Background With the more advanced science in the field of medicine and disease management, the population of geriatric intensive care patients is increasing. The COVID-19 pandemic has impacted healthcare management around the globe, especially on critically-ill elderly patients. We aim to analyse the relationship between underlying illnesses, including COVID-19, and the survival rate of elderly patients who are treated in the intensive care setting. Methods We conducted a prospective cohort study at 14 teaching hospitals for Anaesthesiology and Intensive Therapy Education in Indonesia. We selected all subjects with 60 years of age or older in the period between February to May 2021. Variables recorded included subject characteristics, comorbidities, and COVID-19 status. Subjects were followed for 30-day mortality as an outcome. We analysed the data using Kaplan-Meier survival analysis. Results We recruited 982 elderly patients, and 728 subjects were in the final analysis (60.7% male; 68.0 ± 6.6 years old). The 30-day mortality was 38.6%. The top five comorbidities are hypertension (21.1%), diabetes (16.2%), moderate or severe renal disease (10.6%), congestive heart failure (9.2%), and cerebrovascular disease (9.1%). Subjects with Charlson’s Comorbidity Index Score > 5 experienced 66% death. Subjects with COVID-19 who died were 57.4%. Subjects with comorbidities and COVID-19 had lower survival time than subjects without those conditions (p < 0.005). Based on linear correlation analysis, the more comorbidities the geriatric patients in the ICU had, the higher chance of mortality in 30 days (p < 0.005, R coefficient 0.22). Conclusion Approximately one in four elderly intensive care patients die, and the number is increasing with comorbidities and COVID-19 status.
Latar Belakang: Organisasi Kesehatan Dunia (WHO) mendeklarasikan penyebaran dari coronavirus disease 2019 (COVID-19). Faktor risiko terhadap mortalitas pasien COVID-19 rawat intensive care unit (ICU) belum banyak diteliti.Tujuan: Mengetahui hubungan penanda infeksi, penanda oksigenasi dan faktor risiko lainnya terhadap mortalitas pasien COVID-19 dengan pneumonia.Metode: Penelitian retrospektif dilakukan di ICU Infection Centre RSUP Dr. Wahidin Sudirohusodo, Makassar pada April – Agustus 2020. Sampel penelitian adalah data pasien COVID-19 dengan pneumonia yang dirawat di ICU. Pasien dibagi ke dalam dua kelompok survivor grup (SG) dan non-survivor (NSG). Variabel penelitian berupa penanda infeksi, penanda oksigenasi dan faktor risiko yang didapatkan dari rekam medis pasien. Analisis bivariat dan multivariat dilakukan terhadap semua variabel penelitian.Hasil: Dari 92 pasien didapatkan 46 NSG dan 46 SG. Perbandingan jenis kelamin dan indeks massa tubuh antara kedua kelompok tidak signifikan bermakna secara statistik. Tidak didapatkan perbedaan signifikan secara statistik pada level c-reactive protein (CRP) antara kelompok NSG dengan median 91,1 (IQR 32,3-200,45) dan SG 88,95 (IQR 33,50-177,80), p= 0,899. Faktor risiko usia tua, diabetes mellitus (DM), dan peningkatan rasio neutrofil-limfosit (RNL) berdasarkan klasifikasi cut-off signifikan secara statistik pada mortalitas antar kedua kelompok. Pada NSG didapatkan median usia 60,5 (IQR 53-67,25) vs SG 56 (IQR 35-61,25), p= 0.02. Komorbid DM SG 8 dari 46 pasien (17,4%) dan NSG 17 dari 46 pasien (37%), p = 0,035. Pemeriksaan kadar RNL berdasarkan klasifikasi cut-off > 3,4 NSG 42 dari 46 pasien (91,3%) dan NS 11 dari 46 (23,9%), p= 0,048. Analisis multivariat regresi logistik didapatkan rasio P/F merupakan faktor risiko independen. Mortalitas pasien COVID-19 dengan pneumonia (OR 0,99 95% CI 0,988-1,00, p = 0,043). Kesimpulan: Umur di atas 60 tahun, DM, RNL, dan indeks oksigenasi bermakna secara signifikan terhadap kejadian mortalitas pasien COVID-19 dengan pneumonia, dimana pada indeks oksigenasi yang rendah didapatkan kejadian mortalitas yang tinggi.
Background: As many as 20% of maternal deaths are caused by premature rupture of membranes (PROM). The high rate of PROM is believed to affect newborn asphyxia. In addition, the high rate of cesarean section is one of the reasons or most frequent indications of PROM. Therefore, researchers were interested in knowing how the relationship between PROM and delivery method and newborn asphyxia was.Methods: This study was an analytical study conducted with a cross-sectional approach by taking secondary data from patients through medical records of pregnant women who experienced PROM in January 2020 to July 2021.Results: This study found that the incidence of PROM was more dominant in multiparous women 55.4%, in term pregnancy 79.2%, duration of PROM ≥12 hours 55.4%, have normal leukocyte levels 76.2%, the incidence of asphyxia (mild asphyxia) 90.1% and the rate of cesarean section as much as 24%. The bivariate analysis found a significant relationship between the length of PROM and the method of delivery (p value 0.049) and the duration of PROM with newborn asphyxia (p value 0.040) and there was no significant relationship between maternal leukocyte count and newborn asphyxia (p value 0.444).Conclusions: The longer the duration of PROM with delivery, the greater the chance of infection for the mother and fetus. The length or duration of PROM will have an impact on the method of delivery and increase the likelihood of asphyxia in newborns.
Peritonitis akibat infeksi intraabdominal, khususnya peritonitis sekunder merupakan salah satu penyebab syok sepsis dengan tingkat morbiditas dan mortalitas yang tinggi. Perkembangan dalam pemahaman fisiologi, pemantauan, dan tunjangan sistem kardiopulmonal, serta penggunaan obat-obat baru secara rasional membuat mortalitas stabil pada kisaran 30%. Kasus ini mengenai seorang pasien perempuan usia 67 tahun masuk rumah sakit dengan diagnosis peritonitis generalisata karena suspek perforasi Hollow viscous. Setelah menjalani operasi laparatomi untuk source control, pasien dirawat di ICU selama 5 hari. Selama perawatan pasien mengalami edema paru, sepsis, anemia, hipokalemia, hipoalbuminemia, serta acute kidney injury (AKI). Pada pasien dilakukan tindakan ventilasi mekanik selama 4 hari yang diiringi dengan pemantauan analisis gas darah arteri dan furosemid untuk tata laksana edema paru dan fluid overload. Resusitasi dan pemeliharaan cairan sambil memantau hemodinamik konvensional dan melalui ICON, balance kumulatif, fluid overload, tekanan vena sentral, serta urine output. Terapi antimikrob diberikan berdasar atas pedoman terapi infeksi intraabdominal dan antibiogram ICU rumah sakit. Kondisi perfusi dipantau dengan kadar laktat dan SCVO2. Respons antibiotik dan perbaikan sepsis dipantau dengan pemeriksaan prokalsitonin dan leukosit. Perbaikan AKI dipantau dengan produksi urine serta kadar ureum dan kreatinin. Penatalaksanaan peritonitis sekunder dengan komplikasi sepsis dengan penyulit AKI telah berhasil dilakukan di ICU. Peritonitis sekunder memiliki tingkat mortalitas yang cukup tinggi, namun dengan source control yang adekuat dan manajemen di ICU yang agresif maka diperoleh hasil yang baik seperti pada kasus ini.
Abstracts Objective: This study aims to know the correlation between the degree of glycocalyx damage and the incidence of Acute Renal Injury (AKI) in sepsis patients in the intensive care unit. In this study, a review of Syndecan-1 and sICAM-1 marker represented the severity of glycocalyx damage. Furthermore, the researchers wanted to see whether this marker in the serum of septic patients could predict the occurrence of AKI in the future of septic patients in the ICU. Design: This study is a prospective cohort nested-case control study, a case-control study conducted in a cohort population. Setting: This research has been carried out in the ICU, both RSPTN UNHAS and Dr. Wahidin Sudirohusodo Makassar. Syndecan-1 and sICAM-1 examination was carried out in the Hasanuddin University Hospital laboratory. Patients and participants: The sample was taken from septic patients treated in the ICU of RSPTN UNHAS and Dr. Wahidin Sudirohusodo Makassar admitted in January 2021. The sample selection was carried out consecutively, namely the selection of respondents based on the arrival of patients treated in the ICU until fulfilled. Measurement and Results: Data analysis in this study used the Mann-Whitney and Unpaired T-test. There was a significant difference in serum syndecan-1 levels between the two groups on day 0 and day 3 of ICU admission and changes from day 0 to day three. However, there was no significant relationship between sICAM-1 level in the two groups on day 0 and day 3 of ICU admission likewise its changes. Changes in syndecan-1 levels between the two groups were significantly different through the unpaired T-test. Conclusions: In this study, syndecan-1 levels can be used to predict the occurrence of AKI in the future for septic patients, while sICAM-1 is not statistically significant in predicting the occurrence of AKI among septic patients. Syndecan-1 is vital in the glycocalyx damage and helps predict clinical outcomes in patients with AKI.
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