predicted poor neurological outcomes (OR 3.788, 95% CI 1.131–12.690, P=0.031). Classification tree analysis revealed that hypocapnia was associated with poor neurological outcomes in patients who were less critically ill (APACHE < 50) and without concomitant intracranial hemorrhage (ICH) or intraventricular hemorrhage (IVH) (adjusted P=0.006, χ2 = 7.452). These findings suggested that hyperoxia and hypocapnia may be associated with poor neurological outcomes in patients with aSAH.
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Shang, Wenjin, Kaiyi Zhong, Liming Shu, Zhuhao Li, and Hua Hong. "Poor Internal Jugular Venous Outflow Is Associated with Poor Cortical Venous Outflow and Outcomes after Successful Endovascular Reperfusion Therapy." Brain Sciences 13, no. 1 (December 23, 2022): 32. http://dx.doi.org/10.3390/brainsci13010032.
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Many patients show poor outcomes following endovascular reperfusion therapy (ERT), and poor cortical venous outflow is a risk factor for these poor outcomes. We investigated the association between the outflow of the internal jugular vein (IJV) and baseline cortical venous outflow and the outcomes after ERT. We retrospectively enrolled 78 patients diagnosed with an acute anterior circulation stroke and successful ERT. Poor IJV outflow on the affected side was defined as stenosis ≥50% or occlusion of ipsilateral IJV, and poor outflow of bilateral IJVs was defined as stenosis ≥50% or occlusion of both IJVs. Poor cortical venous outflow was defined as a cortical vein opacification score (COVES) of 0 on admission. Multivariate analysis showed that poor outflow of IJV on the affected side was an independent predictor for hemorrhagic transformation. The poor outflow of bilateral IJVs was an independent risk factor for poor clinical outcomes. These patients also had numerical trends of a higher incidence of symptomatic intracranial hemorrhage, midline shift >10 mm, and in-hospital mortality; however, statistical significance was not observed. Additionally, poor IJV outflow was an independent determinant of poor cortical venous outflow. For acute large vessel occlusion patients, poor IJV outflow is associated with poor baseline cortical venous outflow and outcomes after successful ERT.
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Herzog, Naemi, Rahel Laager, Emanuel Thommen, Madlaina Widmer, Alessia M. Vincent, Annalena Keller, Christoph Becker, et al. "Association of Taurine with In-Hospital Mortality in Patients after Out-of-Hospital Cardiac Arrest: Results from the Prospective, Observational COMMUNICATE Study." Journal of Clinical Medicine 9, no. 5 (May 9, 2020): 1405. http://dx.doi.org/10.3390/jcm9051405.
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Background: Studies have suggested that taurine may have neuro- and cardio-protective functions, but there is little research looking at taurine levels in patients after out-of-hospital cardiac arrest (OHCA). Our aim was to evaluate the association of taurine with mortality and neurological deficits in a well-defined cohort of OHCA patients. Methods: We prospectively measured serum taurine concentration in OHCA patients upon admission to the intensive care unit (ICU) of the University Hospital Basel (Switzerland). We analyzed the association of taurine levels and in-hospital mortality (primary endpoint). We further evaluated neurological outcomes assessed by the cerebral performance category scale. We calculated logistic regression analyses and report odds ratios (OR) and 95% confidence intervals (CI). We calculated different predefined multivariable regression models including demographic variables, comorbidities, initial vital signs, initial blood markers and resuscitation measures. We assessed discrimination by means of area under the receiver operating curve (ROC). Results: Of 240 included patients, 130 (54.2%) survived until hospital discharge and 110 (45.8%) had a favorable neurological outcome. Taurine levels were significantly associated with higher in-hospital mortality (adjusted OR 4.12 (95%CI 1.22 to 13.91), p = 0.02). In addition, a significant association between taurine concentration and a poor neurological outcome was observed (adjusted OR of 3.71 (95%CI 1.13 to 12.25), p = 0.03). Area under the curve (AUC) suggested only low discrimination for both endpoints (0.57 and 0.57, respectively). Conclusion: Admission taurine levels are associated with mortality and neurological outcomes in OHCA patients and may help in the risk assessment of this vulnerable population. Further studies are needed to assess whether therapeutic modulation of taurine may improve clinical outcomes after cardiac arrest.
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Vianello, Andrea, Nello De Vita, Lorenza Scotti, Gabriella Guarnieri, Marco Confalonieri, Valeria Bonato, Beatrice Molena, et al. "Clinical Outcomes in Patients Aged 80 Years or Older Receiving Non-Invasive Respiratory Support for Hypoxemic Acute Respiratory Failure Consequent to COVID-19." Journal of Clinical Medicine 11, no. 5 (March 2, 2022): 1372. http://dx.doi.org/10.3390/jcm11051372.
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As the clinical outcome of octogenarian patients hospitalised for COVID-19 is very poor, here we assessed the clinical characteristics and outcomes of patients aged 80 year or older hospitalised for COVID-19 receiving non-invasive respiratory support (NIRS). A multicentre, retrospective, observational study was conducted in seven hospitals in Northern Italy. All patients aged ≥80 years with COVID-19 associated hypoxemic acute respiratory failure (hARF) undergoing NIRS between 24 February 2020, and 31 March 2021, were included. Out of 252 study participants, 156 (61.9%) and 163 (64.6%) died during hospital stay and within 90 days from hospital admission, respectively. In this case, 228 (90.5%) patients only received NIRS (NIRS group), while 24 (9.5%) were treated with invasive mechanical ventilation (IMV) after NIRS failure (NIRS+IMV group). In-hospital mortality did not significantly differ between NIRS and NIRS+IMV group (61.0% vs. 70.8%, respectively; p = 0.507), while survival probability at 90 days was significantly higher for NIRS compared to NIRS+IMV patients (0.379 vs. 0.147; p = 0.0025). The outcome of octogenarian patients with COVID-19 receiving NIRS is quite poor. Caution should be used when considering transition from NIRS to IMV after NIRS failure.
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Gorgojo-Galindo, Óscar, Marta Martín-Fernández, María Jesús Peñarrubia-Ponce, Francisco Javier Álvarez, Christian Ortega-Loubon, Hugo Gonzalo-Benito, Pedro Martínez-Paz, et al. "Predictive Modeling of Poor Outcome in Severe COVID-19: A Single-Center Observational Study Based on Clinical, Cytokine and Laboratory Profiles." Journal of Clinical Medicine 10, no. 22 (November 20, 2021): 5431. http://dx.doi.org/10.3390/jcm10225431.
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Pneumonia is the main cause of hospital admission in COVID-19 patients. We aimed to perform an extensive characterization of clinical, laboratory, and cytokine profiles in order to identify poor outcomes in COVID-19 patients. Methods: A prospective and consecutive study involving 108 COVID-19 patients was conducted between March and April 2020 at Hospital Clínico Universitario de Valladolid (Spain). Plasma samples from each patient were collected after emergency room admission. Forty-five serum cytokines were measured in duplicate, and clinical data were analyzed using SPPS version 25.0. Results: A multivariate predictive model showed high hepatocyte growth factor (HGF) plasma levels as the only cytokine related to intubation or death risk at hospital admission (OR = 7.38, 95%CI—(1.28–42.4), p = 0.025). There were no comorbidities included in the model except for the ABO blood group, in which the O blood group was associated with a 14-fold lower risk of a poor outcome. Other clinical variables were also included in the predictive model. The predictive model was internally validated by the receiver operating characteristic (ROC) curve with an area under the curve (AUC) of 0.94, a sensitivity of 91.7% and a specificity of 95%. The use of a bootstrapping method confirmed these results. Conclusions: A simple, robust, and quick predictive model, based on the ABO blood group, four common laboratory values, and one specific cytokine (HGF), could be used in order to predict poor outcomes in COVID-19 patients.
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Lindgaard, Sidsel Christy, Jonas Nielsen, Anders Lindmark, and Henrik Sengeløv. "Prognosis of Allogeneic Haematopoietic Stem Cell Recipients Admitted to the Intensive Care Unit: A Retrospective, Single-Centre Study." Acta Haematologica 135, no. 2 (October 20, 2015): 72–78. http://dx.doi.org/10.1159/000440937.
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Background: Allogeneic haematopoietic stem cell transplantation (HSCT) is a procedure with inherent complications and intensive care may be necessary. We evaluated the short- and long-term outcomes of the HSCT recipients requiring admission to the intensive care unit (ICU). Methods: We retrospectively examined the outcome of 54 adult haematological HSCT recipients admitted to the ICU at the University Hospital Rigshospitalet between January 2007 and March 2012. Results: The overall in-ICU, in-hospital, 6-month and 1-year mortality rates were 46.3, 75.9, 79.6 and 86.5%, respectively. Mechanical ventilation had a statistically significant effect on in-ICU (p = 0.02), 6-month (p = 0.049) and 1-year (p = 0.014) mortality. Renal replacement therapy also had a statistically significant effect on in-hospital (p = 0.038) and 6-month (p = 0.026) mortality. Short ICU admissions, i.e. <10 days, had a statistically significant positive effect on in-hospital, 6-month and 1-year mortality (all p < 0.001). The SAPS II, APACHE II and SOFA scoring systems grossly underestimated the actual in-hospital mortality observed for these patients. Conclusion: The poor prognosis of critically ill HSCT recipients admitted to the ICU was confirmed in our study. Mechanical ventilation, renal replacement therapy and an ICU admission of ≥10 days were each risk factors for mortality in the first year after ICU admission.
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Dubljanin-Raspopović, Emilija, Ljiljana Marković-Denić, Dejan Nikolić, Goran Tulić, Marko Kadija, and Marko Bumbaširević. "Is anemia at admission related to short-term outcomes of elderly hip fracture patients?" Open Medicine 6, no. 4 (August 1, 2011): 483–89. http://dx.doi.org/10.2478/s11536-011-0031-3.
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AbstractHip fracture in elderly people is associated with high morbidity and mortality. Therefore, it is important to identify risk factors that potentially influence outcomes after hip surgery. The main purpose of this study was to evaluate the relationship of anemia at admission and short-term outcomes after hip fracture. We studied 343 community-dwelling patients who underwent surgery for hip fracture from March 2009 to March 2010. Functional mobility at discharge, postoperative complications, hospital length of stay and in-hospital mortality were analyzed in respect to presence and severity of anemia at admission. Anemia (defined as hemoglobin levels < 13.0 g/dl for men and < 12.0g/dl for women) was present in 185 (53.9%) patients, of whom 54 (29.2%) were severely anemic (defined as hemoglobin level 10.0g/dl or below). In multivariate analysis anemia was associated with age, gender (female), type of fracture (intertrochanteric) and American Society of Anesthesiologists (ASA) classification (3 or 4), while severity of anemia was associated with recovery of ambulatory ability at discharge. There was no difference in the incidence of postoperative complication, in-hospital mortality and length of hospital stay between the groups at discharge. Overall anemia at admission is an indicator of poor general health status. Ambulatory recovery in hip fracture patients is independently related to severity of anemia at admission.
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Dioun, Shayan M., Eirwen Murray Miller, Joan Tymon-Rosario, Dennis Yi-Shin Kuo, and Nicole Suzanne Nevadunsky. "A retrospective evaluation of unplanned hospital admission rates for women with ovarian cancer." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e18129-e18129. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e18129.
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e18129 Background: Unplanned admission following chemotherapy is a measure of quality cancer care. Large retrospective datasets have shown admission rates 10-35% in women with ovarian cancer receiving chemotherapy. It is unclear whether the Oncology Care Model is sustainable based on these admission rates. We sought to evaluate the rate and risk factors for hospital admission following chemotherapy in our racially diverse urban population. Methods: After IRB approval, all patients with epithelial ovarian cancer who received chemotherapy at our institution from 2005-2016 were identified. Charts were retrospectively reviewed for clinicopathologic data. Categorical variables were compared with chi-squared and continuous variables with the student t-test. Results: 222 evaluable patients were identified. 37 (17%) patients had unplanned admissions following initial chemotherapy. Indications for admission included neutropenic fever (9), abdominal pain (15), metabolic disturbances (2), infection (3), and other (8). The median number of days from chemotherapy to admission was 8 (IQR 7-18.5). No significant differences were seen in race, medical co-morbidities, age, or BMI in admitted patients. Stage and primary neoadjuvant chemotherapy were predictive of admission. Conclusions: Unplanned hospital admission rates following initial chemotherapy in our racially diverse patient population are consistent with previously reported rates. Though age and medical co-morbidities did not predict admission, stage and primary neoadjuvant chemotherapy were predictive of subsequent admission. The Oncology Care Model may not account for hospital admission rates of this magnitude and further investigation is needed to identify predictors of hospitalization and poor outcomes. [Table: see text]
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Cuijpers, Anne C. M., Marielle M. E. Coolsen, Ronny M. Schnabel, Susanne van Santen, Steven W. M. Olde Damink, and Marcel C. G. van de Poll. "Preoperative Risk Assessment: A Poor Predictor of Outcome in Critically ill Elderly with Sepsis After Abdominal Surgery." World Journal of Surgery 44, no. 12 (August 30, 2020): 4060–69. http://dx.doi.org/10.1007/s00268-020-05742-5.
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Abstract Background Postoperative outcome prediction in elderly is based on preoperative physical status but its predictive value is uncertain. The goal was to evaluate the value of risk assessment performed perioperatively in predicting outcome in case of admission to an intensive care unit (ICU). Methods A total of 108 postsurgical patients were retrospectively selected from a prospectively recorded database of 144 elderly septic patients (>70 years) admitted to the ICU department after elective or emergency abdominal surgery between 2012 and 2017. Perioperative risk assessment scores including Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality (P-POSSUM) and American Society of Anaesthesiologists Physical Status classification (ASA) were determined. Acute Physiology and Chronic Health Evaluation IV (APACHE IV) was obtained at ICU admission. Results In-hospital mortality was 48.9% in elderly requiring ICU admission after elective surgery (n = 45), compared to 49.2% after emergency surgery (n = 63). APACHE IV significantly predicted in-hospital mortality after complicated elective surgery [area under the curve 0.935 (p < 0.001)] where outpatient ASA physical status and P-POSSUM did not. In contrast, P-POSSUM and APACHE IV significantly predicted in-hospital mortality when based on current physical state in elderly requiring emergency surgery (AUC 0.769 (p = 0.002) and 0.736 (p = 0.006), respectively). Conclusions Perioperative risk assessment reflecting premorbid physical status of elderly loses its value when complications occur requiring unplanned ICU admission. Risks in elderly should be re-assessed based on current clinical condition prior to ICU admission, because outcome prediction is more reliable then.
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Lorenzo-Villalba, Noel, Emmanuel Andres, Javier Guerrero-Niño, Edward Nasco, Jessy Cattelan, Xavier Jannot, and Marie-Pierre Ledoux. "Frostbite and Cold Agglutinin Disease: Coexistence of Two Entities Leading to Poor Clinical Outcomes." Medicina 57, no. 6 (June 8, 2021): 592. http://dx.doi.org/10.3390/medicina57060592.
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An 83-year-old woman was admitted to the emergency department for a 7-day history of fatigue and progressive cyanosis in the feet and hands after cold exposure despite physical protective measures. Upon arrival, the patient presented with necrotic cutaneous lesions in both hands and distal lower extremities. Upon admission, hemoglobin was 7.6 g/dL and laboratory tests were consistent with cold agglutinin disease (CAD), the presence of monoclonal IgM, and flow cytometry consistent with lymphoplasmacytic lymphoma, but MYD88 L265P mutation was negative. The patient required blood transfusion, resulting in stabilized hemoglobin and a decrease in markers of hemolysis. Treatment with aspirin 250 mg daily and intravenous iloprost 0.5 mL/h was initiated with a poor clinical response at day 4. Amputation was required. Plasma exchange was performed and chemotherapy with rituximab and bendamustine was initiated. The clinical course was marked by further necrosis, prompting discussions regarding an additional amputation that was not performed considering the high surgical risk and refusal by the patient. Supportive treatment was initiated, and the patient expired one month after hospital admission.
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Attard, Joseph A., Bilal Al-Sarireh, Ricky Harminder Bhogal, Alexia Farrugia, Giuseppe Fusai, Simon Harper, Camila Hidalgo-Salinas, et al. "Short-term outcomes after pancreatoduodenectomy in octogenarians: multicentre case–control study." British Journal of Surgery 109, no. 1 (November 9, 2021): 89–95. http://dx.doi.org/10.1093/bjs/znab374.
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Abstract Background Pancreatoduodenectomy (PD) is frequently the surgical treatment indicated for a number of pathologies. Elderly patients may be denied surgery because of concerns over poor perioperative outcomes. The aim of this study was to evaluate postoperative clinical outcomes and provide evidence on current UK practice in the elderly population after PD. Methods This was a multicentre retrospective case–control study of octogenarians undergoing PD between January 2008 and December 2017, matched with younger controls from seven specialist centres in the UK. The primary endpoint was 90-day mortality. Secondary endpoints were index admission mortality, postoperative complications, and 30-day readmission rates. Results In total, 235 octogenarians (median age 81 (range 80–90) years) and 235 controls (age 67 (31–79) years) were included in the study. Eastern Cooperative Oncology Group performance status (median 0 (range 0–3) versus 0 (0–2); P = 0.010) and Charlson Co-morbidity Index score (7 (6–11) versus 5 (2–9); P = 0.001) were higher for octogenarians than controls. Postoperative complication and 30-day readmission rates were comparable. The 90-day mortality rate was higher among octogenarians (9 versus 3 per cent; P = 0.030). Index admission mortality rates were comparable (4 versus 2 per cent; P = 0.160), indicating that the difference in mortality was related to deaths after hospital discharge. Despite the higher 90-day mortality rate in the octogenarian population, multivariable Cox regression analysis did not identify age as an independent predictor of postoperative mortality. Conclusion Despite careful patient selection and comparable index admission mortality, 90-day and, particularly, out-of-hospital mortality rates were higher in octogenarians.
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Juvela, Seppo, Jari Siironen, and Johanna Kuhmonen. "Hyperglycemia, excess weight, and history of hypertension as risk factors for poor outcome and cerebral infarction after aneurysmal subarachnoid hemorrhage." Journal of Neurosurgery 102, no. 6 (June 2005): 998–1003. http://dx.doi.org/10.3171/jns.2005.102.6.0998.
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Object. Stress-induced hyperglycemia has been shown to be associated with poor outcome after aneurysmal subarachnoid hemorrhage (SAH). The authors prospectively tested whether hyperglycemia, independent of other factors, affects patient outcomes and the occurrence of cerebral infarction after SAH. Methods. Previous diseases, health habits, medications, clinical condition, and neuroimaging variables were recorded for 175 patients with SAH who were admitted to the hospital within 48 hours after bleeding. The plasma level of glucose was measured at admission and the fasting value of glucose was measured in the morning after aneurysm occlusion. Factors found to be independently predictive of patient outcomes at 3 months after SAH onset and the appearance of cerebral infarction were tested by performing multiple logistic regression. Plasma glucose values at admission were found to be associated with patient age, body mass index (BMI), history of hypertension, clinical condition, amount of subarachnoid or intraventricular blood, shunt-dependent hydrocephalus, outcome variables, and the appearance of cerebral infarction. When considered independently of age, clinical condition, or amount of subarachnoid, intraventricular, or intracerebral blood, the plasma glucose values at admission predicted poor outcome (per millimole/liter the odds ratio [OR] was 1.24 with a 95% confidence interval [CI] of 1.02–1.51). After an adjustment was made for the amount of subarachnoid blood, the clinical condition, and the duration of temporary artery occlusion during surgery, the BMI was found to be a significant predictor (per kilogram/square meter the OR was 1.15 with a 95% CI of 1.02–1.29) for the finding of cerebral infarction on the follow-up computerized tomography scan. Hypertension (OR 3.11, 95% CI 1.11–8.73)—but not plasma glucose (OR 1.06, 95% CI 0.87–1.29)—also predicted the occurrence of infarction when tested instead of the BMI. Conclusions. Independent of the severity of bleeding, hyperglycemia at admission seems to impair outcome, and excess weight and hypertension appear to elevate the risk of cerebral infarction after SAH.
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Patel, Viral Kumar, and Paul Hayden. "Minimising delays in commencing therapeutic hypothermia after out-of-hospital cardiac arrest: the importance of a multi-disciplinary team approach." Acute Medicine Journal 9, no. 1 (January 1, 2010): 35–39. http://dx.doi.org/10.52964/amja.0266.
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Therapeutic hypothermia (TH) is now a well established therapy in resuscitation guidelines. We retrospectively analysed our first 18 months’ data for all patients who underwent TH for out-of-hospital cardiac arrest (OHCA), measuring delays incurred during each patient episode, safety, and ICU outcomes. Sixteen patients received TH for OHCA. A mean delay of 248mins occurred following hospital admission to commencing therapy. Seven patients survived to hospital discharge with a 6 month Glasgow Outcome Score of 4-5 in 100%. A questionnaire evaluating 30 first responders’ familiarity and knowledge of TH demonstrated poor awareness and knowledge, with most viewing it with low priority. TH is a safe and easy to achieve therapy, however in practice there are significant delays in commencing treatment.
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Faghih Dinevari, Masood, Mohammad Hossein Somi, Elham Sadeghi Majd, Afshin Fattahzadeh, and Zeinab Nikniaz. "Elevated Liver Aminotransferases Level and COVID-19 Prognosis in Hospitalized Patients: A Prospective Study from Iran." Middle East Journal of Digestive Diseases 14, no. 1 (January 30, 2022): 64–69. http://dx.doi.org/10.34172/mejdd.2022.257.
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BACKGROUND: Considering the conflicting results and limited studies on the association between elevated liver enzyme levels and COVID-19 outcomes, in the present study, we aimed to investigate the association between hepatic enzyme changes and the prognosis of COVID-19 during hospital admission. METHODS: In this prospective study, 1017 consecutive patients with COVID-19 participated and were followed up from admission until they were discharged or deceased. The liver enzyme levels were recorded on admission. The patient/disease-related information was recorded by trained nurses using questionnaires. The primary endpoint was the association between elevated liver enzymes and liver injury and mortality from COVID. RESULTS: The mean age of the participants was 62.58±17.45 years; 55.4% of them were male. There was no significant difference between groups regarding the COVID-19 outcomes except for the need for ICU admission (P=0.02). Moreover, all COVID-19 outcomes were significantly higher in patients with liver injury compared with other patients except for the quick sequential organ failure assessment (qSOFA) score. After adjusting for covariates, the patients with Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) levels of more than 40 (IU/L) and participants with liver injury on admission had significantly greater odds of death, ICU admission, and mechanical ventilation requirements. CONCLUSION: The results of the present study support the hypothesis that poor outcomes of COVID-19 infection were higher in patients with elevated liver enzyme levels and liver injury. Therefore, liver chemicals should be closely monitored during the illness and hospital admission, and patients with COVID-19 and an elevated level of transaminases should be followed up carefully, and necessary interventions should be considered to prevent poor outcomes.
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Mulwa, Joseph Kithokoo, Drusilla Makworo, and Mwangi Elijah Githinji. "Perinatal outcomes and maternal complications at a county referral hospital in Kenya." African Journal of Midwifery and Women's Health 16, no. 3 (July 2, 2022): 1–9. http://dx.doi.org/10.12968/ajmw.2021.0020.
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Introduction/Aims Maternal complications during pregnancy and labour are a leading cause of global maternal and neonatal mortality. Despite efforts by the Kenyan Government, the mortality rate in the country is now 22 neonatal deaths per 1000 live births. This study's aims were to observe and compare perinatal outcomes of newborns from women with and without maternal complications. Methods This was a prospective hospital-based paired cohort study of 510 pregnant women, 102 of whom presented with complications. Follow up took place up to 28 days after birth, at which point 132 women with complications and 364 women without complications completed the study (some women developed complications after initial recruitment and crossed over to the complications group). Data were gathered on obstetric characteristics and perinatal outcomes using a structured, researcher-administered questionnaire. Differences between the two groups (with and without complications) in terms of obstetric data were compared using Pearson's Chi-squared test. Associations between complications and obstetric characteristics were tested using relative risk. Results Almost all obstetric characteristics showed significant differences between groups, with the exception of a history of poor obstetric outcomes and known contracted pelvis. A mother with complications was more likely to have a newborn with a low Apgar score (relative risk 8.000, P<0.001), low birth weight (relative risk: 1.838, P<0.001), prematurity (relative risk 9.652, P<0.001), admission to the newborn unit (relative risk 8.000, P<0.001), complications after 28 days (relative risk: 2.186, P=0.017) and admission after 28 days (relative risk: 4.892, P=0.006). Mothers with complications were also more likely to have given birth by caesarean section (relative risk: 13.893, P<0.001). Conclusions The newborns born to women who experienced maternal complications were at a higher risk of poor perinatal outcomes compared to those born to women without maternal complications at the Kitui County Referral Hospital. Newborn care should be scaled up to deal with the most difficult cases brought about by maternal complications. Rural facilities should be well equipped to be able to deal with poor outcomes in newborns.
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Kembuan, Mieke Actress Hanna Nelly, Arthur Hendrik Philips Mawuntu, Yohanna Yohanna, Feliana Feliana, and Melke Joanne Tumboimbela. "Lower GCS is Related to Poor Outcome among Acute Stroke Patients with COVID-19 in A Tertiary Referral Hospital in Indonesia." Indonesian Biomedical Journal 13, no. 4 (December 31, 2021): 409–17. http://dx.doi.org/10.18585/inabj.v13i4.1700.
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BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has forced the health workforce to take mitigative measures such as physical distancing, screening, personal protective equipment donning, and confinement on patient care. We aimed to study the outcome of acute stroke patients with suspected, probable, or confirmed COVID-19 in a tertiary referral hospital in Indonesia during the first year of COVID-19 pandemic.METHODS: This was a retrospective study examining all medical records of adult patients suffering from acute stroke with suspected or confirmed COVID-19 who were admitted to R.D. Kandou Hospital, Manado, Indonesia, between March 2020 to March 2021. Clinical and laboratory parameters were compared between subjects with poor and good outcomes based on Glasgow Outcome Scale (GOS), divided into poor outcome (GOS 1-3) and good outcome (GOS 4-5).RESULTS: Fourty-six eligible subjects were enrolled in the study. Based on the GOS, 36 subjects (78.3%) were admitted to the hospital with poor prognosis. On admission, the median Glasgow Coma Scale (GCS) was 11, breathlessness was found in 54.3% of subjects, fever was found in only 15 subjects (32.6%), and the lowest oxygen saturation on admission 95%. We found that GCS significantly related to outcome after controlled for other factors using the logistic regression method (p=0.03; 95% CI=1.08-4.78).CONCLUSION: Lower GCS can be used to predict poor outcome in acute stroke patients with COVID-19.KEYWORDS: COVID-19, acute stroke, Glasgow Coma Scale, outcome, Indonesia
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Qanitha, Andriany, Cuno S. P. M. Uiterwaal, Jose P. S. Henriques, Idar Mappangara, Irfan Idris, Muzakkir Amir, and Bastianus A. J. M. de Mol. "Predictors of medium-term mortality in patients hospitalised with coronary artery disease in a resource-limited South-East Asian setting." Open Heart 5, no. 2 (July 2018): e000801. http://dx.doi.org/10.1136/openhrt-2018-000801.
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ObjectiveTo measure medium-term outcomes and determine the predictors of mortality in patients with coronary artery disease (CAD) both during and after hospitalisation in a resource-limited South-East Asian setting.MethodsFrom February 2013 to December 2014, we conducted a prospective observational cohort study of 477 patients admitted to Makassar Cardiac Center, Indonesia, with acute coronary syndrome and stable CAD. We actively obtained data on clinical outcomes and after-discharge management until April 2017. Multivariable Cox proportional hazard analysis was performed to examine predictors for our primary outcome, all-cause mortality.ResultsFrom hospital admission, patients were followed over a median of 18 (IQR 6–36) months; in total 154 (32.3%) patients died. More patients with acute myocardial infarction died in the hospital compared with patients with unstable and stable angina (p=0.002). Over the total follow-up, there was a difference in mortality between non-ST-segment elevation myocardial infarction (n=41, 48.2%), ST-segment elevation myocardial infarction (n=65, 30.8%), unstable angina (n=18, 26.5%) and stable coronary artery disease (n=30, 26.5%) groups (p=0.007). The independent predictors of all-cause mortality were hyperglycaemia on admission (HR 1.55 (95% CI 1.12 to 2.14), p=0.008), heart failure/Killip class ≥2 (HR 2.50 (95% CI 1.76 to 3.56), p<0.001), estimated glomerular filtration rate <60 mL/min (HR 1.77 (95% CI 1.26 to 2.50), p=0.001), no revascularisation (percutaneous coronary intervention/coronary artery bypass grafting) (HR 2.38 (95% CI 1.31 to 4.33), p=0.005) and poor adherence to after-discharge medications (HR 10.28 (95% CI 5.52 to 19.16), p<0.001). Poor medication adherence predicted postdischarge mortality and did so irrespective of underlying CAD diagnosis (p interaction=0.88).ConclusionsPatients with CAD in a poor South-East Asian setting experience high in-hospital and medium-term mortality. The initial severity of the disease, lack of access to guidelines-recommended therapy and poor adherence to after-discharge medications are the main drivers for excess mortality. Improved access to early and late hospital care and patient education should be prioritised for better survival.
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Shaw, Pamela A., Jasper B. Yang, Danielle L. Mowery, Emily R. Schriver, Kevin B. Mahoney, Katharine J. Bar, and Susan S. Ellenberg. "Determinants of hospital outcomes for patients with COVID-19 in the University of Pennsylvania Health System." PLOS ONE 17, no. 5 (May 19, 2022): e0268528. http://dx.doi.org/10.1371/journal.pone.0268528.
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There is growing evidence that racial and ethnic minorities bear a disproportionate burden from COVID-19. Temporal changes in the pandemic epidemiology and diversity in the clinical course require careful study to identify determinants of poor outcomes. We analyzed 6255 hospitalized individuals with PCR-confirmed SARS-CoV-2 infection from one of 5 hospitals in the University of Pennsylvania Health System between March 2020 and March 2021, using electronic health records to assess risk factors and outcomes through 8 weeks post-admission. Discharge, readmission and mortality outcomes were analyzed in a multi-state model with multivariable Cox models for each transition. Mortality varied markedly over time, with cumulative incidence (95% CI) 30 days post-admission of 19.1% (16.9, 21.3) in March-April 2020, 5.7% (4.2, 7.5) in July-October 2020 and 10.5% (9.1,12.0) in January-March 2021; 26% of deaths occurred after discharge. Average age (SD) at admission varied from 62.7 (17.6) to 54.8 (19.9) to 60.5 (18.1); mechanical ventilation use declined from 21.3% to 9–11%. Compared to Caucasian, Black race was associated with more severe disease at admission, higher rates of co-morbidities and residing in a low-income zip code. Between-race risk differences in mortality risk diminished in multivariable models; while admitting hospital, increasing age, admission early in the pandemic, and severe disease and low blood pressure at admission were associated with increased mortality hazard. Hispanic ethnicity was associated with fewer baseline co-morbidities and lower mortality hazard (0.57, 95% CI: 0.37, .087). Multi-state modeling allows for a unified framework to analyze multiple outcomes throughout the disease course. Morbidity and mortality for hospitalized COVID-19 patients varied over time but post-discharge mortality remained non-trivial. Black race was associated with more risk factors for morbidity and with treatment at hospitals with lower mortality. Multivariable models suggest there are not between-race differences in outcomes. Future work is needed to better understand the identified between-hospital differences in mortality.
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Wood, Erika L., Janet E. Baack Kukreja, Sima P. Porten, Raphael Ezeagu, Wei Qiao, Neema Navai, Ashish M. Kamat, Colin P. N. Dinney, and Jay Bakul Shah. "Measuring success after radical cystectomy: Feasibility of a novel composite endpoint ("poor recovery") to quantify outcomes after surgery." Journal of Clinical Oncology 33, no. 7_suppl (March 1, 2015): 357. http://dx.doi.org/10.1200/jco.2015.33.7_suppl.357.
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357 Background: Given the predilection of invasive bladder cancer toward older sicker patients and the complexity of radical cystectomy (RC), it is not surprising many patients experience prolonged, difficult recoveries. There is growing interest in identifying ways to improve recovery after RC. To date, studies have focused on inpatient length of stay (LOS) as the primary measure of recovery improvement efforts. Given that many patients suffer complications after discharge and require hospital readmission, inpatient LOS may not be the most useful measure. We propose a novel endpoint – “Poor Recovery” – as a more encompassing measure of outcomes after RC. Methods: A comprehensive perioperative multidisciplinary algorithm known as the Optimized Surgical Journey (OSJ) has been in development at our institution over the last 18 months. We selected 50 patients who underwent RC with the OSJ algorithm and 50 patients who underwent RC with usual care during the same time period. Poor Recovery was defined by inpatient LOS > 7 days or hospital readmission within 30 days. Statistical analyses included Wilcoxon rank-sum test for continuous variables and Fisher’s exact test for categorical variables. Results: Patients in the OSJ group had significantly shorter times to first flatus, bowel movement, ambulation, and resumption of regular diet (Table). There were no differences between the groups in operative time, blood loss, opioid use, or rate of ICU admission. Mean LOS was significantly shorter in the OSJ group (5.6 and 8.5 days, p<0.01). Poor Recovery was experienced by 18% of the patients in the OSJ group and 70% of the patients in the non-OSJ group (p<0.01). Conclusions: We define a novel composite endpoint, Poor Recovery, that can help measure outcomes after RC. For future prospective studies of accelerated recovery pathways, the poor recovery endpoint may be a useful metric by which to determine the efficacy of various interventions. [Table: see text]
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Ogunfowora, O. B., and T. A. Ogunlesi. "Socio-clinical correlates of the perinatal outcome of severe perinatal asphyxia among referred newborn babies in Sagamu." Nigerian Journal of Paediatrics 47, no. 2 (August 6, 2020): 110–18. http://dx.doi.org/10.4314/njp.v47i2.10.
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Background: Most deliveries in the developing world take place outside the hospital with poor assistance for the newborn. This puts the babies at risk of severe intrapartum events such as perinatal asphyxia. Most newborn babies admitted in tertiary centres with severe asphyxia are referred.Objectives: To determine the socio-demographic and clinical correlates of the perinatal outcome of neonates referred to a Nigerian tertiary facility on account of severe perinatal asphyxia.Methods: A prospective crosssectional study was conducted at the Children’s Emergency Room and Neonatal Ward among newborn babies referred with severe asphyxia. Socio-demographic and clinical parameters were recorded and statistically analysed.Results: A total of 72 mother infant pairs were studied. Half of the babies were admitted after 24 hours of birth and 75.0% of the families belonged to the lower socio-economic classes. Only 62.5% of mothers received antenatal care at orthodox health facilities. Most of the deliveries tookplace at private hospitals (29; 40.3%) and Traditional Birth Homes (18; 25.0%). Hypoxic- Ischaemic encephalopathy (HIE) was diagnosed among 57 (79.2%) babies with 46 (80.7%) and 11 (19.3%) classified as Stages II and III HIE respectively. There were 15 (20.8%) early neonatal deaths giving a perinatal mortality rate of 208.3/1000 admissions. The poor perinatal outcome was associated with age at admission within 24 hours, poor intrapartum careseeking behaviour and the commencement of feeding before admission .Conclusion: The quality of antenatal care, intrapartum care, and delivery services appear to influence perinatal outcomes among referred babies with severe asphyxia.
Keywords: Asphyxia, Hypoxic-Ischaemic Encephalopathy, Intrapartum care, Perinatal mortality, Out-born
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Kim, Tae Jung, Soo-Hyun Park, Hae-Bong Jeong, Eun Jin Ha, Won Sang Cho, Hyun-Seung Kang, Jeong Eun Kim, and Sang-Bae Ko. "Optimizing Nitrogen Balance Is Associated with Better Outcomes in Neurocritically Ill Patients." Nutrients 12, no. 10 (October 14, 2020): 3137. http://dx.doi.org/10.3390/nu12103137.
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Marked protein catabolism is common in critically ill patients. We hypothesized that optimal protein supplementation using nitrogen balance might be associated with better outcomes in the neurointensive care unit (NICU) patients. A total of 175 patients admitted to the NICU between July 2017 and December 2018 were included. Nitrogen balance was measured after NICU admission and measurements were repeated in 77 patients. The outcomes were compared according to initial nitrogen balance results and improvement of nitrogen balance on follow-up measurements. A total of 140 (80.0%) patients had a negative nitrogen balance on initial assessments. The negative balance group had more events of in-hospital mortality and poor functional outcome at three months. In follow-up measurement patients, 39 (50.6%) showed an improvement in nitrogen balance. The improvement group had fewer events of in-hospital mortality (p = 0.047) and poor functional outcomes (p = 0.046). Moreover, improvement of nitrogen balance was associated with a lower risk of poor functional outcomes (Odds ratio, 0.247; 95% confidence interval, 0.066–0.925, p = 0.038). This study demonstrated that a significant proportion of patients in the NICU were under protein hypercatabolism. Moreover, an improvement in protein balance was related to improved outcomes in neurocritically ill patients. Further studies are needed to confirm the relationship between protein balance and outcomes.
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Tanderup, Anette, Annmarie Touborg Lassen, Jens-Ulrik Rosholm, and Jesper Ryg. "Disability and morbidity among older patients in the emergency department: a Danish population-based cohort study." BMJ Open 8, no. 12 (December 2018): e023803. http://dx.doi.org/10.1136/bmjopen-2018-023803.
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ObjectivesThe objective was to describe the prevalence of geriatric conditions among older medical patients in the emergency department (ED) and the association with admission, mortality, reattendance and loss of independency.DesignPopulation-based prospective cohort study.SettingED of a large university hospital.ParticipantsAll medical patients ≥65 years of age from a single municipality with a first attendance to the ED during a 1-year period (November 2013 to November 2014).Primary and secondary outcome measuresBased on information from healthcare registers, we defined geriatric conditions as disability, recently increased disability, polypharmacy and comorbidity. Outcomes were admission, length of admission, 30 days postdischarge mortality, 30 days hospital reattendance and home care dependency 0–360 days following ED contact.ResultsTotally, 3775 patients (55% women) were included, age 78 (71–85) years (median (IQR)). No patients were lost to follow-up. The prevalence of 0–4 geriatric conditions was 14.9%, 27.3%, 25.2%, 22.3% and 10.3%, respectively. The number of conditions was significantly associated with hospital admission, length of admission, 30 days postdischarge mortality and 30 days hospital reattendance. Among patients with no geriatric conditions, 70% lived independent all 360 days after discharge, whereas all patients with ≥3 conditions had some dependency or were dead within 360 days following discharge.ConclusionAmong older medical patients in the ED, 50% had two or more geriatric conditions which were associated with poor health outcomes. This highlights the need for studies of the effect of geriatric awareness and competences in the ED.
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Beitland, Sigrid, Espen Rostrup Nakstad, Jens Petter Berg, Anne-Marie Siebke Trøseid, Berit Sletbakk Brusletto, Cathrine Brunborg, Christofer Lundqvist, and Kjetil Sunde. "Urine β-2-Microglobulin, Osteopontin, and Trefoil Factor 3 May Early Predict Acute Kidney Injury and Outcome after Cardiac Arrest." Critical Care Research and Practice 2019 (May 7, 2019): 1–9. http://dx.doi.org/10.1155/2019/4384796.
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Purpose. Acute kidney injury (AKI) is a common complication after out-of-hospital cardiac arrest (OHCA), leading to increased mortality and challenging prognostication. Our aim was to examine if urine biomarkers could early predict postarrest AKI and patient outcome. Methods. A prospective observational study of resuscitated, comatose OHCA patients admitted to Oslo University Hospital in Norway. Urine samples were collected at admission and day three postarrest and analysed for β-2-microglobulin (β2M), osteopontin, and trefoil factor 3 (TFF3). Outcome variables were AKI within three days according to the Kidney Disease Improving Global Outcome criteria, in addition to six-month mortality and poor neurological outcome (PNO) (cerebral performance category 3–5). Results. Among 195 included patients (85% males, mean age 60 years), 88 (45%) developed AKI, 88 (45%) died, and 96 (49%) had PNO. In univariate analyses, increased urine β2M, osteopontin, and TFF3 levels sampled at admission and day three were independent risk factors for AKI, mortality, and PNO. Exceptions were that β2M measured at day three did not predict any of the outcomes, and TFF3 at admission did not predict AKI. In multivariate analyses, combining clinical parameters and biomarker levels, the area under the receiver operating characteristics curves (95% CI) were 0.729 (0.658–0.800), 0.797 (0.733–0.861), and 0.812 (CI 0.750–0.874) for AKI, mortality, and PNO, respectively. Conclusions. Urine levels of β2M, osteopontin, and TFF3 at admission and day three were associated with increased risk for AKI, mortality, and PNO in comatose OHCA patients. This trail is registered with NCT01239420.
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Yuan, Jane Y., Yasheng Chen, Atul Kumar, Zach Zlepper, Keshav Jayaraman, Wint Y. Aung, Julian V. Clarke, et al. "Automated Quantification of Reduced Sulcal Volume Identifies Early Brain Injury After Aneurysmal Subarachnoid Hemorrhage." Stroke 52, no. 4 (April 2021): 1380–89. http://dx.doi.org/10.1161/strokeaha.120.032001.
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Background and Purpose: Early brain injury may be a more significant contributor to poor outcome after aneurysmal subarachnoid hemorrhage (aSAH) than vasospasm and delayed cerebral ischemia. However, studying this process has been hampered by lack of a means of quantifying the spectrum of injury. Global cerebral edema (GCE) is the most widely accepted manifestation of early brain injury but is currently assessed only through subjective, qualitative or semi-quantitative means. Selective sulcal volume (SSV), the CSF volume above the lateral ventricles, has been proposed as a quantitative biomarker of GCE, but is time-consuming to measure manually. Here we implement an automated algorithm to extract SSV and evaluate the age-dependent relationship of reduced SSV on early outcomes after aSAH. Methods: We selected all adults with aSAH admitted to a single institution with imaging within 72 hours of ictus. Scans were assessed for qualitative presence of GCE. SSV was automatically segmented from serial CTs using a deep learning-based approach. Early SSV was the lowest SSV from all early scans. Modified Rankin Scale score of 4 to 6 at hospital discharge was classified as a poor outcome. Results: Two hundred forty-four patients with aSAH were included. Sixty-five (27%) had GCE on admission while 24 developed it subsequently within 72 hours. Median SSV on admission was 10.7 mL but frequently decreased, with minimum early SSV being 3.0 mL (interquartile range, 0.3–11.9). Early SSV below 5 mL was highly predictive of qualitative GCE (area under receiver-operating-characteristic curve, 0.90). Reduced early SSV was an independent predictor of poor outcome, with a stronger effect in younger patients. Conclusions: Automated assessment of SSV provides an objective biomarker of GCE that can be leveraged to quantify early brain injury and dissect its impact on outcomes after aSAH. Such quantitative analysis suggests that GCE may be more impactful to younger patients with SAH.
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Xu, Xiao-yan, Wen-yu Li, and Xing-yue Hu. "Alteration of Thyroid-Related Hormones within Normal Ranges and Early Functional Outcomes in Patients with Acute Ischemic Stroke." International Journal of Endocrinology 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/3470490.
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This study evaluated the prognostic value of thyroid-related hormones within normal ranges after acute ischemic stroke. This was a retrospective study and we reviewed 1072 ischemic stroke patients consecutively admitted within 72 h after symptom onset. Total triiodothyronine (T3), total thyroxine (T4), free T3, free T4, and thyroid-stimulating hormone (TSH) were assessed to determine their values for predicting functional outcome at the first follow-up clinic visits, which usually occurred 2 to 4 weeks after discharge from the hospital. 722 patients were finally included. On univariate analysis, poor functional outcome was associated with presence of atrial fibrillation as the index event. Furthermore, score of National Institutes of Health Stroke Scale (NIHSS), total T4, free T4, and C-reactive protein at admission were significantly higher in patients with poor functional outcome, whereas free T3 and total T3 were significantly lower. On multiple logistic regression analysis, lower total T3 concentrations remained independently associated with poor functional outcome [odds ratio (OR), 0.10; 95% confidence interval (CI), 0.01–0.84;P=0.035]. The only other variables independently associated with poor functional outcome were NIHSS scores. In sum, lower total T3 concentrations that were within the normal ranges were independently associated with poor short-term outcomes.
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Ynga-Durand, Mario, Henrike Maaß, Marko Milošević, Fran Krstanović, Marina Pribanić Matešić, Stipan Jonjić, Alen Protić, Ilija Brizić, Alan Šustić, and Luka Čičin-Šain. "SARS-CoV-2 Viral Load in the Pulmonary Compartment of Critically Ill COVID-19 Patients Correlates with Viral Serum Load and Fatal Outcomes." Viruses 14, no. 6 (June 14, 2022): 1292. http://dx.doi.org/10.3390/v14061292.
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While SARS-CoV-2 detection in sputum and swabs from the upper respiratory tract has been used as a diagnostic tool, virus quantification showed poor correlation to disease outcome and thus, poor prognostic value. Although the pulmonary compartment represents a relevant site for viral load analysis, limited data exploring the lower respiratory tract is available, and its association to clinical outcomes is relatively unknown. Using bronchoalveolar lavage (BAL) and serum samples, we quantified SARS-CoV-2 copy numbers in the pulmonary and systemic compartments of critically ill patients admitted to the intensive care unit of a COVID-19 referral hospital in Croatia during the second and third pandemic waves. Clinical data, including 30-day survival after ICU admission, were included. We found that elevated SARS-CoV-2 copy numbers in both BAL and serum samples were associated with fatal outcomes. Remarkably, the highest and earliest viral loads after initiation of mechanical ventilation support were increased in the non-survival group. Our results imply that viral loads in the lungs contribute to COVID-19 disease severity, while blood titers correlate with lung virus titers, albeit at a lower level. Moreover, they suggest that BAL SARS-CoV-2 copy number quantification at ICU admission may provide a predictive parameter of clinical COVID-19 outcomes.
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Leichtle, Stefan W., Audrey Pendleton, Sarah Wang, Beth Torres, Rachel Collins, and Michel B. Aboutanos. "Triage of Patients With Rib Fractures." American Surgeon 86, no. 9 (July 29, 2020): 1194–99. http://dx.doi.org/10.1177/0003134820939907.
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Background Most triage guidelines for blunt chest wall trauma focus on advanced age and multiple fractured ribs to indicate a high-risk patient population that should be admitted to an intensive care unit (ICU). Overly sensitive ICU admission criteria, however, may result in overutilization of resources. We revised our rib fracture triage guideline to de-emphasize age and number of rib fractures, hypothesizing that we could lower ICU admission rates without compromising outcomes. Methods Patients admitted to our level 1 trauma center over 9 months after the institution of the revised guideline (N = 248) were compared with those admitted over 6 months following the original guideline (N = 207) using Fisher’s exact and Wilcoxon-Mann-Whitney tests, as appropriate. Univariate followed by multivariate analyses were performed to determine risk factors for complications. Results The ICU admission rate significantly decreased from 73% to 63% ( P = .02) after the institution of the revised guideline, despite an increase in the patient’s age and injury acuity of the cohort. There was no significant difference in respiratory complications, unplanned ICU admission rates, and overall mortality. Poor incentive spirometer effort (750 mL or less) and dyspnea in the trauma bay were the strongest predictors of an adverse composite outcome and prolonged hospital length of stay. Discussion A revised rib fracture triage guideline with less emphasis on the patient’s age and the number of fractured ribs safely lowered ICU admission rates. Poor functional status rather than age and anatomy was the strongest predictor of complications and prolonged hospital stay.
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Cox, Narelle S., Aroub Lahham, Christine F. McDonald, Ajay Mahal, Paul O'Halloran, Graham Hepworth, Lissa Spencer, et al. "Home-based pulmonary rehabilitation early after hospitalisation in COPD (early HomeBase): protocol for a randomised controlled trial." BMJ Open Respiratory Research 8, no. 1 (November 2021): e001107. http://dx.doi.org/10.1136/bmjresp-2021-001107.
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IntroductionChronic obstructive pulmonary disease (COPD) is characterised by exacerbations of respiratory disease, frequently requiring hospital admission. Pulmonary rehabilitation can reduce the likelihood of future hospitalisation, but programme uptake is poor. This study aims to compare hospital readmission rates, clinical outcomes and costs between people with COPD who undertake a home-based programme of pulmonary rehabilitation commenced early (within 2 weeks) of hospital discharge with usual care.MethodsA multisite randomised controlled trial, powered for superiority, will be conducted in Australia. Eligible patients admitted to one of the participating sites for an exacerbation of COPD will be invited to participate. Participants will be randomised 1:1. Intervention group participants will undertake an 8-week programme of home-based pulmonary rehabilitation commencing within 2 weeks of hospital discharge. Control group participants will receive usual care and a weekly phone call for attention control. Outcomes will be measured by a blinded assessor at baseline, after the intervention (week 9–10 posthospital discharge), and at 12 months follow-up. The primary outcome is hospital readmission at 12 months follow-up.Ethics and disseminationHuman Research Ethics approval for all sites provided by Alfred Health (Project 51216). Findings will be published in peer-reviewed journals, conferences and lay publications.Trial registration numberACTRN12619001122145.
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Ou, Zilin, Yicong Chen, Jianle Li, Fubing Ouyang, Gang Liu, Shuangquan Tan, Weixian Huang, et al. "Glucose-6-phosphate dehydrogenase deficiency and stroke outcomes." Neurology 95, no. 11 (July 10, 2020): e1471-e1478. http://dx.doi.org/10.1212/wnl.0000000000010245.
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ObjectiveTo assess the risk of glucose-6-phosphate dehydrogenase (G6PD) on stroke prognosis, we compared outcomes between patients with stroke with and without G6PD deficiency.MethodsThe study recruited 1,251 patients with acute ischemic stroke. Patients were individually categorized into G6PD-deficiency and non-G6PD-deficiency groups according to G6PD activity upon admission. The primary endpoint was poor outcome at 3 months defined by a modified Rankin Scale (mRS) score ≥2 (including disability and death). Secondary outcomes included the overall mRS score at 3 months and in-hospital death and all death within 3 months. Logistic regression and Cox models, adjusted for potential confounders, were fitted to estimate the association of G6PD deficiency with the outcomes.ResultsAmong 1,251 patients, 150 (12.0%) were G6PD-deficient. Patients with G6PD deficiency had higher proportions of large-artery atherosclerosis (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.09–2.17) and stroke history (OR 1.93, 95% CI 1.26–2.90) compared to the non-G6PD-deficient group. The 2 groups differed significantly in the overall mRS score distribution (adjusted common OR 1.57, 95% CI 1.14–2.17). Patients with G6PD deficiency had higher rates of poor outcome at 3 months (adjusted OR 1.73, 95% CI 1.08–2.76; adjusted absolute risk increase 13.0%, 95% CI 2.4%–23.6%). The hazard ratio of in-hospital death for patients with G6PD-deficiency was 1.46 (95% CI 1.37–1.84).ConclusionsG6PD deficiency is associated with the risk of poor outcome at 3 months after ischemic stroke and may increase the risk of in-hospital death. These findings suggest the rationality of G6PD screening in patients with stroke.
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Rass, Verena, Bogdan-Andrei Ianosi, Andreas Wegmann, Max Gaasch, Alois J. Schiefecker, Mario Kofler, Anna Lindner, et al. "Delayed Resolution of Cerebral Edema Is Associated With Poor Outcome After Nontraumatic Subarachnoid Hemorrhage." Stroke 50, no. 4 (April 2019): 828–36. http://dx.doi.org/10.1161/strokeaha.118.024283.
Full textAbstract:
Background and Purpose— Global cerebral edema occurs in up to 57% of patients with subarachnoid hemorrhage (SAH) and is associated with prolonged hospital stay and poor outcome. Recently, admission brain edema was successfully graded using a simplified computed tomography-based semiquantitative score (subarachnoid hemorrhage early brain edema score [SEBES]). Longitudinal evaluation of the SEBES grade may discriminate patients with rapid and delayed edema resolution after SAH. Here, we aimed to describe the resolution of brain edema and to study the relationship between this radiographic biomarker and hospital course and outcome after SAH. Methods— For the current observational cohort study, computed tomography scans of 283 consecutive nontraumatic SAH patients admitted to the neurological intensive care unit of a tertiary hospital were graded based on the absence of visible sulci at 2 predefined brain tissue levels in each hemisphere (SEBES ranging from 0 to 4). A score of ≥3 was defined as high-grade SEBES. Multivariable regression models using generalized linear models were used to identify associated factors with delayed edema resolution based on the median time to resolution (SEBES ≤2) in SAH survivors. Results— Patients were 57 years old (interquartile range, 48–68) and presented with a median admission Hunt and Hess grade of 3 (interquartile range, 1–5). High-grade SEBES was common (106/283, 37%) and resolved within a median of 8 days (interquartile range, 4–15) in survivors (N=80). Factors associated with delayed edema resolution were early (<72 hours) hypernatremia (>150 mmol/L; adjusted odds ratio [adjOR], 4.88; 95% CI, 1.68–14.18), leukocytosis (>15 G/L; adjOR, 3.14; 95% CI, 1.24–8.77), hyperchloremia (>121 mmol/L; adjOR, 5.24; 95% CI, 1.64–16.76), and female sex (adjOR, 3.71; 95% CI, 1.01–13.64) after adjusting for admission Hunt and Hess grade and age. Delayed brain edema resolution was an independent predictor of worse functional 3-month outcome (adjOR, 2.52; 95% CI, 1.07–5.92). Conclusions— Our data suggest that repeated quantification of the SEBES can identify SAH patients with delayed edema resolution. Based on its’ prognostic value as radiographic biomarker, the SEBES may be integrated in future trials aiming to improve edema resolution after SAH.