58 research outputs found
Elevated Cardiac Troponin Levels as a Predictor of Increased Mortality Risk in Non-Cardiac Critically Ill Patients Admitted to a Medical Intensive Care Unit
No full textBackground: Cardiac troponin I (TnI) is a specific marker of myocardial damage used in the diagnosis of acute coronary syndrome (ACS). TnI levels can also be elevated in patients without ACS, which is linked to a worse prognosis and mortality. We evaluated the clinical implications and prognostic significance of serum TnI levels in critically ill non-cardiac patients admitted to the intensive care unit (ICU) at a tertiary-level hospital. Materials and Methods: A three-year retrospective study including the years 2017–2020 was conducted to evaluate in-hospital mortality during ICU stay and mortality rates at 28 and 90 days, as well as one and two years after admission, in 557 patients admitted to the medical ICU for non-cardiac causes. Results: TnI levels were elevated in 206 (36.9%) patients. Patients with elevated TnI levels were significantly older and had higher rates of comorbidities, including chronic heart failure, coronary heart disease, and chronic kidney disease (p < 0.05 for all). Patients with elevated TnI levels required more invasive mechanical ventilation, vasopressor infusion, and dialysis in the ICU and experienced more shock within the first 72 h (p = 0.001 for all). High TnI levels were associated with higher Acute Physiological and Chronic Health Evaluation (APACHE) II (27.6 vs. 20.3, p = 0.001) and Sequential Organ Failure assessment (8.8 vs. 5.26, p = 0.001) scores. Elevated TnI levels were associated with higher mortality rates at 28 days (58.3% vs. 19.4%), 90 days (69.9% vs. 35.0%), one year (78.6% vs. 46.2%), and two years (82.5% vs. 55.6%) (p < 0.001 for all). Univariate logistic regression analysis revealed that high TnI levels were a strong independent predictor of mortality at all time points: 28 days (OR = 1.2, 95% CI: 1.108–1.3, p < 0.001), 90 days (OR = 1.207, 95% CI: 1.095–1.33, p = 0.001), one year (OR = 1.164, 95% CI: 1.059–1.28, p = 0.002), and two year (OR = 1.119, 95% CI: 1.026–1.22, p = 0.011). Multivariate analysis revealed that age, albumin level, APACHE II score, and requirements for dialysis and vasopressor use in the ICU were important predictors of mortality across all timeframes, but elevated TnI levels were not. Conclusions: Elevated TnI levels in critically ill non-cardiac patients are markers of disease severity. While elevated TnI levels were significant predictors of mortality in the univariate analysis, they lost significance in the multivariate model when adjusted for other factors. Patients with elevated TnI levels had higher mortality rates across all timeframes, from 28 days to two years
Renal replacement therapy in the ICU: comparison of clinical features and outcomes of patients with acute kidney injury and dialysis-dependent end-stage renal disease
No full textThe goal of this study is to study clinical features and outcomes of the patients who had renal replacement therapy (RRT) in the intensive care unit (ICU) between 2000 and 2007. We retrospectively studied 222 patients. Overall ICU mortality and invasive mechanical ventilation (IMV) rates were 58.1 and 61.3 %. The mean APACHE II score was 27.6 +/- A 8.3. Chronic dialysis (CD) patients formed 45.5 % of the study population. Acute kidney injury (AKI) patients had higher rates of IMV (73 vs. 51.5 %, p = 0.002), cancer (27.8 vs. 7.9 %, p a parts per thousand currency sign 0.001) and mortality (67.8 vs. 50.5 %, p = 0.010) than CD patients. AKI patients with normal kidney function (NKF) before ICU admission had poorer prognosis than acute-on-chronic kidney disease (CKD) and CD patients (78.6, 51 and 50.5 %, respectively, p a parts per thousand currency sign 0.001). Multivariate analysis showed that IMV (OR, 14.8; 95 % CI, 5.47-40.05; p a parts per thousand currency sign 0.001) and having NKF before hospitalization (OR, 2.8; 95 % CI, 1.04-7.37; p = 0.041) were predictors of overall ICU mortality. Additionally, IMV is found as a prognostic factor for both AKI (OR, 18.7; 95 % CI, 4.48-77.72; p a parts per thousand currency sign 0.001) and CD patients (OR, 8.14; 95 % CI, 2.01-33.04; p = 0.003), but APACHE II score is meaningful only for CD patients (OR, 1.13; 95 % CI, 1.02-1.26; p = 0.024). The areas under the ROC curves for APACHE II score were 0.52 (95 % CI, 0.39-0.66) for AKI and 0.78 (95 % CI, 0.55-0.89) for CD patients. The observed ICU mortality among patients requiring RRT is high and IMV is associated with mortality. AKI patients have increased mortality compared to CD patients. AKI patients with past NKF have poorer prognosis than acute-on-CKD and CD patients
Long length of stay in the ICU associates with a high erythrocyte transfusion rate in critically ill patients
No full textAkbas, Turkay/0000-0002-2150-6866WOS: 000473513700014PubMed: 30859888Objective This study aimed to evaluate epidemiology and outcome among critically ill patients under a restrictive transfusion practice. Methods One hundred sixty-nine patients who were admitted to the intensive care unit (ICU) between March 2016 to December 2017 and remained in the ICU > 24 hours were retrospectively included. Results Hemoglobin levels on admission were = 7 to >= 15 days. Age, vasopressor use, dialysis, and erythrocyte transfusion >= 5 units were predictors of mortality. Conclusion Patients receiving transfusion are severely ill and have more life support therapies. The number of erythrocyte units transfused, age, and organ support therapies are independent predictors of mortality
The analogue of grad-div stabilization in DG methods for incompressible flows: Limiting behavior and extension to tensor-product meshes
No full textSchroeder, Philipp W./0000-0001-7644-4693WOS: 000442638700037grad-div stabilization is a classical remedy in conforming mixed finite element methods for incompressible flow problems, for mitigating velocity errors that are sometimes called poor mass conservation. Such errors arise due to the relaxation of the divergence constraint in classical mixed methods, and are excited whenever the spatial discretization has to deal with comparably large and complicated pressures. In this contribution, an analogue of grad-div stabilization for Discontinuous Galerkin methods is studied. Here, the key is the penalization of the jumps of the normal velocities over facets of the triangulation, which controls the measure-valued part of the distributional divergence of the discrete velocity solution. Our contribution is twofold: first, we characterize the limit for arbitrarily large penalization parameters, which shows that the stabilized nonconforming Discontinuous Galerkin methods remain robust and accurate in this limit; second, we extend these ideas to the case of non-simplicial meshes; here, broken grad-div stabilization must be used in addition to the normal velocity jump penalization, in order to get the desired pressure robustness effect. The analysis is performed for the Stokes equations, and more complex flows and Crouzeix-Raviart elements are considered in numerical examples that also show the relevance of the theory in practical settings. (C) 2018 Elsevier B.V. All rights reserved.German Academic Exchange Service (DAAD)Deutscher Akademischer Austausch Dienst (DAAD); program "Research Grants for Doctoral Candidates and Young Academics and Scientists", 2017/18 [57299291]; National Science FoundationNational Science Foundation (NSF) [DMS1522191]; U.S. ArmyUnited States Department of Defense [65294-MA]The authors would especially like to thank Christoph Lehrenfeld for several related fruitful discussions on stabilization and hybridization and the invaluable help he provided in using the finite element library NGSolve in the context of this work. Mine Akbas acknowledges support from the German Academic Exchange Service (DAAD) with the program "Research Grants for Doctoral Candidates and Young Academics and Scientists", 2017/18 (57299291). The third author was supported by National Science Foundation grant DMS1522191 and U.S. Army grant 65294-MA
The Endocrinologic Changes in Critically III Chronic Obstructive Pulmonary Disease Patients
No full textBackground: Alterations in the neuroendocrine system occur during critical illness. Chronic obstructive pulmonary disease (COPD) itself causes hormonal changes. The aim of this study was to determine neu roendocrine hormones of COPD patients with acute respiratory failure and to investigate the relationship between hormonal changes, mortality, and morbidity. Methods: We enrolled 21 patients (13 F/8 M) with COPD exacerbation requiring artificial airway support. Blood samples were collected on admission to the ICU, and on the day of hospital discharge. Eighteen healthy people were included as controls. Results: Female patients had lower luteinizing hormone (LH), follicle stimulating hormone (FSH), and free triiodothyronine (fT3), and higher prolactin (PRL) levels than controls on admission to the ICU (FSH: 70.3 vs. 29.3 mIU/mL; LH: 26.6 vs. 6.8 mIU/mL; fT3: 2.9 vs. 2.0 pg/mL; PRL: 12.4 vs. 21.3 ng/mL). Male patients had low testosterone and TSH and high PRL but only changes in TSH and PRL reached statistical significance (testosterone: 3.5 vs. 1.5 ng/mL, TSH: 1.1 vs. 0.5 uIU/mL, PRL: 9.7 vs. 14.2 ng/mL). Female patients had lower fT3 than males (fT3(female): 2.7 vs. fT3(male): 2.0 pg/mL). On follow-up, significantly elevated FSH and fT3 and decreased estradiol concentrations were documented among recovered women (FSH: 28.4 vs. 46.6 mIU/mL, fT3,: 2.0 vs. 2.6 pg/mL, E-2: 27.7 vs. 19.0 pg/mL). Patients had high C-reactive protein levels and acute physiologic and chronic health evaluation II scores. Mortality rate was 9.5% and a negative correlation between E-2 and duration of noninvasive mechanical ventilation and length of hospital stay was found in male patients. Conclusion: Men and women with acute respiratory failure in the presence of COPD develop significant changes in the neuroendocrine axis. Hormonal suppression vanishes with disease improvement
Characteristics and outcomes of patients with chronic obstructive pulmonary disease admitted to the intensive care unit due to acute hypercapnic respiratory failure
No full textBackground: The study aimed to describe the clinical course, outcomes, and prognostic factors of chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure. Methods: This retrospective study involved patients with acute hypercapnic respiratory failure due to COPD of any cause admitted to the intensive care unit (ICU) for non-invasive or invasive mechanical ventilation (IMV) support between December 2015 and February 2020. Results: One hundred patients were evaluated. The main causes of acute hypercapnic respiratory failure were bronchitis, pneumonia, and heart failure. The patients' mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 23.0 +/- 7.2, and their IMV rate was 43%. ICU, in-hospital, and 90-day mortality rates were 21%, 29%, and 39%, respectively. Non-survivors had more pneumonia, shock within the first 24 hours of admission, IMV, vasopressor use, and renal replacement therapy, along with higher APACHE II scores, lower admission albumin levels and PaO2/FiO(2) ratios, and longer ICU and hospital stays than survivors. Logistic regression analysis identified APACHE II score (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.017-1.317; P=0.026), admission PaO2/FiO(2) ratio (OR, 0.989; 95% CI, 0.978-0.999; P=0.046), and vasopressor use (OR, 8.827; 95% CI, 1.650-47.215; P=0.011) as predictors of ICU mortality. APACHE II score (OR, 1.099; 95% CI, 1.021-1.182; P=0.011) and admission albumin level (OR, 0.169; 95% CI, 0.056-0.514; P=0.002) emerged as predictors of 90-day mortality. Conclusions: APACHE II scores, the PaO2/FiO(2) ratio, vasopressor use, and albumin levels are significant short-term mortality predictors in severely ill COPD patients with acute hypercapnic respiratory failure
The Relationship between the Sydney Classification and the First-Line Treatment Efficacy in Helicobacter-Associated Gastritis
No full textObjective: Helicobacter pyloriis responsible for a wide spectrum of diseases. Due to ease of use and access, the standard triple therapy is being used as first-line eradication in many areas. Intestinal metaplasia (IM) is a precancerous lesion that requires eradication therapy. Our aim is to investigate the effect of IM on the standard triple therapy success in H. pylori-positive patients. Subjects and Methods: The patients who were referred to Duzce University Hospital and Avrasya Hospital Gastroenterohepatology clinic between January 2014 and December 2016 and diagnosed with H. pylori-positive gastritis and underwent first-line eradication were evaluated retrospectively. Biopsy specimens were evaluated according to the updated Sydney system. All patients diagnosed with H. pylori started treatment with pantoprazole 40 mg b.i.d., amoxicillin 1 g b.i.d. and clarithromycin 500 mg b.i.d. for 14 days. Results: The mean age of 181 patients included in the study was 55.5 +/- 7.8. The success rate of H. pylori eradication was found to be low in severe chronic inflammation (p = 0.001). The success rate was found to be high among patients with no neutrophil activity (p = 0.009). As the intensity of IM increased, density of H. pylori was found to be decreased (p = 0.019). There was no correlation between glandular atrophy, IM, and H. pylori eradication success rate (p = 0.390 and p = 0.812). Conclusion: The severity of chronic inflammation is the most effective Sydney criteria for success of eradication, while the presence on IM does not have any effect
Characteristics of Active Tuberculosis Patients Requiring Intensive Care Monitoring and Factors Affecting Mortality
No full textBackground: One to three percent of cases of acute tuberculosis (TB) require monitoring in the intensive care unit (ICU). The purpose of this study is to establish and determine the mortality rate and discuss the causes of high mortality in these cases, and to evaluate the clinical and laboratory findings of TB patients admitted to the pulmonary ICU. Methods: The data of patients admitted to the ICU of Yedikule Chest Diseases and Chest Surgery Education and Research Hospital due to active TB were retrospectively evaluated. Demographic characteristics, medical history, and clinical and laboratory findings were evaluated. Results: Thirty-five TB patients (27 males) with a median age 0117 years were included, of whom 20 died within 30 days (57%). The Acute Physiology and Chronic Health Evaluation 11 (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores were significantly higher, and albumin and PaO2/FIO2 levels were significantly lower, and shock, multiple organ failure, the need for invasive mechanical ventilation and drug resistance were more common in the patients who died. The mortality risk was 7.58 times higher in the patients requiring invasive mechanical ventilation. The SOFA score alone was a significant risk factor affecting surviVal Conclusion: The survival rate is low in cases of tuberculosis treated in an ICU. The predictors of mortality include the requirement of invasive mechanical ventilation and multiple organ failure. :Another factor specific to rt B patients is the presence of drug resistance, which should be taken seriously in countries where there is a high incidence of the disease. Finding new variables that can be established with new prospective studies may help to decrease the high mortalit\ rate
A severe case of systemic lupus erythematosus with increased pressure communicating hydrocephalus
No full textNormal/increased pressure hydrocephaly is an unusual manifestation of systemic lupus erythematosus (SLE), and the pathogenesis is still unclear. We report the case of an 18-year-old white female with severe refractory renal and pulmonary involvement who developed stupor during intensive immunosuppressive treatment. Enlarged ventricles on imaging and increased intracranial pressure with the exclusion of infectious and hemorrhagic/thrombotic processes suggested increased pressure communicating hydrocephalus associated with SLE. Few case reports are reviewed, and potential pathophysiologic mechanisms are discussed
A retrospective study demonstrating properties of nonvariceal upper gastrointestinal bleeding in Turkey
No full textBackground/aims: Helicobacter pylori infection, non-steroidal anti-inflammatory drugs and peptic ulcer are considered as the major factors for upper gastrointestinal system bleeding. The objective of the study was to determine the sociodemographic and etiologic factors, management and outcome of patients with non-variceal upper gastrointestinal system bleeding in Turkey. Methods: Patients who admitted to hospitals with upper gastrointestinal system bleeding and in whom upper gastrointestinal endoscopy was performed were enrolled in this retrospective study. The detailed data of medical history, comorbid diseases, medications, admission to intensive care units, Helicobacter pylori infection, blood transfusion, upper gastrointestinal endoscopy, and treatment outcome were documented. Results: The most frequent causes of bleeding (%) were duodenal ulcer (49.4), gastric ulcer (22.8), erosion (9.6), and cancer (2.2) among 1,711 lesions in endoscopic appearances of 1,339 patients from six centers. Seven hundred and four patients were evaluated for Helicobacter pylori infection and the test was positive in 45.6% of those patients. Comorbid diseases were present in 59.2% of the patients. The percentage of patients using acetylsalicylic acid and I or other non-steroidal anti-inflammatory drug was 54.3%. Bleeding was stopped with medical therapy in 66.9%. Only 3.7% of the patients underwent emergency surgery, and a 1.1% mortality rate was determined. Conclusions: Patients with upper gastrointestinal system bleeding were significantly older, more likely to be male, and more likely to use non-steroidal anti-inflammatory drugs. Though most of the patients were using gastro-protective agents, duodenal and gastric ulcers were the contributing factors in more than 70% of the upper gastrointestinal bleeding. The extensive use of non-steroidal anti-inflammatory drug is a hazardous health issue considering the use of these drugs in half of the patients
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