Tag Archives: mortality

Hyperglycemia, diabetes, and de novo diabetes in patients hospitalized in intensive care units for COVID-19 in Colombia: Results from a longitudinal cohort study

John Jaime Sprockel1,2, Ana Maria Perez2, Maria Camila Chamorro2, Jose Alejandro Vergel2, Ximena Espinosa1, Juan Carlos Vargas1, Carlos Angarita1, Jhon Edinson Parra1

1 El Tunal Hospital, Bogota, Cundinamarca, Colombia
2 Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia

DOI: 10.2478/jccm-2025-0026

Introduction: Hyperglycemia and diabetes have been identified as risk factors for severe COVID-19 and death, with a high rate of reported de novo diabetes. We evaluated their incidence and relationship with adverse outcomes in critically ill COVID-19 patients.
Methods: Prospective single-center longitudinal cohort study in adults hospitalized in intensive care units for confirmed COVID-19. ROC curves for serum glucose and glycated hemoglobin were plotted in relation to 60-day mortality. A Cox proportional hazards model was used to assess the association of diabetes and de novo diabetes with 60-day mortality.
Results: 547 patients were included, with a mean age of 59.8 years; 133 (24.3%) had a history of diabetes, and 67 (12.2%) had de novo diabetes. At 60 days, 317 (57.9%) had died. For mortality, the AUC for glucose at admission was 0.55 (95% CI: 0.48 – 0.62) and 0.51 (95% CI: 0.41 – 0.62) for glycated hemoglobin. In the Cox model, diabetes had an HR of 0.888 (95% CI: 0.695 – 1.135, p: 0.344), history of DM had an HR of 0.881 (95% CI: 0.668 – 1.163, p: 0.371), and de novo diabetes had an HR of 0.963 (95% CI: 0.672 – 1.378, p: 0.835).
Conclusion: There was a high incidence of de novo diabetes in patients hospitalized in intensive care for COVID-19. Neither hyperglycemia, history of diabetes, nor de novo diabetes were associated with the development of complications or 60-day mortality.

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The effect of antiseizure medication on mortality in spontaneous aneurysmal subarachnoid hemorrhage

John Harold Kanter, Adam C. Glaser, Pablo Martinez-Camblor, Jakob V.E. Gerstl, Anna B. Lebouille-Veldman, Harshit Arora, Lauren Buhl, Myles D. Boone, Christopher S. Ogilvy

1 Department of Neurological Surgery, University of California, San Francisco, California; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
2 Department of Neurological Surgery, Brigham and Women’s Hospital, Harvard Medical School Department of Neurological Surgery, Boston Children’s Hospital, USA
3 Department of Anesthesiology, Dartmouth Health Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, USA
4 Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women’s Hospital, Boston, USA
5 Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women’s Hospital, Boston, USA; Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
6 Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women’s Hospital, Boston, USA. Department of Neurosurgery, University of Kentucky, Lexington, KY, USA
7 Department of Anesthesiology, Dartmouth Health, Dartmouth Hitchcock Medical Center, USA
8 Department of Anesthesiology, Dartmouth Health Department of Neurology, Dartmouth Health, Dartmouth Hitchcock Medical Center, USA
9 Neurosurgical Service, BIDMC Brain Aneurysm Institute, Harvard Medical School, Beth Israel Deaconess Medical Center, USA

DOI: 10.2478/jccm-2025-0014

Background: Spontaneous aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of morbidity and mortality in the United States. The efficacy of early antiseizure medication (ASM) is debated. Recent literature reports seizure rates ranging from 7.8% to 15.2% following spontaneous aSAH. Current guidelines recommend use of early ASM in patients with “high-risk features,” but whether early ASM use decreases the rate of death associated with aSAH remains unclear. This study assessed whether early administration of early ASM impacts mortality rates after spontaneous aSAH.
Methods: We conducted a retrospective cohort study using a publicly available dataset from the Massachusetts Institute of Technology, Medical Information Mart for Intensive Care-III (MIMIC) database of all patients over the age of 18 with spontaneous aSAH resulting in an intensive care unit (ICU) admission to a major United States trauma center from 2001 to 2012. The primary exposure was receiving early ASM and primary outcome of death within 7 days. Different regression models were created to explore the association between early ASM administration within 24 hours of admission and a composite outcome of seizure and/or death within 7 days of admission. Secondary outcomes included 30-day and one-year mortality.
Results: Of 253 patients with spontaneous aSAH, 148 received early ASM within 24 hours. Patients who did receive early ASM were less likely to die within 7 days of admission (adjusted odd ratio, [aOR]: 0.26 95% CI 0.10 to 0.68; P=0.006) but were more likely to have a seizure (aOR: 7.63 95% CI 2.07 to 28.17; P=0.002).
Conclusion: Early ASM administration was associated with lower rates of death and composite death/seizure within 7 days of admission among patients who presented to an ICU with spontaneous aSAH. These findings suggest broader use of early ASM in patients who present with spontaneous aSAH may improve early mortality.

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Hypercapnia outcome in COVID-19 acute respiratory distress syndrome patients on mechanical ventilator: A retrospective observational cohort

Sarwat Rasheed1,2, Sidra Javed1,2, Thanyat Rasheed3, Shaiza Farman1,2, Elisha Shalim1,2

1 Sindh Infectious Disease Hospital and Research Centre, Karachi, Pakistan
2 Dow University of Health Sciences, Karachi, Pakistan
3 Patel Hospital, Karachi, Pakistan

DOI: 10.2478/jccm-2025-0004

Introduction: Acute respiratory distress syndrome (ARDS) is characterized by progressive lung inflammation which leads to increased dead space that can cause hypercapnia and can increase the risk of patient morbidity and mortality. In an attempt to improve ARDS patient outcomes provision of protective lung ventilation has been shown to improve patient mortality but increases the incidence of hypercapnia. Therefore, the role of carbon dioxide in ARDS remains contradicted by conflicted evidence. This study aims to examine this conflicting relationship between hypercapnia and mortality in mechanically ventilated COVID-19 ARDS patients.
Methods: We conducted a retrospective cohort study. The data was collected from the medical records of the patients admitted with COVID-19 ARDS in Sindh Infectious Disease Hospital &Research Centre (SIDH & RC) from August 2020 to August 2022 and who received mechanical ventilation for more than 48 hours. The patients were grouped into severe and no severe hypercapnia groups based on their arterial blood carbon dioxide levels (PaCO2). To understand the effect of hypercapnia on mortality we performed multivariable logistic regression, and inverse probability-weighted regression to adjust for time-varying confounders.
Results: We included 288 patients to detect at least 3% of the effect on mortality. Our analysis revealed an association of severe hypercapnia with severe lung injury, low PaO2/FiO2, high dead space, and poor compliance. In univariate analysis severe hypercapnia showed higher mortality: OR=3.50, 95% CI (1.46-8.43). However, after, adjusting for disease severity hypercapnia is not found to be associated with mortality: OR=1.08, 95% CI (0.32 -3.64). The sensitive analysis with weighted regression also shows no significant effect on mortality: OR=1.04, 95% CI (0.95-1.14).
Conclusion: This study showed that hypercapnia is not associated with mortality in COVID-19 ARDS patients.

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Outcomes of Patients Transferred to Tertiary Center by Life-Saving System in Saudi Arabia. A Propensity Score Matching Observational Study

Mohammed Soliman1, Hanan Alenzi1, Rehab Alfenaikh1, Ahmed Aletreby2, Malak Alenzi1, Hend Alenzi1, Jennifer Gano1, Rana Alrashed1, Yasmeen Altaymani3, Mohammed Al-Odat1, Waleed Aletreby1

1 King Saud Medical City, Riyadh, Ar Riyad, Saudi Arabia
2 Faculty of Medicine, Alexandria University, Alexandria, Egypt
3 Imam Abdulrahman Alfaisal Hospital, Riyad, Saudi Arabia

DOI: 10.2478/jccm-2024-0038

Background: Inter-hospital transfer is intended to provide access to centralized special care for critically ill patients, when resources in their hospitals are not available. However, an empirical gap exists in available evidence, as outcomes of transferred patients to higher centers are inconsistent.
Method: Single center propensity score matching retrospective observational study. Life-Saving transfers during 2023 were matched to direct admissions to the ICU. Hospital mortality, ICU length of stay, and costs of both groups were compared.
Results: During the study period, 328 Life-Saving transfers were matched to 656 direct admissions. Propensity score matching eliminated all imbalances between groups. Hospital mortality was not different between groups, there were 114 (34.8%) hospital mortalities of Life-Saving transfers, while there were 216 (32.9%) hospital mortalities of direct admissions, with a percent difference of 1.9% (95% CI: -4.5%, 8.4%); p value = 0.6, this result persisted in the sensitivity analysis. There were no differences in mortality risks for all the studied subgroups except pediatric patients. ICU length of stay of direct admissions and Life-Saving transfers were 10 ± 13.1 and 11.6 ± 12.4 days respectively, mean difference was statistically significant (-1.6 [95% CI: -3.2, 0.1]; p = 0.005). Life-Saving transfers entailed significantly higher costs per admission by 28,200 thousand SAR (95% CI: 26,400 – 30,000; p < 0.001).
Conclusion: Our study shows no difference in hospital mortality between Life-Saving transfers and direct admissions to ICU, however, Life-Saving transfers had a longer ICU length of stay, and higher costs per admission.

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Outcome and Determining Characteristics of ICU Patients with Acute Kidney Injury in a Low-Income Country, a Multicenter Experience

Abubakar Ballah1, Jika Mohammed2, Gyadale Abdulhamid Njidda2, Halima Bidemi Yahaya3, Nwokorie Mabong Rosemary4, Ibrahim Naziru2, Adamu Yusuf Baffah2, Hassan Ali Maina5, Hajara Galadima2, Abdullahi Maryam Mohammed6, Franklin Andibanbang7, Adam Ibrahim Abdullahi8

1 Abubakar Tafawa Balewa University, Bauchi, Nigeria
2 Federal Medical Centre Gombe, Gombe, Nigeria
3 Airdale NHS Foundation Trust, Steeton, England
4 Nile University of Nigeria, Abuja, Nigeria
5 Modibbo Adama University of Technology, Yola, Nigeria
6 Aminu Kano Teaching Hospital, Kano, Nigeria
7 Saudi Arabia Ministry of Health, Fayfa, Saudi Arabia
8 Bauchi State University Gadau, Bauchi, Nigeria

DOI: 10.2478/jccm-2024-0037

Background: Acute kidney injury (AKI) is a disease that affects millions of people globally making it a major public health concern. It is defined as an abrupt decrease in kidney function that occurs within ours affecting both the structure and functionality of the kidneys.
The outcome of AKI and the determinants in Nigeria are largely unknown. This study aimed to describe the determining factors of the outcome of AKI patients admitted into the ICU of three tertiary health institutions in Northeast Nigeria.
Methods: The study is a prospective multicentered observational study of the patients admitted into the ICU in three tertiary health institutions from January 2022 to December 2023. KDIGO criteria was used to define AKI. The outcome of the study was to determine survivors among the patients admitted into the ICU with AKI or developed AKI while in ICU and also the determinants of mortality. A chi-square test was done to determine the association between the dependent variable (patient outcome) and the independent variables. To determine the predictors of patient outcomes, a regression analysis was done. The sociodemographic data of the patients admitted during these periods were studied in addition to Acute Physiology and Chronic Health Evaluation (APACHE) II, Kidney Disease: Improving Global Outcomes (KDIGO), Average length of stay in the ICU, Admitting/referring ward (Obstetrics, Gynae, Medical, Surgical or Emergency unit), Ability to afford care (out of pocket payment, social welfare or through Health insurance Scheme, Co-morbidity (presence or absence of comorbidity), Interventions done while in ICU (use of vasopressors and inotropes, mechanical ventilation (MV) support and renal replacement therapy (RRT) and outcome (discharge to the wards or mortality).
Results: Of 1494 patient records screened, 464 met the inclusion criteria. The overall incidence of AKI was 57%. About 53% were females, the mean age was 42.2 years, and 81% of the patients had a normal BMI (18.5 – 24.9). About 40% of the patients had APACHE II scores ≥ 29%. More than three-quarters (79.5%) of the patients paid for their health care expenditure out-of-pocket. Most patients (72%) were from the Medical and Gynae/Ward. Mortality was highest (54.2%) among patients who were brought into the ICU from the Medical ward. Most patients admitted were KDIGO I (44.3%) followed by KDIGO II (35.1%). Among the patients, 61.2% present with one or more comorbidity. Mortality was higher (50%) among those with comorbidity compared to 13.6% among those without comorbidity. Mortality was lowest among patients who stayed in the ICU between 8-14 days compared to those who stayed > 2 weeks. Most of the patients (72%) were from the Medical and Gynae/Ward. Mortality was highest (54.2%) among patients who were brought into the ICU from the Medical ward followed by those brought in from the Obstetric and Gynecological ward (20.4%). An association was found between the intervention received in the ICU and the outcome, which was found to be statistically significant (p < 0.001). A regression analysis was done to determine the predictors of patients’ outcomes admitted in the ICU. The results showed that APACHE II score greater than 10 (p-value < 0.001), presence of comorbidities (p = 0.031) and intervention which included a combination of Vasopressors, mechanical ventilation and RRT (p < 0.01) are the predictors of patients’ outcome. The regression model is valid (X2 = 469.894, df = 24, p < 0.001) and it fits the sample as shown by the Hosmer and Lemeshow test (X2 = 7.749, p = 0.45, df = 8,). It also shows that the predictors account for 92% of patients’ outcomes (Nagelkerke R2 = 0.92).
Conclusions: Our study revealed that the presence of comorbidity, high APACHE II score, and the need for interventional supports including both mechanical ventilatory and ionotropic, were found to be strong mortality predictors in patients with AKI.

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Awake Prone Decubitus Positioning in COVID-19 Patients: A Systematic Review and MetaAnalysis

Agustin García1, Rita Galeiras1, Sonia Pertega-Díaz2

1 A Coruna University Hospital, A Coruña, Spain
2 University of A Coruna, A Coruña, Spain

DOI: 10.2478/jccm-2023-0014

To date, recommendations for the implementation of awake prone positioning in patients with hypoxia secondary to SARSCoV2 infection have been extrapolated from prior studies on respiratory distress. Thus, we carried out a systematic review and metaanalysis to evaluate the benefits of pronation on the oxygenation, need for endotracheal intubation (ETI), and mortality of this group of patients. We carried out a systematic search in the PubMed and Embase databases between June 2020 and November 2021. A randomeffects metaanalysis was performed to evaluate the impact of pronation on the ETI and mortality rates. A total of 213 articles were identified, 15 of which were finally included in this review. A significant decrease in the mortality rate was observed in the group of pronated patients (relative risk [RR] = 0.69; 95% confidence interval [CI]: 0.480.99; p = 0.044), but no significant effect was observed on the need for ETI (RR = 0.79; 95% CI: 0.631.00; p = 0.051). However, a subgroup analysis of randomized clinical trials (RCTs) did reveal a significant decrease in the need for this intervention (RR = 0.83; 95% CI: 0.710.97). Prone positioning was found to significantly reduce mortality, also diminishing the need for ETI, although this effect was statistically significant only in the subgroup analysis of RCTs. Patients’ response to awake prone positioning could be greater when this procedure is implemented early and in combination with noninvasive mechanical ventilation (NIMV) or highflow nasal cannula (HFNC) therapy.

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Early Lactate Clearance as a Determinant of Survival in Patients with Sepsis: Findings from a Low-resource Country

Fazal Rehman1, Saad Bin Zafar1, Adil Aziz1, Abdul Aziz1, Pirbhat Shams Memon1, Taymmia Ejaz1, Summaira Aziz2

1 Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
2 Department of Community Health Sciences, The Aga Khan University Hospital, Karachi, Pakistan

DOI: 10.2478/jccm-2023-0005

Background: Single lactate measurements have been reported to have prognostic significance, however, there is a lack of data in local literature from Pakistan. This study was done to determine prognostic role of lactate clearance in sepsis patients being managed in our lower-middle income country.
Methods: This prospective cohort study was conducted from September 2019-February 2020 at the Aga Khan University Hospital, Karachi. Patients were enrolled using consecutive sampling and categorized based on their lactate clearance status. Lactate clearance was defined as decrease by 10% or greater in repeat lactate from the initial measurement (or both initial and repeat levels <=2.0 mmol/L).
Results: A total 198 patients were included in the study, 51% (101) were male. Multi-organ dysfunction was reported in 18.6% (37), 47.7% (94) had single organ dysfunction, and 33.8% (67) had no organ dysfunction. Around 83% (165) were discharged and 17% (33) died. There were missing data for 25.8% (51) of the patients for the lactate clearance, whereas 55% (108) patients had early lactate clearance and 19.7% (39) had delayed lactate clearance.On univariate analysis, mortality rate was higher in patients with delayed lactate clearance (38.4% vs 16.6%) and patients were 3.12 times (OR = 3.12; [95% CI: 1.37-7.09]) more likely to die as compared with early lactate clearance. Patients with delayed lactate clearance had higher organ dysfunction (79.4% vs 60.1%) and were 2.56 (OR = 2.56; [95% CI: 1.07-6.13]) times likely to have organ dysfunction. On multivariate analysis, after adjusting for age and co-morbids, patients with delayed lactate clearance were 8 times more likely to die than patients with early lactate clearance [aOR = 7.67; 95% CI:1.11-53.26], however, there was no statistically significant association between delayed lactate clearance [aOR = 2.18; 95% CI: 0.87-5.49)] and organ dysfunction.
Conclusion: Lactate clearance is a better determinant of sepsis and septic shock effective management. Early lactate clearance is related to better outcomes in septic patients.

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Characteristics and risk factors for mortality in critically ill patients with COVID-19 receiving invasive mechanical ventilation: the experience of a private network in Sao Paulo, Brazil

Eduardo Atsushi Osawa, Alexandre Toledo Maciel

Imed Group, Research Department, Sao Paulo, Brazil; Adult Intensive Care Unit, São Camilo Hospital, Brazil

DOI: 10.2478/jccm-2022-0015

Introduction: The use of invasive mechanical ventilation (IMV) in COVID-19 represents in an incremental burden to healthcare systems.
Aim of the study: We aimed to characterize patients hospitalized for COVID-19 who received IMV and identify risk factors for mortality in this population.
Material and Methods: A retrospective cohort study including consecutive adult patients admitted to a private network in Brazil who received IMV from March to October, 2020. A bidirectional stepwise logistic regression analysis was used to determine the risk factors for mortality.
Results: We included 215 patients, of which 96 died and 119 were discharged from ICU. The mean age was 62.7 ± 15.4 years and the most important comorbidities were hypertension (62.8%), obesity (50.7%) and diabetes (40%). Non-survivors had lower body mass index (BMI) (28.3 [25.5; 31.6] vs. 31.2 [28.3; 35], p<0.001, and a shorter duration from symptom onset to intubation (8.5 [6.0; 12] days vs. 10 [8.0; 12.5] days, p = 0.005). Multivariable regression analysis showed that the risk factors for mortality were age (OR: 1.07, 95% CI: 1.03 to 1.1, p < 0.001), creatinine level at the intubation date (OR: 3.28, 95% CI: 1.47 to 7.33, p = 0.004), BMI (OR: 0.91, 95% CI: 0.84 to 0.99, p = 0.033), lowest PF ratio within 48 hours post-intubation (OR: 0.988, 95% CI: 0.979 to 0.997, p = 0.011), barotrauma (OR: 5.18, 95% CI: 1.14 to 23.65, p = 0.034) and duration from symptom onset to intubation (OR: 0.76, 95% CI: 0.76 to 0.95, p = 0.006).
Conclusion: In our retrospective cohort we identified the main risk factors for mortality in COVID-19 patients receiving IMV: age, creatinine at the day of intubation, BMI, lowest PF ratio 48-hours post-intubation, barotrauma and duration from symptom onset to intubation.

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Predictive Value of Systemic Immune-inflammation Index in Determining Mortality in COVID-19 Patients

Tahsin Karaaslan1, Esra Karaaslan2

1 Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
2 Istanbul Medipol University, Istanbul, Turkey

DOI: 10.2478/jccm-2022-0013

Aim: The aim of this study was to evaluate whether systemic immune-inflammation index (SII) could predict mortality in patients with novel coronavirus 2019 (COVID-19) disease.
Methods: This two-center, retrospective study included a total of 191 patients with confirmed diagnosis of COVID-19 via nucleic acid test (NAT). The SII was calculated based on the complete blood parameters (neutrophil × platelet/lymphocyte) during hospitalization. The relationship between the SII and other inflammatory markers and mortality was investigated.
Results: The mortality rate was 18.3%. The mean age was 54.32±17.95 years. The most common symptoms were fever (70.7%) and dry cough (61.3%), while 8 patients (4.2%) were asymptomatic. The most common comorbidities were hypertension (37.7%), diabetes (23.0%), chronic renal failure (14.7%), and heart failure (7.9%) which all significantly increased the mortality rate (p<0.001). There was a highly positive correlation between the SII and polymorphonuclear leukocyte (PNL), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) (r=0.754, p<0.001; r=0.812, p<0.001; r=0.841, p<0.001, respectively), while a moderate, positive correlation was found between the SII and C-reactive protein (CRP) (r=0.439, p<0.001). There was a significant correlation between the SII and mortality (U=1,357, p<0.001). The cut-off value of SII was 618.8 (area under the curve=0.751, p<0.001) with 80.0% sensitivity and 61.5% specificity. A cut-off value of >618.8 was associated with a 4.68-fold higher mortality.
Conclusion: Similar to NLR and PLR, the SII is a proinflammatory marker of systemic inflammation and can be effectively used in independent predicting COVID-19 mortality .

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Renal Manifestations and their Association with Mortality and Length of Stay in COVID-19 Patients at a Safety-net Hospital

Sandra Gomez-Paz1, Eric Lam2, Luis Gonzalez-Mosquera2, Diana Cardenas-Maldonado2, Joshua Fogel3, Ellen Gabrielle Kagan2, Sofia Rubinstein1

1 Division of Nephrology and Hypertension, Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA
2 Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA
3 Department of Business Management, Brooklyn College, Brooklyn, New York, USA

DOI: 10.2478/jccm-2022-0010

Background: Renal involvement in COVID-19 leads to severe disease and higher mortality. We study renal parameters in COVID-19 patients and their association with mortality and length of stay in hospital. Methods: A retrospective study (n=340) of confirmed COVID-19 patients with renal involvement determined by the presence of acute kidney injury. Multivariate analyses of logistic regression for mortality and linear regression for length of stay (LOS) adjusted for relevant demographic, comorbidity, disease severity, and treatment covariates. Results: Mortality was 54.4% and mean LOS was 12.9 days. For mortality, creatinine peak (OR:35.27, 95% CI:2.81, 442.06, p<0.01) and persistent renal involvement at discharge (OR:4.47, 95% CI:1.99,10.06, p<0.001) were each significantly associated with increased odds for mortality. Increased blood urea nitrogen peak (OR:0.98, 95%CI:0.97,0.996, p<0.05) was significantly associated with decreased odds for mortality. For LOS, increased blood urea nitrogen peak (B:0.001, SE:<0.001, p<0.01), renal replacement therapy (B:0.19, SE:0.06, p<0.01), and increased days to acute kidney injury (B:0.19, SE:0.05, p<0.001) were each significantly associated with increased length of stay. Conclusion: Our study emphasizes the importance in identifying renal involvement parameters in COVID-19 patients. These parameters are associated with LOS and mortality, and may assist clinicians to prognosticate COVID-19 patients with renal involvement.

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