Association between lactate to hematocrit ratio and 30-day all-cause mortality in patients with sepsis: a retrospective analysis of the Medical Information Mart for Intensive Care IV database
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PROVIDER: S-EPMC11347292 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:Cardiac arrest (CA) can activate the coagulation system. Some coagulation-related indicators are associated with clinical outcomes. Early evaluation of patients with cardiac arrest-associated coagulopathy (CAAC) not only predicts clinical outcomes, but also allows for timely clinical intervention to prevent disseminated intravascular coagulation. To assess whether CAAC predicts 30-day cumulative mortality. From the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, we conducted a retrospective cohort study from 2008 to 2019. Based on international normalized ratio (INR) value and platelet count, we diagnosed CAAC cases and made the following stratification of severity: mild CAAC was defined as 1.4 > INR≧1.2 and 100,000/µL < platelet count≦150,000/µL; moderate CAAC was defined with either 1.6 > INR≧1.4 or 80,000/µL < platelet count≦100,000/µL; severe CAAC was defined as an INR≧1.6 and platelet count≦80,000/µL. A total of 1485 patients were included. Crude survival analysis showed that patients with CAAC had higher mortality risk than those without CAAC (33.0% vs 52.0%, P < 0.001). Unadjusted survival analysis showed an incremental increase in the risk of mortality as the severity of CAAC increased. After adjusting confounders (prehospital characteristics and hospitalization characteristics), CAAC was independently associated with 30-day mortality (hazard rate [HR] 1.77, 95% confidence interval [CI] 1.41-2.25; P < 0.001); moderate CAAC (HR 1.48, 95% CI 1.09-2.10; P = 0.027) and severe CAAC (HR 2.22, 95% CI 1.64-2.97; P < 0.001) were independently associated with 30-day mortality. The presence of CAAC identifies a group of CA at higher risk for mortality, and there is an incremental increase in risk of mortality as the severity of CAAC increases. However, the results of this study should be further verified by multicenter study.
| S-EPMC10777779 | biostudies-literature
Project description:This research sought to ascertain the relationship between hematocrit (HCT) and mortality in patients with sepsis.MethodsA retrospective analysis was conducted on the clinical data of septic patients who were hospitalized between 2008 and 2019 in an advanced academic medical center in Boston, Massachusetts, registered in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, We analyzed basic information including gender, age, race, and types of the first admission, laboratory indicators including HCT, platelets, white blood cells, albumin, bilirubin, hemoglobin, and serum creatinine, and 30-day mortality. A Cox proportional hazards regression model was utilized to analyze the relationship between HCT and 30-day mortality in patients with sepsis.ResultsThis research recruited 2057 patients who met the research requirements from 2008 to 2019. According to the HCT level, it was classified into the low HCT level, the regular HCT level, and the high HCT level. The 30-day mortality rate was 62.6%, 27.5%, and 9.9% for patients with the low HCT level, the regular HCT level, and the high HCT level, respectively (p < 0.05). The multivariate Cox proportional hazard regression model analysis displayed that compared with patients with the regular HCT level, the 30-day mortality of patients with the low HCT level increased by 58.9% (hazard ratio = 1.589, 95% confidence interval (CI) = 1.009-2.979, p < 0.05).ConclusionThe low HCT level is an independent risk factor for the increase of the 30-day mortality in patients with sepsis and can be used as a significant predictor of the clinical outcome of sepsis.
| S-EPMC8947025 | biostudies-literature
Project description:IntroductionThis study aimed to explore the association of serum lactate with clinical outcomes in elderly patients with sepsis based on data from the MIMIC-IV database.MethodsAll elderly patients with sepsis (age ≥ 65 years) were included. Different models were constructed for exploring the relationships between lactate and 28-day mortality. A two-segment linear regression model was performed to verify the threshold effects of lactate on clinical outcomes and smooth curve fitting was performed.ResultsA total of 4199 elderly patients with sepsis were included. The 28-day mortality was 32.22% (n = 1395). After adjustment for all potential cofounders, for each 1 mmol/l increment in lactate, the odds ratio (OR) of 28-day mortality was 1.23 (95% CI 1.18-1.28, P < 0.0001). Smooth fitting curves indicated a non-linear positive relationship between lactate and 28-day mortality. The turning point of lactate level was 5.7 mmol/l: at ≤ 5.7 mmol/l, with each 1 mmol/l increment in lactate, the risk of 28-day mortality increased significantly (OR 1.32, 95% CI 1.25-1.38, P < 0.0001); the significantly positive relationship was still present at lactate > 5.7 mmol/l (OR 1.10, 95% CI 1.04-1.18, P = 0.0019). The area under the ROC curve (AUC) of lactate was 0.618 (95% CI 0.599-0.635) and the cutoff value of lactate was 2.4 mmol/l with a sensitivity of 0.483 and a specificity of 0.687.ConclusionIn elderly patients with sepsis, a non-linear positive relationship was discovered between serum lactate and 28-day mortality. Physicians should be alert to lactate assessment at admission and pay more attention to those patients with higher levels of lactate.
| S-EPMC9925625 | biostudies-literature
Project description:ObjectiveThis study aimed to investigate the relationship between serum lactate levels at admission to the intensive care unit (ICU) and the clinical outcomes of children with sepsis.MethodsWe used the Pediatric Intensive Care (PIC) database to identify 288 pediatric patients with sepsis. We analyzed the relationship between lactate levels and hospital and ICU mortality in sepsis by establishing a segmented multivariable Cox regression model. We also conducted subgroup analysis as well as analyzed the restricted cubic spline curves.ResultsAfter adjusting for all potential confounding factors, an increase of 1 mmol/L in lactate levels was found to be associated with an 17% rise in the 28-day hospital mortality risk among sepsis patients (HR: 1.17, 95% CI: 1.08-1.27, P = 0.0002). When considering lactate as a categorical variable, the mortality risk of patients with lactate levels ≥ 2.2 mmol/L was significantly increased (HR: 3.61, 95% CI: 1.24-10.54, P = 0.0189). The restricted cubic spline curve analysis revealed a nonlinear correlation between lactate and 28-day mortality, with an inflection point at 2.2 mmol/L. Similar findings were also observed in the assessment of secondary outcomes.ConclusionsOur study demonstrates a non-linear correlation between lactate levels and 28-day mortality in pediatric sepsis, with a critical threshold of 2.2mmol/l for lactate levels in septic patients. Early assessment of lactate levels is recommended for children with sepsis to facilitate prompt intervention and mitigate the risk of fatality.
| S-EPMC11542395 | biostudies-literature
Project description:BackgroundStatins, acknowledged for their ability to reduce cardiovascular risk, demonstrate a variety of pleiotropic effects, including anti-inflammatory, antithrombotic, endothelial stabilizing activity and prevention of acute kidney injury (AKI) post cardiac surgery. Patients in the intensive care unit (ICU) face heightened risks of cardiovascular disease, infections, and thrombotic complications, but the effect of statin therapy on ICU mortality remains controversial. The Medical Information Mart for Intensive Care IV (MIMIC-IV) database is a publicly available intensive care medicine information database that includes data on critically ill patients admitted to the ICU at Beth Israel Deaconess Medical Center from 2008 to 2019, with a large sample size. In this retrospective cohort study, the MIMIC-IV database was used to clarify the association between statin therapy and all-cause mortality in critically ill patients. An additional aim was to compare the effect of different statin types on mortality.MethodsPatients aged 18 years or older, with first-time admissions and complete data, were categorized based on their use of statins during their ICU stay. The primary outcome was 28-day mortality, analyzed through multivariable Cox regression and expressed as adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). The relationship between statin therapy and 28-day mortality in ICU patients was estimated using propensity score matching (PSM) and multivariable analysis to adjust for covariates.ResultsAmong the 50,624 enrolled patients, 30.9% were treated with statins. Compared to patients not receiving statin therapy, those on statins were older, had a higher proportion of males (62.0% vs. 53.1%), a greater percentage with health insurance (50.2% vs. 39.5%), and a higher rate of concurrent aspirin use (70.8% vs. 18.2%). In terms of comorbidities, patients in the statin group had higher proportions of congestive heart failure (CHF), AKI, myocardial infarction, and chronic obstructive pulmonary disease (COPD). Statin treatment in patients in the ICU was correlated with reduced 28-day all-cause mortality in the multivariate Cox analysis (statins: HR =0.66, 95% CI: 0.61-0.70; atorvastatin: HR =0.71, 95% CI: 0.66-0.78; rosuvastatin: HR =0.57, 95% CI: 0.45-0.72; simvastatin: HR =0.54, 95% CI: 0.48-0.62; other statins: HR =0.68, 95% CI: 0.56-0.83). PSM confirmed these findings (statins: HR =0.69, 95% CI: 0.63-0.75).ConclusionsStatin use may correlate with a decreased risk of 28-day mortality in patients in the ICU, with simvastatin showing a more pronounced effect. The robustness of these findings remain unaffected in the subgroup analyses, sensitivity analyses, and PSM, indicating potential clinical significance. The high mortality rate among ICU patients means that any method capable of reducing mortality could have significant implications for ICU treatment.
| S-EPMC11833575 | biostudies-literature
Project description:BackgroundThe severity of sepsis is associated with systemic clotting activation. Atrial fibrillation (AF) is the most commonly observed arrhythmia in patients with sepsis and can lead to a poor prognosis. The aim of this study is to elucidate the association between oral anticoagulants and survival from septic patients complicated with AF.MethodsThe data of 8,828 septic patients, including 2,955 AF and 5,873 without AF, were all originated from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients with sepsis and AF are divided into OAC- group (n = 1,774) and OAC+ group (n = 1,181) based on OAC therapy. Septic patients with no AF were considered as the control group (n = 5,873, sepsis and no AF group). The main outcome endpoint was the survival rate of 30 day. The secondary outcome endpoint was the length of stay (LOS) from intensive care unit and hospital. Propensity score matching (PSM) was used to adjust the influence of superfluous factors, and a restricted mean survival time (RMST) analysis was used for calculating the benefit of survival time and survival rate. Analysis including univariate and multivariate logistic regression analysis was conducted to find prognosis-related predictors.ResultsAfter PSM, the OAC+group had a higher 30-day survival rate compared to the OAC- group (81.59% vs. 58.10%; P < 0.001) in the ICU. Despite the higher survival, the hospital LOS (14.65 days vs. 16.66 days; P = 0.15) and ICU LOS (6.93 days vs. 5.92 days; P = 0.02) were prolonged at OAC+ group than OAC- group. No difference was found in survival rate of 30 day between the sepsis patients using warfarin and patients using NOAC (85.60% vs. 79.84%, P = 0.12). The sepsis patients using warfarin had a prolonged LOS in ICU and hospital compared with the sepsis patients using NOAC. In the vasopressor subgroup, patients who received NOAC therapy were associated with a reduced 30-day survival rate (73.57% vs. 84.03%; P = 0.04) and reduced LOS in ICU and hospital than those on warfarin therapy.ConclusionThis study demonstrated that oral anticoagulants may increase the 30-day survival rate of patients with sepsis and AF.
| S-EPMC10830619 | biostudies-literature
Project description:ObjectiveThis study planned to analyse the association between ondansetron use within 24 hours before intensive care unit (ICU) admission to within 48 hours after ICU admission and the risk of sepsis in ICU patients.DesignA cohort study.Setting and participantsData of 65 366 participants in Medical Information Mart for Intensive Care IV from ICU in the Beth Israel Deaconess Medical Center.Primary and secondary outcome measuresSepsis was the primary outcome, which indicated patients with documented or suspected infection and acute change in total Sequential Organ Failure Assessment (SOFA) score ≥2 points. In-hospital mortality was the secondary outcome.ResultsThere were 6737 patients with early ondansetron use. In total, 1646 patients suffered sepsis. According to the data from multivariate cox regression model, compared with participants without early ondansetron use, the risk of sepsis was reduced in participants with early ondansetron use relative to those without HR (HR=0.84, 95% CI: 0.76 to 0.93). The risk of in-hospital mortality was reduced in those with early ondansetron use (HR=0.63, 95% CI: 0.55 to 0.72). Subgroup analysis revealed that the association between early ondansetron use and decreased risk of sepsis was significant in participants aged <65 years, men, not complicated with trauma, no surgery, systemic inflammatory response syndrome ≥2, Charlson Comorbidity Index ≥2, with ventilation use, without antibiotics use or without insulin use. In both patients with SOFA <3 or SOFA ≥3, early ondansetron use was correlated with a reduced risk of sepsis.ConclusionPatients with early ondansetron use had lower odds of experiencing sepsis than patients without early ondansetron use, which might provide a reference for the management of sepsis in ICU patients.
| S-EPMC11752024 | biostudies-literature
Project description:BackgroundThis study aimed to evaluate the association between the glucose-to-lymphocyte ratio (GLR) and in-hospital mortality in intensive care unit (ICUs) patients with sepsis.MethodsThis is a retrospective cohort study. Patients with sepsis from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database had their baseline data and in-hospital prognosis retrieved. Multivariable Cox regression analyses were applied to calculate adjusted hazard ratios (HR) with 95% confidence intervals (CI). Survival curves were plotted, and subgroup analyses were stratified by relevant covariates. To address the non-linearity relationship, curve fitting and a threshold effect analysis were performed.ResultsOf the 23,901 patients, 10,118 patients with sepsis were included. The overall in-hospital mortality rate was 17.1% (1,726/10,118). Adjusted for confounding factors in the multivariable Cox regression analysis models, when GLR was used as a categorical variable, patients in the highest GLR quartile had increased in-hospital mortality compared to patients in the lowest GLR quartile (HR = 1.26, 95% CI: 1.15-1.38). When GLR was used as a continuous variable, each unit increase in GLR was associated with a 2% increase in the prevalence of in-hospital mortality (adjusted HR = 1.02, 95% CI: 1.01-1.03, p = 0.001). Stratified analyses indicated that the correlation between the GLR and in-hospital mortality was stable. The non-linear relationship between GLR and in-hospital mortality was explored in a dose-dependent manner. In-hospital mortality increased by 67% (aHR = 1.67, 95% CI: 1.45-1.92) for every unit GLR increase. When GLR was beyond 1.68, in-hospital mortality did not significantly change (aHR: 1.04, 95% CI: 0.92-1.18).ConclusionThere is a non-linear relationship between GLR and in-hospital mortality in intensive care patients with sepsis. A higher GLR in ICU patients is associated with in-hospital mortality in the United States. However, further research is needed to confirm the findings.
| S-EPMC9448903 | biostudies-literature
Project description:ImportanceWhile corticosteroid administration in septic shock has been shown to result in faster shock reversal and lower short-term mortality, the role of corticosteroids in the management of cardiogenic shock (CS) remains unexplored.ObjectivesDetermine the impact of corticosteroid administration on 90-day mortality (primary outcome) in patients admitted to a critical care unit with CS.Design, setting, and participantsIn this retrospective cohort study, we used the critical care database of Medical Information Mart for Intensive Care-IV, and included all adult patients diagnosed with CS excluding repeated admissions, patients with adrenal insufficiency, those receiving baseline corticosteroids, and those requiring extracorporeal life support. We considered exposure based on receiving systemic corticosteroids from 6 hours before to 24 hours post-critical care admission.Main outcomes and measuresWe calculated Cox proportional hazards using multivariate analysis for 90-day mortality (primary outcome). We also explored the association of corticosteroid use with hospital length of stay, ventilator-free days (VFDs), vasopressor-free days, ventilator-associated pneumonia, central-line-associated bloodstream infections, and hyperglycemia.ResultsWe included 2000 eligible patients, with 143 (7.2%) receiving systemic corticosteroids. Corticosteroid-treated patients were younger (67.7 vs. 71.2 yr; p = 0.006), had higher Sequential Organ Failure Assessment scores at baseline (9.4 vs. 7.8; p < 0.001), and more often required vasopressors (78% vs. 63%; p < 0.001), and invasive mechanical ventilation (73% vs. 45%; p < 0.001). Corticosteroid use was associated with increased 90-day mortality in multivariate analysis (hazard ratio, 1.60; 95% CI, 1.25-2.05) and fewer VFDs (2.8 d fewer; 95% CI, 0.35-5.26) with no effect on other secondary outcomes.Conclusions and relevanceUse of corticosteroids may be associated with increased mortality and a reduction in VFDs in patients admitted to critical care with CS. These findings suggesting potential harm of corticosteroids in CS might reflect unmeasured confounding and require corroboration through additional observational studies and ultimately randomized clinical trials.
| S-EPMC11789865 | biostudies-literature
Project description:BackgroundAtrial fibrillation (AF) is a common cardiac arrhythmia. The ratio of red cell distribution width (RDW) to albumin has been recognized as a reliable prognostic marker for poor outcomes in a variety of diseases. However, the evidence regarding the association between RDW to albumin ratio (RAR) and in hospital mortality in patients with AF admitted to the Intensive Care Unit (ICU) currently was unclear. The purpose of this study was to explore the association between RAR and in hospital mortality in patients with AF in the ICU.MethodsThis retrospective cohort study used data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database for the identification of patients with atrial fibrillation (AF). The primary endpoint investigated was in-hospital mortality. Multivariable-adjusted Cox regression analysis and forest plots were utilized to evaluate the correlation between the RAR and in-hospital mortality among patients with AF admitted to ICU. Additionally, receiver operating characteristic (ROC) curves were conducted to assess and compare the predictive efficacy of RDW and the RAR.ResultsOur study included 4,584 patients with AF with a mean age of 75.1 ± 12.3 years, 57% of whom were male. The in-hospital mortality was 20.3%. The relationship between RAR and in-hospital mortality was linear. The Cox proportional hazard model, adjusted for potential confounders, found a high RAR independently associated with in hospital mortality. For each increase of 1 unit in RAR, there is a 12% rise in the in-hospital mortality rate (95% CI 1.06-1.19). The ROC curves revealed that the discriminatory ability of the RAR was better than that of RDW. The area under the ROC curves (AUCs) for RAR and RDW were 0.651 (95%CI: 0.631-0.671) and 0.599 (95% CI: 0.579-0.620).ConclusionsRAR is independently correlated with in hospital mortality and in AF. High level of RAR is associated with increased in-hospital mortality rates.
| S-EPMC10956318 | biostudies-literature