• Acute kidney injury
• MIMIC-IV
• intensive care unit
• nomogram
• prediction model

• Humans
• Nomograms
• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/etiology
• Acute Kidney Injury/epidemiology
• Male
• Aged
• Female
• Intensive Care Units/statistics & numerical data
• Aged, 80 and over
• Risk Factors
• ROC Curve
• Risk Assessment/methods
• Retrospective Studies
• Simplified Acute Physiology Score
• Age Factors
• Logistic Models
• Organ Dysfunction Scores

• COVID-19
• JAK inhibitors
• critically ill
• cytokine storm
• hyperinflammation
• mortality

• Cardiac arrest
• Cerebral performance category
• Extracorporeal cardiopulmonary resuscitation (ECPR)
• In-hospital cardiac arrest
• Neurological outcomes
• Out-of-hospital cardiac arrest
• Survival rate

• Humans
• Male
• Female
• Prospective Studies
• Middle Aged
• Aged
• Out-of-Hospital Cardiac Arrest/mortality
• Out-of-Hospital Cardiac Arrest/complications
• Qatar/epidemiology
• Survival Rate
• Cohort Studies
• Adult
• Nervous System Diseases/etiology
• Heart Arrest/mortality
• Heart Arrest/complications
• Cardiopulmonary Resuscitation

• COVID-19
• cloud computing
• electrocardiography
• machine learning
• mortality
• myocardial injury
• severity

• Humans
• Hospital Mortality
• Female
• Male
• Aged
• Risk Assessment
• Middle Aged
• Decision Support Techniques
• Databases, Factual
• Clinical Decision-Making
• Risk Factors
• Predictive Value of Tests
• ROC Curve
• Intraoperative Period

• apache ii
• calibration
• discrimination
• intensive care unit
• predictive accuracy
• rems
• saps ii
• sofa

• 30 day mortality
• Heart failure
• Intensive care unit
• White blood cell-to-haemoglobin ratio

• Humans
• Retrospective Studies
• Intensive Care Units
• Critical Care
• Prognosis
• Heart Failure

• 59945 China Academy of Chinese Medical Sciences
• China Academy of Chinese Medical Sciences

• Intensive care units
• galectin 3
• interleukin 27
• interleukin 33
• outcome

• Brixia score
• COVID-19
• barotrauma
• chest radiography
• mechanical ventilation

• Humans
• Respiration, Artificial/adverse effects
• Pneumothorax/diagnostic imaging
• Pneumothorax/epidemiology
• Pneumothorax/etiology
• Retrospective Studies
• Mediastinal Emphysema/diagnostic imaging
• Mediastinal Emphysema/epidemiology
• Mediastinal Emphysema/etiology
• Pandemics
• X-Rays
• COVID-19/diagnostic imaging
• Barotrauma/diagnostic imaging
• Barotrauma/epidemiology
• Barotrauma/etiology
• Subcutaneous Emphysema/diagnostic imaging
• Subcutaneous Emphysema/epidemiology
• Subcutaneous Emphysema/etiology
• Hospitalization
• Italy/epidemiology

• Cerebral metabolism
• Multimodal monitoring
• Subarachnoid hemorrhage
• Traumatic brain injury

• Adult
• Humans
• Retrospective Studies
• Microdialysis
• Brain/metabolism
• Glucose/cerebrospinal fluid
• Lactic Acid/cerebrospinal fluid

• Heart failure
• Heart transplantation
• IMPACT score
• Patient-centered outcomes
• Risk prediction

• Critical care
• Extracorporeal membrane oxygenation
• Percutaneous embolectomy
• Pulmonary embolism

Aneurysmal subarachnoid hemorrhage (aSAH) is a severe cerebrovascular disease not only causing brain injury but also frequently inducing a significant systemic reaction affecting multiple organ systems. In addition to hemorrhage severity, comorbidities and acute extracerebral organ dysfunction may impact the prognosis after aSAH as well. The study objective was to assess the value of illness severity scores for early outcome estimation after aSAH. A retrospective analysis of consecutive aSAH patients treated from 2012 to 2020 was performed. Comorbidities were evaluated applying the Charlson comorbidity index (CCI) and the American Society of Anesthesiologists (ASA) classification. Organ dysfunction was assessed by calculating the simplified acute physiology score (SAPS II) 24 h after admission. Modified Rankin scale (mRS) at 3 months was documented. The outcome discrimination power was evaluated. A total of 315 patients were analyzed. Significant comorbidities (CCI > 3) and physical performance impairment (ASA > 3) were found in 15% and 12% of all patients, respectively. The best outcome discrimination power showed SAPS II (AUC 0.76), whereas ASA (AUC 0.65) and CCI (AUC 0.64) exhibited lower discrimination power. A SAPS II cutoff of 40 could reliably discriminate patients with good (mRS ≤ 3) from those with poor outcome (p < 0.0001). Calculation of SAPS II allowed a comprehensive depiction of acute organ dysfunctions and facilitated a reliable early prognosis estimation in our study. In direct comparison to CCI and ASA, SAPS II demonstrated the highest discrimination power and deserves a consideration as a prognostic tool after aSAH.

• critically ill patients
• mortality
• prognostic nutritional index
• propensity score matching

Numerous patient-related clinical parameters and treatment-specific variables have been identified as causing or contributing to the severity of peritonitis. We postulated that a combination of clinical and surgical markers and scoring systems would outperform each of these predictors in isolation. To investigate this hypothesis, we developed a multivariable model to examine whether survival outcome can reliably be predicted in peritonitis patients treated with open abdomen. This single-center retrospective analysis used univariable and multivariable logistic regression modeling in combination with repeated random sub-sampling validation to examine the predictive capabilities of domain-specific predictors (i.e., demography, physiology, surgery). We analyzed data of 1,351 consecutive adult patients (55.7% male) who underwent open abdominal surgery in the study period (January 1998 to December 2018). Core variables included demographics, clinical scores, surgical indices and indicators of organ dysfunction, peritonitis index, incision type, fascia closure, wound healing, and fascial dehiscence. Postoperative complications were also added when available. A multidomain peritonitis prediction model (MPPM) was constructed to bridge the mortality predictions from individual domains (demographic, physiological and surgical). The MPPM is based on data of n = 597 patients, features high predictive capabilities (area under the receiver operating curve: 0.87 (0.85 to 0.90, 95% CI)) and is well calibrated. The surgical predictor “skin closure” was found to be the most important predictor of survival in our cohort, closely followed by the two physiological predictors SAPS-II and MPI. Marginal effects plots highlight the effect of individual outcomes on the prediction of survival outcome in patients undergoing staged laparotomies for treatment of peritonitis. Although most single indices exhibited moderate performance, we observed that the predictive performance was markedly increased when an integrative prediction model was applied. Our proposed MPPM integrative prediction model may outperform the predictive power of current models.

• Decision support
• MPI score
• Mortality
• Open abdomen
• Peritonitis
• SAPS-II score

• Clinical manifestation
• Diagnosis
• Pathogenesis
• Prognosis
• Tertiary peritonitis
• Treatment

• Healthcare-associated infections
• Intensive care unit
• Machine learning
• Risk prediction

• adverse outcomes
• healthcare-associated infections
• intensive care unit
• machine learning
• mortality
• risk prediction

• PSN - 4.9.2 Assessorato della Salute, Regione Siciliana - Progetti Obiettivo di Piano Sanitario Nazionale

Risk of over-immunosuppression or immunization may mitigate the overall and long-term renal outcomes of kidney transplant recipients (KTR) admitted to the ICU in the modern era but remain poorly described. Thus, there is an unmet need to better characterize the survival of KTR admitted to the ICU, but also the renal and immunological outcomes of survivors.

Retrospective observational study that included 200 KTR admitted between 2010 and 2016 to the ICU of a teaching hospital (median age 61 years [IQR 50.7–68]; time from transplantation 41 months [IQR 5–119]). Survival curves were compared using the Log-rank test.

Mortality rates following admission to the ICU was low (26.5% at month-6), mainly related to early mortality (20% in-hospital), and predicted by the severity of the acute condition (SAPS2 score) but also by Epstein Barr Virus proliferation in the weeks preceding the admission to the ICU. Acute kidney injury (AKI) was highly prevalent (85.1%). Progression toward chronic kidney disease (CKD) was observed in 45.1% of survivors. 15.1% of survivors developed new anti-HLA antibodies (donor-specific antibodies 9.2% of cases) that may impact the long-term renal transplantation function.

Notwithstanding the potential biases related to the retrospective and monocentric nature of this study, our findings obtained in a large cohort of KTR suggest that survival of KTR admitted in ICU is good but in-ICU management of these patients may alter both survival and AKI to CKD transition, as well as HLA immunization. Further interventional studies, including systematic characterization of the Epstein Barr virus proliferation at the admission (i.e., a potential surrogate marker of an underlying immune paralysis and frailty) will need to address the optimal management of immunosuppressive regimen in ICU to improve survival but also renal and immunological outcomes.

• HLA immunization
• Intensive care unit
• Outcomes
• Renal transplantation

To evaluate the relationship between drug interactions and QT-interval prolongation in patients admitted to a general intensive care unit (ICU).

This study was approved by the Institutional Review Board and written informed consent was obtained from all patients. From May 2015 to July 2016, all patients over 18 years-old admitted to the ICU for more than 24 h and in whom the QT-interval on the ECG could be read were prospectively included in this observational, cross-sectional study. All medications administered in the 24 h prior to admission were recorded and the QT-interval was measured upon ICU admission and corrected with Bazzet’s formula (QTc). Drug-drug interactions involving drugs potentially associated with QTc prolongation (DDIQT) were searched and QTc increase associated with pharmacokinetic (PK-DDIQT) and pharmacodynamic (PD-DDIQT) interactions was assessed with multiple regression adjusted by patient varibles.

The study population consisted of 283 patients, 54.4% males, mean age 57.6 ± 16.7 years-old. Forty five (15.9%) patients presented 65 DDIQT with predominance of pharmacodynamic (66.1%). The risk of DDIQT prescription increased with lower systolic blood pressure, in hypokalemia, in non-diabetics and with the number of medications. PK-DDIQT alone did not affect the QTc interval (7.75 ms, 95%CI: –22.4 to 37.9 ms, p = 0.61), but PD-DDIQT increased QTc by 28.4 ms (95%CI: 9.67 to 47.4 ms, p = 0.003). Most PD-DDIQT involved metoclopramide with ondansetron or amiodarone, and ondansetron with ciprofloxacin.

In patients exposed to drugs associated with prolonged QTc in the 24 h prior to ICU admission, pharmacodynamic DDIQT are associated with increased risk of QTc prolongation.

• Arrythmias
• Cardiac
• Drug interactions
• Drug prescriptions
• Intensive Care Units
• Long QT syndrome
• Torsades de pointes

• Critical care
• Prognostic scores
• Surgical intensive care unit

• Adult
• Aged
• Amiodarone/adverse effects
• Amiodarone/therapeutic use
• Clopidogrel/adverse effects
• Clopidogrel/therapeutic use
• Critical Illness
• Cross-Sectional Studies
• Electrocardiography
• Female
• Furosemide/adverse effects
• Furosemide/therapeutic use
• Haloperidol/adverse effects
• Haloperidol/therapeutic use
• Humans
• Intensive Care Units
• Long QT Syndrome/diagnosis
• Long QT Syndrome/epidemiology
• Long QT Syndrome/etiology
• Male
• Middle Aged
• Odds Ratio
• Prevalence
• Prospective Studies
• Risk Factors

Lung ultrasound can be used as an alternative to chest radiography (CXR) for the diagnosis and follow-up of various lung diseases in the intensive care unit (ICU). Our aim was to evaluate the influence that introducing a routine daily use of lung ultrasound in critically ill patients may have on the number of CXRs and as a consequence, on medical costs and radiation exposure.

Data were collected by conducting a retrospective evaluation of the medical records of adult patients who needed thoracic imaging and were admitted to our academic polyvalent ICU. We compared the number of CXRs and relative costs before and after the introduction of lung ultrasound in our ICU.

A total of 4134 medical records were collected from January 2010 to December 2014. We divided our population into two groups, before (Group A, 1869 patients) and after (Group B, 2265 patients) the introduction of a routine use of LUS in July 2012. Group A performed a higher number of CXRs compared to Group B (1810 vs 961, P = 0.012), at an average of 0.97 vs 0.42 exams per patient. The estimated reduction of costs between Groups A and B obtained after the introduction of LUS, was 57%. No statistically significant difference between the outcome parameters of the two groups was observed.

Lung ultrasound was effective in reducing the number of CXRs and relative medical costs and radiation exposure in ICU, without affecting patient outcome.

• Acute care
• Imaging, Ultrasound
• Imaging, X-Rays
• Ultrasound
• X-Rays