Background:Sepsis is an important cause of mortality in the Intensive Care Units (ICUs) worldwide. Information regarding early predictive factors for mortality and morbidity is limited.Aims and Objectives:The primary objective of the study was to estimate the mortality of severe sepsis among adult patients admitted into the medical ICU. The secondary objective was to identify the predictors associated with mortality.Materials and Methods:Adult patients admitted with severe sepsis in the medical ICU were studied. The primary outcome was the mortality among the study population. Baseline demographic, clinical, and laboratory data were recorded upon inclusion into the study. Risk factors associated with mortality were studied by univariate analysis. The variables having statistical significance were further included in multivariate analysis to identify the independent predictors of mortality.Results:Out of eighty patients, 54 (67.5%) died. Univariate analysis showed that age >60 years, tachycardia, hypotension, elevated C-reactive protein (CRP) and lactate, thrombocytopenia, need of mechanical ventilation, and high Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment scores were variables associated with high mortality. The independent predictors of mortality identified by multivariate regression analysis were platelet count below 1 lakhs, serum levels of CRP >100, APACHE II score >25 on the day of admission to the ICU with severe sepsis, and the need for invasive mechanical ventilation.Conclusions:Low platelet count, elevated serum levels of CRP, APACHE score >25, and the need for invasive mechanical ventilation were found to be independent predictors of mortality of severe sepsis among adult patients with severe sepsis in the medical ICU.
BACKGROUND: Atrial Fibrillation (AF) is the most frequent type of arrhythmia. Termination of acute AF is generally undertaken in a hospital setting. Available drugs for termination of acute AF have severe side effects and complicated dose regimens. There is a need for new drugs with a high conversion rate, favourable safety profile and easier dosing. OBJECTIVES: To describe the characteristics and hospital treatment patterns of patients with AF. To investigate the requirements for an improved cost‐effective anti‐arrhythmic therapy. METHODS: A database was used containing aggregated and anonymised diagnostic information, hospital experience (e.g., length of stay), and demographic data for over 80 million inpatient episodes in the UK over ten years. The database contains 28,524 hospital admissions of patients (65 and over) with a diagnosis of AF during 1999/2000. 53.3% are female, with mean length of stay (LOS) 6.1 days; 46.7% are male with LOS 4.3 days. Controlling for age, the gender LOS difference is significant (p < 0.01). RESULTS: Comorbid Conditions. 17.5% of AF patients also had a diagnosis of chronic ischaemic heart disease (IHD), a further 7.5% had myocardial ischaemia, and 19.5%, congestive heart failure. Furthermore, 24.2% of CHF patients and 16.9% of all angina patients also had clinically significant AF. Cardioversion. Cardioversion (defibrillation) is used when pharmacological therapy fails to terminate acute AF. However, significant numbers (35%) of cardioversion procedures were undertaken on an elective day case basis. We are currently investigating and will report on the resource consequences in acute AF. CONCLUSIONS: There is a clear unmet medical need for improved anti‐arrhythmic drugs. Using the dataset, we identify two potentially cost‐effective possibilities for improved anti‐arrhythmic treatment: an agent which can simultaneously demonstrate effectiveness in associated cardiovascular conditions such as IHD or CHF; or an agent reducing the need for cardioversion in acute AF.
BACKGROUND An exacerbation of COPD is defined as an acute worsening of respiratory symptoms that result in additional therapy. COPD is currently the fourth leading cause of death in the world. There is a need for prospective trials in COPD based on hard clinical outcomes such as death to bring improvements in clinical managements. Chronic obstructive pulmonary disease (COPD) ranks fourth as a cause of death in the United States, behind heart disease, cancer, and stroke. COPD is a costly disease with both direct costs (value of health care resource devoted to diagnosis and management) and indirect costs (monetary consequences of disability, missed work, premature mortality and caregiver or family costs resulting from the illness 1). Diagnostics test for COPD is spirometry FEV1/FVC. Spirometry is costly and is not readily available in rural settings and the technique to perform spirometry involves a lot of patient's conscious effort. Whereas ECG is easily available, affordable, does not require patient's conscious effort. We wanted to predict the electrocardiographic findings predicting mortality in acute exacerbation of COPD. METHODS This is an observational study including 101 patients with COPD acute exacerbations admitted in our institution for a period of 1 year. Selected patients were evaluated with a detailed clinical history and a 12 lead ECG is taken. Data was collected and tabulated. Statistical analysis was done using SPSS Software Version 12.0 and Epi Info Version 3.4.1. Univariate analysis comparing various variables in survivors and non survivors was done using Chi Square test and p value and Odds ratio were calculated. Then multivariate analysis was done using linear regression analysis to find out the most important independent predictors of mortality in COPD acute exacerbations. Study was approved by institutional ethics committee. RESULTS In this study, all the patients were males. 34 patients died during treatment. In the study, mean age of patients was 62.33 years. Of the patients who died, 10 (29.41%) were beedi smokers, and 24 patients were cigarette smokers. More patients belonged to the group with heavy smoking score, i.e.; >400. Presence of p pulmonale and RVH in ECG was found to be a predictor of poor outcome in case of a COPD acute exacerbation (p value <0.05). CONCLUSIONS In this study, majority of the patients belonged to the age group 60-70 years. Dyspnoea was the predominant symptom of our patients. Mortality rate of COPD acute exacerbations was 33.66% in this observational study. Electrocardiographic findings of p pulmonale and right ventricular hypertrophy were found to be predictors of mortality in COPD acute exacerbations by univariate analysis and multivariate analysis. In this study, electrocardiographic findings of p pulmonale and right ventricular hypertrophy were found to be important predictors of mortality in COPD acute exacerbations.
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