Association between a four-parameter inflammatory index and all-cause mortality in critical ill patients with non-traumatic subarachnoid hemorrhage: a retrospective analysis of the MIMIC-IV database (2012-2019).
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SUBMITTER: Huang YW
PROVIDER: S-EPMC10626529 | biostudies-literature | 2023
REPOSITORIES: biostudies-literature
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Association between a four-parameter inflammatory index and all-cause mortality in critical ill patients with non-traumatic subarachnoid hemorrhage: a retrospective analysis of the MIMIC-IV database (2012-2019).
Huang Yong-Wei YW Zhang Ye Y Li Zong-Ping ZP Yin Xiao-Shuang XS
Frontiers in immunology 20231023
<h4>Background</h4>Non-traumatic subarachnoid hemorrhage (SAH), primarily due to the rupture of intracranial aneurysms, contributes significantly to the global stroke population. A novel biomarker, pan-immune-inflammation value (PIV) or called the aggregate index of systemic inflammation (AISI), linked to progression-free survival and overall survival in non-small-cell lung cancer and mortality in Coronavirus Disease 2019 (COVID-19) patients, has surfaced recently. Its role in non-traumatic SAH ...[more]
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Project description:BackgroundSerum creatinine is a prognostic marker for various conditions, but its significance of spontaneous subarachnoid hemorrhage is still poorly understood. This study aims to elucidate the correlation between admission serum creatinine (sCr) levels and all-cause mortality within 30 days among individuals affected by non-traumatic subarachnoid hemorrhage (SAH).MethodsThis cohort study included 672 non-traumatic SAH adults. It utilized data from the MIMIC-IV database from 2008 to 2019. The patients' first-time serum creatinine was recorded. Subsequently, an examination of the 30-day all-cause mortality was conducted. Employing a multiple logistic regression model, a nomogram was constructed, while the association between sCr and 30-day all-cause mortality was evaluated using Kaplan-Meier survival curves. The calibration curve was employed to assess the model's performance, while subgroup analysis was employed to examine the impact of additional complications and medication therapy on outcomes.ResultsA total of 672 patients diagnosed with non-traumatic subarachnoid hemorrhage were included in the study. The mortality rate within this timeframe was found to be 24.7%. Multiple logistic regression analysis revealed that sCr served as an independent prognostic indicator for all-cause mortality within 30 days of admission for SAH patients [OR: 2(1.18-3.41); p = 0.01]. A comprehensive model was constructed, incorporating age, sCr, white blood cell count (WBC), glucose, anion gap, and partial thromboplastin time (PTT), resulting in a prediction model with an AUC value of 0.806 (95% CI: 0.768, 0.843), while the AUC for the test set is 0.821 (95% CI: 0.777-0.865).ConclusionCreatinine emerges as a significant biomarker, closely associated with heightened in-hospital mortality in individuals suffering from SAH.
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Project description:BackgroundIn critically ill patients, transcutaneous oxygen saturation (SpO2) upon admission is typically associated with in-hospital mortality. Nevertheless, the available information for patients with non-traumatic subarachnoid hemorrhage (SAH) is limited. In our study, our objective was to assess the correlation between SpO2 levels and mortality among patients diagnosed with severe SAH.MethodsIn this study, we extracted data from the Medical Information Marketplace in Intensive Care (MIMIC-IV) database, which comprises information on critically ill patients. By employing matching ICD-9 and ICD-10 codes, we identified 3,328 patients diagnosed with SAH. Every individual who was admitted to the intensive care unit (ICU) had their SpO2 data and various covariates, including age, sex, diagnosis, and duration of stay, recorded upon admission. Subsequently, the patients were categorized into three distinct groups according to their SpO2 levels: low (≤95%), moderate (95-98%), and high (≥98%). To investigate the association between percutaneous oxygen saturation and mortality in patients with severe SAH, logistic regression, and cubic spline models were utilized. The main outcomes of interest were 28- and 90-day mortality rates. Additionally, subgroup analyses were conducted to evaluate these correlations and assess the consistency of interactions.ResultsA cohort of 864 patients diagnosed with non-traumatic SAH was included in this study. The correlation between SpO2 and mortality displayed a U-shaped curve when utilizing a finite cubic spline function (non-linearity < 0.001), with the nadir in the probability of in-hospital death at 96%. Mortality at 28 and 90 days showed an inverse correlation with SpO2 < 96% (adjusted odds ratio [OR], 0.8; 95% confidence interval [CI], 0.67-0.95, and 0.76; 95% CI, 0.6-0.96). Conversely, there was a positive correlation between percutaneous oxygen saturation (SpO2) levels of ≥96% and mortality rates at both 28 and 90 days (adjusted OR, 1.17; 95% CI, 1.02-1.35 and 1.2; 95% CI, 1.05-1.39).ConclusionIn patients with severe subarachnoid hemorrhage, the association between SpO2 and mortality at 28 and 90 days demonstrated a U-shaped pattern. When SpO2 levels were between 95 and 98%, both short- and long-term mortality rates were at their lowest. Patients with significant subarachnoid hemorrhage had a lower chance of survival when their SpO2 values were either high or low.
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Project description:ObjectiveThe study aimed to evaluate the relationship between serum sodium and mortality in critically ill patients with non-traumatic subarachnoid hemorrhage.MethodsThis is a retrospective investigation of critically ill non-traumatic patients with subarachnoid hemorrhage (SAH) utilizing the MIMIC-IV database. We collected the serum sodium levels at admission and determined the all-cause death rates for the ICU and hospital. We employed a multivariate Cox proportional hazard regression model and Kaplan-Meier survival curve analysis to ascertain the relationship between serum sodium and all-cause mortality. In order to evaluate the consistency of correlations, interaction and subgroup analyses were also conducted.ResultsA total of 864 patients with non-traumatic SAH were included in this study. All-cause mortality in the ICU and hospital was 32.6% (282/864) and 19.2% (166/864), respectively. Sodium levels at ICU admission showed a statistically significant J-shaped non-linear relationship with ICU and hospital mortality (non-linear P-value < 0.05, total P-value < 0.001) with an inflection point of ~141 mmol/L, suggesting that mortality was higher than normal serum sodium levels in hypernatremic patients. Multivariate analysis after adjusting for potential confounders showed that high serum sodium levels (≥145 mmol/L) were associated with an increased risk of all-cause mortality in the ICU and hospital compared with normal serum sodium levels (135-145 mmol/L), [hazard ratio (HR) = 1.47, 95% CI: 1.07-2.01, P = 0.017] and (HR = 2.26, 95% CI:1.54-3.32, P < 0.001). Similarly, Kaplan-Meier (K-M) survival curves showed lower survival in patients with high serum sodium levels. Stratified analysis further showed that the association between higher serum sodium levels and hospital all-cause mortality was stronger in patients aged < 60 years with a hospital stay of <7 days.ConclusionHigh serum sodium levels upon ICU admission are related to higher ICU and hospital all-cause mortality in patients with non-traumatic SAH. A new reference is offered for control strategies to correct serum sodium levels.
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Project description:BackgroundHigh serum anion gap (AG) on admission is often correlated with poor outcomes in critically ill patients; however, data in patients with non-traumatic subarachnoid hemorrhage (SAH) are lacking. Herein, we aimed to identify the association between serum AG and all-cause mortality in patients with non-traumatic SAH.MethodsA retrospective analysis of data from the Medical Information Mart for Intensive Care (MIMIC-IV) database was performed on critically ill patients with non-traumatic SAH. Serum AG was collected on Intensive Care Unit (ICU) admission, and ICU and hospital all-cause mortality were analyzed. The multivariate Cox proportional hazard regression model and Kaplan-Meier survival curve analysis were used to analyze the correlation of serum AG with ICU and hospital all-cause mortality. Furthermore, interaction and subgroup analyses were evaluated for the consistency of these correlations.ResultsA total of 893 patients with non-traumatic SAH were included in this study. The all-cause mortality in ICU and hospital were 14.8% (132/893), and 18.9% (169/893), respectively. Multivariate analysis after adjusting for potential confounders indicated that high serum AG levels (≥16 mmol/L) were associated with increased risk of ICU and hospital all-cause mortality as compared to that with low serum AG levels (<16mmol/L), (hazards ratio (HR): 2.31 [95% CI: 1.58-3.38]) and HR: 1.91 [95% CI: 1.36-2.67)], respectively). Similarly, the Kaplan-Meier (K-M) survival curve also showed that patients with high serum AG levels presented with a lower survival rate. Stratified analyses further showed that depending on the variable testes, an association between higher serum AG levels and hospital all-cause mortality in different subgroups was observed.ConclusionAmong patients with non-traumatic SAH, high serum AG level at ICU admission was associated with increased ICU and hospital all-cause mortality.
| S-EPMC9321397 | biostudies-literature
Project description:Sixty-nine million people have a traumatic brain injury (TBI) each year, and TBI is the most common cause of subarachnoid hemorrhage (SAH). Traumatic SAH (TSAH) has been described as an adverse prognostic factor leading to progressive neurological deterioration and increased morbidity and mortality. A limited number of studies, however, evaluate recent trends in the diagnosis and management of SAH in the context of trauma. The objective of this scoping review was to understand the extent and type of evidence concerning the diagnostic criteria and management of TSAH. This scoping review was conducted following the Joanna Briggs Institute methodology for scoping reviews. The review included adults with SAH secondary to trauma, where isolated TSAH (iTSAH) refers to the presence of SAH in the absence of any other traumatic radiographic intracranial pathology, and TSAH refers to the presence of SAH with the possibility or presence of additional traumatic radiographic intracranial pathology. Data extracted from each study included study aim, country, methodology, population characteristics, outcome measures, a summary of findings, and future directives. Thirty studies met inclusion criteria. Studies were grouped into five categories by topic: TSAH associated with mild TBI (mTBI), n = 13), and severe TBI (n = 3); clinical management and diagnosis (n = 9); imaging (n = 3); and aneurysmal TSAH (n = 1). Of the 30 studies, two came from a low- and middle-income country (LMIC), excluding China, nearly a high-income country. Patients with TSAH associated with mTBI have a very low risk of clinical deterioration and surgical intervention and should be treated conservatively when considering intensive care unit admission. The Helsinki and Stockholm computed tomography scoring systems, in addition to the American Injury Scale, creatinine level, age decision tree, may be valuable tools to use when predicting outcome and death.
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Project description:A non-convulsive status epilepticus (ncSE) is a potentially fatal complication for patients in neurointensive care. In patients with aneurysmal subarachnoid hemorrhage (SAH), ncSE remains scarcely investigated. In this study, we aim to investigate the frequency and influence of non-convulsive status epilepticus on outcome in patients with SAH. We retrospectively analyzed data of consecutive patients with aneurysmal subarachnoid hemorrhage and evaluated clinical, radiological, demographical and electroencephalogram (EEG) data. Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months and stratified into favorable (mRS 0-2) vs. unfavorable (mRS 3-6). We identified 171 patients with SAH, who received EEG between 01/2012 and 12/2020. ncSE was diagnosed in 19 patients (3.7%), only one of whom achieved favorable outcome. The multivariate regression analysis revealed four independent predictors of unfavorable outcome: presence of ncSE (p = 0.003; OR 24.1; 95 CI% 2.9-195.3), poor-grade SAH (p < 0.001; OR 14.0; 95 CI% 8.5-23.1), age (p < 0.001; OR 2.8; 95 CI% 1.6-4.6) and the presence of DIND (p < 0.003; OR 1.9; 95 CI% 1.2-3.1) as independent predictors for unfavorable outcome. According to our study, development of ncSE in patients suffering SAH might correlate with poor prognosis. Even when medical treatment is successful and no EEG abnormalities are detected, the long-term outcome remains poor.
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Project description:Traumatic subarachnoid hemorrhage (SAH), a common finding following head trauma, is usually a benign condition with a favorable outcome, seldom requiring surgical intervention. Unlike nontraumatic aneurysmal SAH, most cases of traumatic SAH occur in the sulci of the cerebral convexities, and only rarely arise at the base of the brain. Basal traumatic SAH can be life-threatening and is primarily associated with rupture of vertebrobasilar arteries. We herein present a rare case of basal traumatic SAH resulting from rupture of the posterior communicating artery (PCoA). A 77-year-old male was taken to the emergency department in a semicomatose state. Upon arrival at emergency room, the patient had a Glasgow coma scale (GCS) score of 6 (E1M3V2), and the neurologic examination demonstrated no focal neurologic deficit. Although the trauma history was evident from abrasions and bruising on the face and chest, brain computed tomography (CT) demonstrated basal SAH, which is typical for nontraumatic aneurysmal SAH. Subsequent digital subtraction angiography (DSA) disclosed a traumatic rupture at the mid-portion of right PCoA and ongoing extravasation of contrast media. Despite emergent trapping of the right PCoA by endovascular surgery, the patient's clinical condition only minimally improved. The patient remained bed-ridden with stuporous mentality and persistent hydrocephalus. To the best of our knowledge, this is the first reported case of basal traumatic SAH originating from rupture of the PCoA. This case demonstrates that a meticulous vascular workup is mandatory for every patient with basal SAH, even though a trauma history is clear.
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Project description:Background/objective Uncontrolled systemic inflammation after non-traumatic subarachnoid hemorrhage (SAH) is associated with worse outcomes. Changes in the peripheral eosinophil count have been linked to worse clinical outcomes after ischemic stroke, intracerebral hemorrhage, and traumatic brain injury. We aimed to investigate the association of eosinophil counts with clinical outcomes after SAH. Methods This retrospective observational study included patients with SAH admitted from January 2009 to July 2016. Variables included demographics, modified Fisher scale (mFS), Hunt–Hess Scale (HHS), global cerebral edema (GCE), and the presence of any infection. Peripheral eosinophil counts were examined as part of routine clinical care on admission and daily for 10 days after aneurysmal rupture. Outcome measures included dichotomized discharge mortality, modified Ranked Scale (mRS) score, delayed cerebral ischemia (DCI), vasospasm, and need for ventriculoperitoneal shunt (VPS). Statistical tests included the chi-square test, Student's t-test, and multivariable logistic regression (MLR) model. Results A total of 451 patients were included. The median age was 54 (IQR 45, 63) years, and 295 (65.4%) were female patients. On admission, 95 patients (21.1%) had a high HHS (>4), and 54 (12.0%) had GCE. A total of 110 (24.4%) patients had angiographic vasospasm, 88 (19.5%) developed DCI, 126 (27.9%) had an infection during hospitalization, and 56 (12.4%) required VPS. Eosinophil counts increased and peaked on days 8–10. Higher eosinophil counts on days 3–5 and day 8 were seen in patients with GCE (p < 0.05). Higher eosinophil counts on days 7–9 (p < 0.05) occurred in patients with poor discharge functional outcomes. In multivariable logistic regression models, higher day 8 eosinophil count was independently associated with worse discharge mRS (OR 6.72 [95% CI 1.27, 40.4], p = 0.03). Conclusion This study demonstrated that a delayed increase in eosinophils after SAH occurs and may contribute to functional outcomes. The mechanism of this effect and the relationship with SAH pathophysiology merit further investigation.
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Project description:ObjectivesTo describe the findings in cerebrospinal fluid from patients with acute headache that could distinguish subarachnoid hemorrhage from the effects of a traumatic lumbar puncture.DesignA substudy of a prospective multicenter cohort study.Setting12 Canadian academic emergency departments, from November 2000 to December 2009.ParticipantsAlert patients aged over 15 with an acute non-traumatic headache who underwent lumbar puncture to rule out subarachnoid hemorrhage.Main outcome measureAneurysmal subarachnoid hemorrhage requiring intervention or resulting in death.ResultsOf the 1739 patients enrolled, 641 (36.9%) had abnormal results on cerebrospinal fluid analysis with >1 × 10(6)/L red blood cells in the final tube of cerebrospinal fluid and/or xanthochromia in one or more tubes. There were 15 (0.9%) patients with aneurysmal subarachnoid hemorrhage based on abnormal results of a lumbar puncture. The presence of fewer than 2000 × 10(6)/L red blood cells in addition to no xanthochromia excluded the diagnosis of aneurysmal subarachnoid hemorrhage, with a sensitivity of 100% (95% confidence interval 74.7% to 100%) and specificity of 91.2% (88.6% to 93.3%).ConclusionNo xanthochromia and red blood cell count <2000 × 10(6)/L reasonably excludes the diagnosis of aneurysmal subarachnoid hemorrhage. Most patients with acute headache who meet this cut off will need no further investigations and aneurysmal subarachnoid hemorrhage can be excluded as a cause of their headache.
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Project description:Background: The predictive ability of the ventilatory ratio (VR) for extubation failure risk in critically ill patients on mechanical ventilation is unclear. This study aims to examine the predictive ability of VR for extubation failure risk. Methods: This retrospective study was based on the MIMIC-IV database. The MIMIC-IV database consists of the clinical information of patients who were admitted to the intensive care unit at the Beth Israel Deaconess Medical Center between 2008 and 2019. With extubation failure as the primary outcome and in-hospital mortality as the secondary outcome, we assessed the predictive value of VR 4 hours before extubation using a multivariate logistic regression model. Results: Of 3,569 ventilated patients who were included, the rate of extubation-failure was 12.7% and the median Sequential Organ Failure Assessment (SOFA) score was 6 before extubation. Increased VR, elevated heart rate, greater positive end-expiratory pressure, higher blood urea nitrogen level, higher platelet count, greater SOFA score, decreased pH, decreased tidal volume, presence of chronic pulmonary disease, paraplegia, and metastatic solid tumor were independent predictors for extubation failure. A threshold of 1.595 of VR was associated with prolonged intensive care unit length of stay, higher risk of mortality and extubation failure. The area under the receiver operating characteristic curve (ROC) for VR was 0.669 [0.635-0.703], which was significantly larger than the rapid shallow breathing index [0.510 (0.476-0.545)] and the partial pressure of oxygen to the fraction of inspired oxygen [0.586 (0.551-0.621)]. Conclusion: VR 4 hours before extubation was associated with extubation failure, mortality, and prolonged length of stay in the intensive care unit. VR provides good predictive performance for extubation failure (measured by ROC) than the rapid shallow breathing index. Further prospective studies are warranted to confirm these findings.
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