Lactate / albumin ratio as prognostic tool for risk stratification in septic patients admitted to ICU

INTRODUCTION: Sepsis stands as the primary cause behind intensive care unit (ICU) admissions. The most critical parameters in sepsis management have been shown to be early recognition. Management delays have been associated with increased mortality and morbidity The aim of this study is to study the lactate/albumin (L/A) ratio as prognostic tool for risk stratification in septic patients admitted to ICU. MATERIALS AND METHODS: This prospective observational study was conducted with100 patients. Admitted in ICU with sepsis and septic shock were studied. Serum lactate/albumin ratio was calculated at the time of admission. Apache 2 and SOFA score was calculated at admission. All patients received initial treatment according standard protocol. All patients were followed up till discharge. An adverse outcome in terms of in hospital mortality, length of ICU stays and inotropic support was used in this study. RESULTS: Lactate/albumin ratio >1.5(AUC 0.89) correctly predicted in-hospital mortality among 27% patients with sensitivity and specificity of 90% and 78.6% respectively (p value =0.001). Lactate/albumin ratio <1.50 (AUC 0.73) correctly predicted length of ICU stays <72 hours among 17% patients with sensitivity and specificity of 85% and 58.8% respectively (p value =0.001). Lactate/albumin ratio >1.50 (AUC 0.91) correctly predicted requiring inotropic support among 36% patients with sensitivity and specificity of 83.7% and 89.5% respectively (p value =0.001). CONCLUSIONS: We concluded that lactate/albumin ratio was a stronger parameter than lactate, albumin, APACHE score and SOFA alone in predicting mortality, length of ICU stay and requiring noradrenaline inotropic support among sepsis patients in the ICU

Comparative evaluation of acute respiratory distress syndrome in patients with and without H1N1 infection at a tertiary care referral center

H1N1 subtype of influenza A virus has clinical presentation ranging from mild flu like illness to severe lung injury and acute respiratory distress syndrome (ARDS). The aim of our study was to compare the demographic characteristics, clinical presentation, and mortality of critically ill patients with (H1N1+) and without H1N1 infection (H1N1-). We retrospectively analyzed medical charts of patients admitted in “Swine Flu ICU” with ARDS from August 2009 to May 2010. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay was used for detection of H1N1 virus in the respiratory specimens. Clinical data from 106 (H1N1, 45; H1N1+, 61) patients was collected and compared. Mean delay in presentation to our hospital was 5.7 ± 3.1 days and co-morbidities were present in two-fifth of the total admissions. Sequential Organ Failure Assessment (SOFA) score of patients with and without H1N1 infection was comparable; 7.8 ± 3.5 and 6.6 ± 3.1 on day 1 and 7.2 ± 4.5 and 6.5 ± 3.1 on day 3, respectively. H1N1+ patients were relatively younger in age (34.2 ± 12.9 years vs. 42.8 ± 18.1, P = 0.005) but presented with significantly lower PaO2:FiO2 ratio (87.3 ± 48.7 vs. 114 ± 51.7) in comparison to those who subsequently tested as H1N1. The total leucocyte counts were significantly lower in H1N1+ patients during the first four days of illness but incidence of renal failure (P = 0.02) was higher in H1N1+ patients. The mortality in both the groups was high (H1N1+, 77%; H1N1, 68%) but comparable. There was a mean delay of 5.7 ± 3.1 days in initiation of antivirals. Patients with H1N1 infection were relatively younger in age and with a significantly higher incidence of refractory hypoxia and acute renal failure. Mortality from ARDS reported in our study in both the groups was high but comparable

Association of glycosylated hemoglobin with mortality of patients in intensive care unit: a prospective observation study

INTRODUCTION: Glycated hemoglobin (HbA1c) is the most commonly used clinical test to estimate mean blood glucose during the past 2 to 3 months. In addition to diagnostic purposes, the HbA1c level also predicts diabetes complications. The aim of this study was to determine the association of glycosylated hemoglobin with mortality in intensive care unit (ICU). MATERIALS AND METHODS: A prospective observational study was conducted in the ICU with a total of 281 patients. These patients were classified into two groups based on their HbA1c levels: one group with HbA1c level < 6.5 % and another group with HbA1c level ≥ 6.5%. The following data were collected during the study period. Clinical details and scores such as the APACHE II score (Acute Physiology and Chronic Health Assessment) and daily SOFA (Sequential Organ Failure Assessment) scores for the period of stay in the ICU. ICU morbidities as the need for mechanical ventilation, the use of inotropes / vasopressors, the length of stay in the ICU, and the requirement of renal replacement therapy (RRT). The outcome measures were ICU mortality and 28-day mortality. RESULTS: Of 281 patients admitted to the ICU for more than 48 hours, 157 patients (55.9%) had HbA1c levels < 6.5%, with the remaining 124 (44.1%) had levels ≥ 6.5%. ICU mortality was present in 107 (38.07%) cases. ICU mortality was higher in patients in the HbA1c ≥ 6.5% group compared to the HbA1c < 6.5% group. This was statistically significant (p-value <0.001). Mortality at 28 days was observed in 125 (44.48%) cases. Patients with an HbA1c value ≥ 6.5%, there was a higher mortality at 28 days compared to patients with an HbA1c value < 6.5%. This was found to be statistically significant (p-value <0.001). CONCLUSIONS: The study showed that glycated hemoglobin levels (HbA1c) levels ≥ 6.5% had a significantly higher mortality rate compared to the patient in the HbA1c level < 6.5%

To compare the effects of multiple sessions of Hyperbaric Oxygen Therapy in neurological improvement in head injury patients: A prospective randomized trial

Introduction: Hyperbaric oxygen therapy (HBOT) is used to improve functional outcome following brain injuries. Different number of sessions of HBOT have been reported but the frequency of HBOT sessions in head injured patients has not been standardized. We planned this prospective randomized study with an aim to compare the neurological effects of 10, 20 and 30 sessions of HBOT in the head injured patients. Materials and Methods: After review board approval, this study was conducted in 60 head injury patients with Glasgow Coma Scale (GCS) score ≤ 9. All patients were resuscitated, stabilized and received neurological care according to institutional protocol. Patients were randomly allotted to–Group H10 (n-20)–which received 10 sittings of HBOT, Group H20 (n-20)–which received 20 sittings of HBOT, Group H30 (n-30)–which received 30 sittings of HBOT. GCS score was recorded after every 10 sittings and at 30 days from initiation of HBOT. Improvement Global rating and Glasgow outcome scale (GOS) were recorded after 30 days. Results: The maximum improvement in GCS scores was seen in group H30. The difference in the average improvement global rating scale was significant between group H10 and group H20, between group H10 and group H30 but was comparable between groups H20 and H30. The GOS was better after 30 sessions as compared to 10 sessions. Patients of all groups showed improvement in spasticity but group H30 showed a maximum improvement. Conclusion: A minimum of 30 HBOT sessions should be considered in head injury patients to show improvement with HBOT. Progressive improvement in GCS scores, GOS, spasticity, mood swings was better seen with increased number of HBOT sessions

Correlation of vitamin D deficiency with mortality in critically ill patients admitted to the intensive care unit

INTRODUCTION: Vitamin D, which is a fat-soluble vitamin, plays a key role in enhancing the intestinal absorption of calcium, magnesium and phosphate. In severely ill patients, vitamin D can adversely affect immune and metabolic functions, contributing to poorer outcomes. The aim of this study was to correlate vitamin D with mortality in critically ill patients. MATERIALS AND METHODS: prospective observational study was conducted, involving 162 patients in an intensive care unit (ICU). 162 patients were divided into two groups according to vitamin D Deficiency Group levels ≤ 20 ng/ml and Non vitamin D deficiency group levels <20 ng / ml and non-vitamin D deficiency group B levels > 20ng/ml. Data collected during the study included the APACHE II (acute physiology and chronic health evaluation) score at ICU admission, SOFA (sequential organ failure assessment) scores throughout the ICU stay, the need for mechanical ventilation, inotropic support, length of stay in ICU, and ICU outcomes, which were classified as either discharge or mortality. RESULTS: Of the 162 patient admitted to ICU, the prevalence of vitamin D deficiency in this study was 140 (86.4%) and nondeficient 22 (13.6%). The mortality rate in the vitamin D deficient group was 40% compared to 18.18% in the nondeficient group. The difference in mortality in both groups for mortality was statistically significant (p-value < 0.05). Vitamin D deficiency was not associated as an independent risk factor for ICU mortality [Odds ratio (OR) 1.220, 95% CI (0.825- 1.805) (p-value -0.320)]. CONCLUSIONS: The vitamin D-deficient group had a significantly higher mortality rate compared to the patient in the nondeficient group. But vitamin D deficiency was not found to be an independent risk factor for mortality

Flucytosine for treatment of Candida albicans in H1N1-positive patient

A 17-year-old H1N1-positive patient was successfully extubated after 25 days of ventilatory support for treatment of viral pneumonia which was complicated by empyema thoracis due to Candida albicans. Hematogenous spread was suspected as simultaneous culture of ascitic fluid identified Candida species sensitive to flucytosine but resistant to amphotericin B and azole group of antifungals. Monotherapy with flucytosine led to clinical and radiological improvement