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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Role of Redcell Distribution Weight in Predicting Disease Severity, Mortality and Complication in Patients With Acute Pancreatitis

Abstract

The goal of the present study was to investigate the significance of the Red Cell Distribution Width (RDW) in identifying the severity, mortality and complications of the disease at an early stage in patients with acute pancreatitis (AP).

343 patients with AP presented to the emergency department during one year were included in this retrospective study. Demographic, laboratory and imaging results were recorded. Bedside Index for Severity in AP (BISAP) score was calculated. The patients who developed pancreatitis-related mortality were recorded.

The diagnostic powers of RDW values in the diagnosis of BISAP Score (≥3), exitus, severe pancreatitis and pancreatitis with complication were analysed by means of Receiver Operating Characteristic Curve (ROC) analysis. p<0,05 was considered statistically significant.

The mean age of the subjects was 59,7 ± 18,0 years. Area under curve (AUC) in ROC analysis conducted for RDW in patients with BISAP score≥ 3 was 0,649 (95% Cl 0,576-0,722) and p <0,001. For developed complications, AUC for RDW was 0,558 (95% Cl 0,454-0,662) and p was 0,243. For RDW<14,4 cut-off value; the sensitivity was 66,25%, specificity was 71,48% in the prediction of BISAP≥ 3, sensitivity was 87,5%, specificity was 65,14% in the prediction of mortality, sensitivity was 72,73%, specificity was 71,12% in the prediction of severe AP.

RDW is as significant as the BISAP score in predicting the severity and mortality of pancreatitis in the patients with acute pancreatitis in the emergency department(ED). But it cannot predict the complications in AP.

Keywords: Emergency, acute pancreatitis, mortality, severity, complications, redcell distribution weight.

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Ketamine use for endotracheal intubation in severe sepsis and septic shock

Abstract

Objective. We conducted this study to evaluate the clinical outcomes of patients with severe sepsis and septic shock who were treated with ketamine for endotracheal intubation.

Methods. A single-center, retrospective study was carried out to compare the outcomes of patients with severe sepsis and septic shock who received a ketamine or non-ketamine agent for rapid sequence intubation (RSI). We analyzed the sepsis registry for adult patients who presented to the emergency department (ED), met the criteria for severe sepsis or septic shock, and underwent endotracheal intubation between August 2008 and March 2014. The primary outcome was 28-day mortality. We performed a multivariable logistic regression analysis to assess the association between ketamine use for intubation and 28-day mortality.

Results. In all, 170 patients were intubated during the study period. Of the eligible patients, 95 received ketamine and 75 received a non-ketamine agent. The 28-day mortality of the ketamine group was not significantly different from that of the non-ketamine group (38% vs. 40%, respectively, P=0.78). The unadjusted odds ratio (OR) of ketamine use for 28-day mortality was 0.92 (95% CI: 0.49–1.70, P=0.78). The association remained insignificant after adjusting for age, gender, malignancy, initial lactate level on ED admission, time to first antibiotic administration, Acute Physiology and Chronic Health Evaluation II score on admission day, and propensity score regarding ketamine use (adjusted OR: 1.09; 95% confidence interval [CI]: 0.49–2.40; P=0.84). Initial serum lactate on ED admission was the only significant predictive factor of 28-day mortality (adjusted OR: 1.23; 95% CI: 1.10–1.38; P<0.01).

Conclusions. For patients with severe sepsis and septic shock who were intubated using RSI, we found no significant difference in 28-day mortality between those who received ketamine as a sedative agent and those who received alternative sedatives.

Key words: sepsis, ketamine, intubation, mortality

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Clinical characteristics and mortality of patients in the intensive care unit with and without new-onset arrhythmias

Abstract

Objective. The aims of this study were to analyze the risk factors for and types of new-onset arrhythmias in ICU (Intensive care unit), and to evaluate their impact on patient outcomes.

Methods. We studied 1051 patients who were admitted to the two general ICUs between December 2013 and February 2016. These patients were divided into two groups: patients with new-onset arrhythmias and patients without new-onset arrhythmias. We compared the risk factors, types and prognoses of new-onset arrhythmias between these two groups.

Results. New-onset arrhythmias were observed in 20.84% (n=219) of 1051 patients. The main risk factors leading to arrhythmias included age, emergency operation, past cardiovascular disease, patients with multiple systemic diseases, acute respiratory distress syndrome, severe sepsis/septic shock, acute renal dysfunction, cardiovascular disease, electrolyte disturbance, patients on ventilators, patients on vasopressors and higher Acute Physiology and Chronic Health Evaluation II scores (APACHE II score) on ICU admission. Multivariate logistic regression revealed that age, emergency operation, severe sepsis/septic shock, cardiovascular disease, electrolyte disturbance, patients on ventilators and those with higher APACHE II scores on ICU admission, were all significantly associated with new-onset arrhythmias. Arial fibrillation was the most frequent arrhythmia. ICU mortality in patients with new-onset arrhythmias was 22.37% (49 out of 219) compared with 3.61% (30 out of 832) in patients without new-onset arrhythmias (p<0.001). Among surviving patients, ICU stay for those with new-onset arrhythmias was longer than those without new-onset arrhythmias (median stay of 10 days versus 5 days, p<0.001).

Conclusion. We found a high prevalence of new-onset arrhythmias in ICU patients. Arrhythmia, especially atrial fibrillation, was a common complication in ICU patients and was associated with increasing length of ICU stay and higher mortality.

Key words: arrhythmia, intensive care unit, critical illness, mortality

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CRIB II score versus gestational age and birth weight in preterm infant mortality prediction: who will win the bet?

Abstract

Introduction. In neonatology, various illness severity scores have been developed to predict mortality and morbidity risk in neonates. The aim of our study was to validate the ability of the ‘Clinical Risk Index for Babies’ (CRIB) II score to predict mortality in neonates born before 32 weeks’ gestation in a level 3 neonatal intensive care unit (NICU), setting.

Materials and Methods. Prospective birth cohort study including all live-born neonates of 32 weeks’ gestation or less. . CRIB II score was calculated and the predicted mortality was compared with the observed mortality. Discrimination (the ability of the score to correctly predict survival or death) was assessed by calculating the receiver operating characteristic curve (ROC curve) and its associated area under the curve (AUC).

Results. The ROC curve analysis in our study showed that the AUC was 0.9008 suggesting that mortality prediction was 90% accurate for all infants. Sensitivity and specificity were 77% and 88% respectively. In our study population, the CRIB II score appears to be more accurate than gestational age and birth weight in predicting mortality.

Conclusions. The CRIB II scoring system is a useful tool for predicting mortality and morbidity in NICUs, and also a useful tool for evaluating the variations in mortality and other outcomes seen between different NICUs.

Key words: CRIB, CRIB II, mortality, neonates, outcome, prematurity, scoring system

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Methicillin-Resistant Staphylococcus Species in a cardiac surgical intensive care unit

Abstract

Objective. Multi-drug resistant bacterial infections, in particular when Methicillin-Resistant Staphylococcus Aureus (MRSA) is involved, have become a relevant problem in both general and specialized intensive care units. The aim of this study was to identify the epidemiology of MRSA infections in a Cardiac Surgical Intensive Care Unit, to assess their impact on mortality and to identify predictors of MRSA infection and mortality in this population.

Design and settings. A 7-year observational study in a cardiac surgery teaching center.

Participants. Eight thousand, one hundred and sixty-two microbiological samples were obtained from 7,313 patients who underwent cardiac surgery in the study period.

Interventions. None.

Variables of interest and main results. Twenty-eight patients (0.38%) had MRSA infection. The most frequent site of MRSA isolation was from bronchoalveolar samples. Hospital mortality was 50% in patients with MRSA infection and 2% in patients without MRSA infection (p<0.001).

Few preoperative independent predictors of MRSA infection and hospital mortality were found at multivariate analysis. Outcomes were found to be most influenced by perioperative variables. MRSA infection was the strongest predictor of mortality, with an odds ratio of 20.5 (95% CI 4.143-101.626).

Conclusions. Methicillin-resistant Staphylococcus aureus infections following cardiac surgery still have a strong impact on the patients’ outcome. More efforts should be directed toward the development of new risk analysis models that might implement health care practices and might become precious instruments for infection prevention and control.

Key words: Methicillin-Resistant Staphylococcus Aureus, infections, cardiac surgery, mortality, intensive care, cardiac anaesthesia

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