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Intensive care unit mortality in sub-Saharan Africa: The modified sequential organ function assessment score
Abstracts
Conclusions: Mortality rate for ICU and inhospital patients with hematological cancer are worse than patients with solid cancer admitted to the ICU. When admitting these patients in the ICU, age, ECOG, need for mechanical ventilation, and SAPS3 are important variables to take into consideration. Keywords: Cancer, Intensive care unit, Outcome, SAPS3 http://dx.doi.org/10.1016/j.jcrc.2015.04.041
Abstract Development of sepsis rates and costs in German hospitals Christiane S. Hartog, Carolin Fleischmann, Konrad Reinhart Jena University Hospital, Germany Background/Purpose: Sepsis is a life-threatening condition after acute infections; it is a global public health disaster. Current epidemiological data on incidence, mortality, and costs of sepsis are missing in Germany. Methods: We performed a nationwide analysis of coded sepsis cases from 2007 to 2013 based on diagnosis-related groups, hospital statistics, and causes of death statistics. Costs were estimated based on data issued by the German Federal (Social) Insurance Office. Results: Sepsis incidence increased by 15% overall from 110 653 to 252 812 cases. Mortality was 30.5%, resulting in more than 75 000 deaths per year. Sepsis now ranks third among the causes of death in Germany. Average direct costs per patient amounted to 36 129 Euros; total costs are estimated at approximately 9.1 billion Euros or 3% of the national health care budget. Hospital statistics use microbiological sepsis codes, which considerably underestimate the incidence derived from clinical sepsis codes. Conclusions: Incidence and mortality of sepsis in Germany are higher than expected and are on the rise. Transectorial quality measures in other countries have contributed to a considerable decrease of mortality. Similar measures are urgently needed in Germany. Monitoring of sepsis indices should become a regular feature of the Federal Health Monitoring and Hospital Statistics reporting. Keywords: Sepsis, Incidence, Epidemiology, Diagnosis related http://dx.doi.org/10.1016/j.jcrc.2015.04.042
Abstract Intensive care unit mortality in sub-Saharan Africa: The modified sequential organ function assessment score Cornelius Sendagirea, Michael Lipnickb, Daniel Obuaa, Jane Nakibuukac, Joseph Ejokuc a
Makerere University Department of Anaesthesia and Critical Care, Uganda University of CA, San Francisco, USA c Mulago National Referral Hospital, Uganda b
Background/Purpose: Sub-Saharan Africa has a significant and growing burden of critical illness. Limited medical infrastructure including workforce shortages aggravated by late presentation of patients contributes to high mortality for a young critically illpopulation. With little known about organ dysfunction in SubSaharan Africa, we set out to evaluate the feasibility and utility of the modified Sequential Organ Function Assessment (mSOFA) score in a low-income country. Methods: We conducted a study in Mulago National Referral Hospital general intensive care unit on patients 12 years and older.
835
The mSOFA scores were calculated at admission and 48 hours and then followed up with mortality as primary outcome. The mSOFA score was modified by replacing the Pao2/Fio2 ratio with Spo2/Fio2 ratio. Results: Interim analysis had 118 patients; the median age was 34 years, 57.6% were male, and the overall ICU mortality was 47.5%. Only 47% had blood gas analysis results. By comparison, the nonsurvivors had significantly higher initial, mean, and highest mSOFA scores (P = .007, P = .000, P = .000, respectively). The delta mSOFA scores were also significantly different (P = .000). The logistic regression analysis showed no significant association mSOFA scores with mortality. The length of stay had an odds ratio for mortality of 0.49 and 95% confidence interval of 0.34 to 0.79 (P = .000), while the duration of ventilation had an odds ratio for mortality of 1.03 and 95% confidence interval of 1.01 to 1.04 (P = .000). Conclusions: The modified SOFA score is feasible in low-income country, although it was not statistically significant for mortality, but this was because of the small sample size. The study is still ongoing with a plan to include 2 more ICUs. Keywords: MSOFA, Low-income country, Delta mSOFA
http://dx.doi.org/10.1016/j.jcrc.2015.04.043
Abstract Risk factors of ICU readmission within 48 hours in the critically ill cancer patients Dae-sang Lee, Jinkyeong Park, Jeong-am Ryu, Chi ryang Chung, Jeong hoon Yang, Chi-min Park, Gee young Suh, Kyeongman Jeon Samsung Medical Center (Samsung Seoul Hospital), Republic of Korea Background/Purpose: The risk factors for intensive care unit (ICU) readmission in the critically ill cancer patients are poorly understood. We evaluated the risk factors associated with the readmission of ICU in the critically ill cancer patients. Methods: We retrospectively identified patient unplanned ICU readmission within 48 hours after ICU discharge. Data were collected for all cancer patients admitted to medical ICU of Samsung Medical Center between January 1, 2011, and December 31, 2012. If patients were repeatedly admitted to the ICU during study period, first ICU admission was used as the index event. Results: All patients 18 years or older who were consecutively admitted to the ICU were enrolled (n = 1039); patients who died during the first ICU admission (n = 265) or patients who were discharged from the ICU for palliative care (n = 83) were excluded from final analysis. The primary outcome variables were unplanned readmission (n = 41). Using logistic regression analysis, the factors associated with ICU readmission were COPD (odds ratio [OR], 4.96; 95% confidence interval [CI], 1.41-17.46), major organ involvement (OR, 2.20; 95% CI, 1.05-4.64), mechanical ventilation during the first ICU stay (OR, 2.33; 95% CI, 1.12-4.85), ECOG over 3 (OR, 2.13; 95% CI, 1.05-4.35), heart rate over 114 per minute (OR, 4.05; 95% CI, 1.91-8.61), and respiratory rate over 25 per minute (OR, 2.53; 95% CI, 1.15-5.56). Conclusions: COPD, major organ involvement, mechanical ventilation during ICU stay, poor ECOG, tachycardia, and tachypnea put critically ill cancer patients at risk for ICU readmission. Keywords: Readmission, Intensive care unit, Risk factors
http://dx.doi.org/10.1016/j.jcrc.2015.04.044
Conclusions: Mortality rate for ICU and inhospital patients with hematological cancer are worse than patients with solid cancer admitted to the ICU. When admitting these patients in the ICU, age, ECOG, need for mechanical ventilation, and SAPS3 are important variables to take into consideration. Keywords: Cancer, Intensive care unit, Outcome, SAPS3 http://dx.doi.org/10.1016/j.jcrc.2015.04.041
Abstract Development of sepsis rates and costs in German hospitals Christiane S. Hartog, Carolin Fleischmann, Konrad Reinhart Jena University Hospital, Germany Background/Purpose: Sepsis is a life-threatening condition after acute infections; it is a global public health disaster. Current epidemiological data on incidence, mortality, and costs of sepsis are missing in Germany. Methods: We performed a nationwide analysis of coded sepsis cases from 2007 to 2013 based on diagnosis-related groups, hospital statistics, and causes of death statistics. Costs were estimated based on data issued by the German Federal (Social) Insurance Office. Results: Sepsis incidence increased by 15% overall from 110 653 to 252 812 cases. Mortality was 30.5%, resulting in more than 75 000 deaths per year. Sepsis now ranks third among the causes of death in Germany. Average direct costs per patient amounted to 36 129 Euros; total costs are estimated at approximately 9.1 billion Euros or 3% of the national health care budget. Hospital statistics use microbiological sepsis codes, which considerably underestimate the incidence derived from clinical sepsis codes. Conclusions: Incidence and mortality of sepsis in Germany are higher than expected and are on the rise. Transectorial quality measures in other countries have contributed to a considerable decrease of mortality. Similar measures are urgently needed in Germany. Monitoring of sepsis indices should become a regular feature of the Federal Health Monitoring and Hospital Statistics reporting. Keywords: Sepsis, Incidence, Epidemiology, Diagnosis related http://dx.doi.org/10.1016/j.jcrc.2015.04.042
Abstract Intensive care unit mortality in sub-Saharan Africa: The modified sequential organ function assessment score Cornelius Sendagirea, Michael Lipnickb, Daniel Obuaa, Jane Nakibuukac, Joseph Ejokuc a
Makerere University Department of Anaesthesia and Critical Care, Uganda University of CA, San Francisco, USA c Mulago National Referral Hospital, Uganda b
Background/Purpose: Sub-Saharan Africa has a significant and growing burden of critical illness. Limited medical infrastructure including workforce shortages aggravated by late presentation of patients contributes to high mortality for a young critically illpopulation. With little known about organ dysfunction in SubSaharan Africa, we set out to evaluate the feasibility and utility of the modified Sequential Organ Function Assessment (mSOFA) score in a low-income country. Methods: We conducted a study in Mulago National Referral Hospital general intensive care unit on patients 12 years and older.
835
The mSOFA scores were calculated at admission and 48 hours and then followed up with mortality as primary outcome. The mSOFA score was modified by replacing the Pao2/Fio2 ratio with Spo2/Fio2 ratio. Results: Interim analysis had 118 patients; the median age was 34 years, 57.6% were male, and the overall ICU mortality was 47.5%. Only 47% had blood gas analysis results. By comparison, the nonsurvivors had significantly higher initial, mean, and highest mSOFA scores (P = .007, P = .000, P = .000, respectively). The delta mSOFA scores were also significantly different (P = .000). The logistic regression analysis showed no significant association mSOFA scores with mortality. The length of stay had an odds ratio for mortality of 0.49 and 95% confidence interval of 0.34 to 0.79 (P = .000), while the duration of ventilation had an odds ratio for mortality of 1.03 and 95% confidence interval of 1.01 to 1.04 (P = .000). Conclusions: The modified SOFA score is feasible in low-income country, although it was not statistically significant for mortality, but this was because of the small sample size. The study is still ongoing with a plan to include 2 more ICUs. Keywords: MSOFA, Low-income country, Delta mSOFA
http://dx.doi.org/10.1016/j.jcrc.2015.04.043
Abstract Risk factors of ICU readmission within 48 hours in the critically ill cancer patients Dae-sang Lee, Jinkyeong Park, Jeong-am Ryu, Chi ryang Chung, Jeong hoon Yang, Chi-min Park, Gee young Suh, Kyeongman Jeon Samsung Medical Center (Samsung Seoul Hospital), Republic of Korea Background/Purpose: The risk factors for intensive care unit (ICU) readmission in the critically ill cancer patients are poorly understood. We evaluated the risk factors associated with the readmission of ICU in the critically ill cancer patients. Methods: We retrospectively identified patient unplanned ICU readmission within 48 hours after ICU discharge. Data were collected for all cancer patients admitted to medical ICU of Samsung Medical Center between January 1, 2011, and December 31, 2012. If patients were repeatedly admitted to the ICU during study period, first ICU admission was used as the index event. Results: All patients 18 years or older who were consecutively admitted to the ICU were enrolled (n = 1039); patients who died during the first ICU admission (n = 265) or patients who were discharged from the ICU for palliative care (n = 83) were excluded from final analysis. The primary outcome variables were unplanned readmission (n = 41). Using logistic regression analysis, the factors associated with ICU readmission were COPD (odds ratio [OR], 4.96; 95% confidence interval [CI], 1.41-17.46), major organ involvement (OR, 2.20; 95% CI, 1.05-4.64), mechanical ventilation during the first ICU stay (OR, 2.33; 95% CI, 1.12-4.85), ECOG over 3 (OR, 2.13; 95% CI, 1.05-4.35), heart rate over 114 per minute (OR, 4.05; 95% CI, 1.91-8.61), and respiratory rate over 25 per minute (OR, 2.53; 95% CI, 1.15-5.56). Conclusions: COPD, major organ involvement, mechanical ventilation during ICU stay, poor ECOG, tachycardia, and tachypnea put critically ill cancer patients at risk for ICU readmission. Keywords: Readmission, Intensive care unit, Risk factors
http://dx.doi.org/10.1016/j.jcrc.2015.04.044