Aim As the COVID‐19 pandemic has been spreading rapidly all over the world, there are plenty of ongoing works to shed on light to unknown factors related to disease. One of the factors questioned is also to be the factors affecting the disease course. In this study, our aim is to determine the factors that affect the course of the disease in the hospitalised patients because of COVID‐19 infection and to reveal whether the seasonal change has an effect on the disease course. Methods Our study was conducted on 1950 PCR test positive patients who were hospitalised for COVID‐19 disease between March 16 and July 15. Results As the seasonal temperature increases, decrease in WBC, PLT and albumin levels and increase in LDH and AST levels were observed. Risk of need for ICU has been found statistically significant (P < .05) with the increase in the age, LDH levels and CRP levels and with the decrease in the Ca and Albumin levels. Conclusions It is predicted with these results that, seasonal change might have affects on the clinical course of the disease, although it has no affect on the spread of the disease. And it might beneficial to check biochemical parameters such as LDH, CRP, Ca and Albumin to predict the course of the disease.
A bstract Background Knowing the risk factors for patients in intensive care units (ICUs) facilitates patient's management. The goal of this study was to determine the risk agents that influence our medical ICU mortality. Patients and methods This 11-month retrospective trial was managed in the medical ICU. In this study, 340 patients who were followed up for at least 24 hours in ICUs were accepted. The clinical data on patients were recorded retrospectively, and the mortality-related factors were analyzed. A regression analysis was also performed to determine the independent risk factors for ICU mortality. Results The median age was 73 (53–82) years. The death rate was 23.8%. Length of stay (LOS) in ICU was 3 (2–5) days, and APACHE-II (acute physiologic and chronic health evaluation) score was 19 (13–25). The prevalence of chronic diseases was not dissimilar except acute and chronic renal failures among survivors and deceased patients ( p >0.05). Acute and chronic renal failures were higher in deceased patients than in survivors and were statistically important [107 (41.3%) vs 47 (58%), p = 0.008] and 38 (14.7%) vs 22 (27.2%), p = 0.01], respectively. In the binary logistic regression analysis, age, APACHE II score, need for invasive mechanical ventilation (IMV), decreased serum albumin levels, and increased creatinine levels were established to be independent risk factors for death [(OR (odds ratio): 1.045 (1.009–1.081), p = 0.013, OR: 1.076 (21.008–1.150), p = 0.029, OR: 19.655 (6.337–60.963), p = 0.001), OR: 2.673 (1.191–6.024), p = 0.017, OR: 1.422 (1.106–1.831), p = 0.006)], respectively. Conclusion The most significant risk agents of death were determined through high APACHE II score, decreased serum albumin levels, and increased creatinine levels. How to cite this article Kalın BS, Özçaylak S, Solmaz İ, Kılıç J. Assessment of Risk Factors for Mortality in Patients in Medical Intensive Care Unit of a Tertiary Hospital. Indian J Crit Care Med 2022;26(1):49–52.
GirişBeta bloker intoksikasyonları, tüm intoksikasyon olgularının içerisinde düşük bir yüzde (%0,9) oluşturmakla birlikte mortalite oranı yüksek seyretmektedir (1,2). Lipid çözünürlüğünün yüksek olması ve santral sinir sistemine kolay geçişine bağlı olarak intoksikasyon durumunda; nöbet, solunum depresyonu ve koma gibi ciddi bulgular görülebilir. Kardiyovasküler sistemde; dirençli bradikardi, hipotansiyon ve şok gözlenebilir. Beta bloker intoksikasyonu tedavisinde; insülin + dekstroz, glukagon, sodyum bikarbonat, noradrenalin, adrenalin, dopamin, mekanik destek (pacemaker, ekstra korporeal membran oksijenasyonu, intraaortik balon pompası) ve intravenöz (i.v.) lipid emülsiyon (İLE) tedavisi uygulanmaktadır. Lipid emülsiyonların, lipofilik ajanların yol açtığı kardiyak yan etkileri farklı mekanizmalar ile geriye çevirdiği çeşitli hayvan deneyleri ve olgu sunumları ile gösterilmiştir (3-7). Biz de çeşitli ilaç alımı eşliğinde yüksek doz propranolol alımı sonrasında İLE tedavisi sonucunda başarılı olduğumuz, tedaviye dirençli olguyu sunmayı amaçladık.ABSTRACT Diagnosis and treatment management is difficult in cases of intoxication with multiple drugs. A 29-year-old female patient was admitted to the emergency department with multiple doses of propranolol, biperidene, risperidone and valproic acid for suicidal purposes. She had cardiovascular collapse despite fluid therapy and multiple high-dose vasopressor infusions. Intravenous lipid emulsion (ILE) treatment was administered to the patient who had hypotension that was resistant to hyperinsulinemic euglycemia and glucagon therapy. Hemodynamic stability was achieved after three hours. Intoxication with beta-blockers may be life threatening. Propranolol is a beta-blocker drug that binds highly to plasma proteins and has high lipophilic properties. The classical therapies recommended for severe beta-blocker intoxications may be insufficient, and successful results can be obtained with ILE application. In this case report, we wanted to emphasize that management of multiple drug intoxication is difficult and ILE treatment may be successful in treatment-resistant beta-blocker intoxications.ÖZ Çok sayıda ilaç alınarak meydana gelen intoksikasyonlarda tanı ve tedavi yönetimi zordur. Yirmi dokuz yaşında kadın hasta özkıyım amaçlı aşırı doz propranolol, biperiden, risperidon ve valproik asit alarak çoklu ilaç zehirlenmesi tablosunda acil servise getirildi. Sıvı tedavisi ve çoklu yüksek doz vazopresör infüzyonuna karşın kardiyovasküler kollaps tablosu düzelmedi. Hiperinsülinemik öglisemi ve glukagon tedavisine dirençli hipotansiyonu devam eden olguya intravenöz lipid emülsiyon (İLE) tedavisi uygulandı. Üç saat sonra hemodinamik stabilite sağlandı. Beta blokerler ile olan zehirlenmeler hayatı tehdit edebilen ciddi zehirlenmelerdir. Propranolol, plazma proteinlerine yüksek oranda bağlanan yüksek lipofilik özellik gösteren beta bloker ilaçtır. Ciddi beta bloker zehirlenmelerinde önerilen klasik tedaviler yetersiz kalabilmekte ve İLE uygulaması ile başarılı sonuçlar alınabilmektedi...
Objective The aim of this study was to determine the prevalence of the causative agents of multi‐drug resistant bacteria in pneumonia and also evaluate their mortality rates in the intensive care unit (ICU). Methods This study included all the cases of hospital‐acquired pneumonia (HAP) and community‐acquired pneumonia (CAP) in the ICU between the period of January 2018 and December 2019. Results Seventy‐four patients in pneumonia were included. Mortality rate was 45.9%. In patients with HAP had higher length of stay days in hospital and ICU, the use of sedative agents, sepsis rate and mortality rate as compared in patients with CAP (for all P < .05). Microorganism was identified in 27 (36.6%) of the patients. Respiratory samples were positive in 25.4% of patients with CAP and 60.8% of patients with HAP. Acinetobacter baumannii and Klebsiella pneumoniae were the most frequent aetiologic agents (40.7% and 22.2%, respectively). Acinetobacter baumannii was not susceptible to the third generation cephalosporin, piperacillin‐tazobactam, carbapenem, fluoroquinolone and trimethoprim/sulfamethoxazole. Amongst gram‐positive bacteria, the most common isolate was Staphylococcus aureus. The frequency of methicillin‐resistant Staphylococcus aureus was 75% but these isolates were susceptible to vancomycin and tigecycline. Conclusion The predominance of gram‐negative agents was observed in pneumonia patients and because of the high resistance to antibiotics, treatment strategies need to be reconsidered in order to improve the poor prognosis.
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