Factors Associated With Clinical Deterioration Among Patients Hospitalized on the Wards at a Tertiary Cancer Hospital

Lyons, Patrick G.; Klaus, Jeff; McEvoy, Colleen; Westervelt, Peter; Gage, Brian F.; Kollef, Marin H.

doi:10.1200/jop.18.00765

Cited by 18 publications

(13 citation statements)

References 47 publications

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“…In this study, we investigate cases of MET activation for patients with early deterioration (less than 2 days after admission), intermediate deterioration (2–7 days after admission), and late deterioration (more than 7 days after admission) and associate them with patient characteristics, activation characteristics, and patient outcomes [ 6 ]. We also aim to determine the association, adjusted for confounders, between the duration of hospitalization stay before MET activation and patient mortality.…”

Section: Introductionmentioning

confidence: 99%

Impact of hospitalization duration before medical emergency team activation: A retrospective cohort study

et al. 2021

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Background The rapid response system has been implemented in many hospitals worldwide and, reportedly, the timing of medical emergency team (MET) attendance in relation to the duration of hospitalization is associated with the mortality of MET patients. We evaluated the relationship between duration of hospitalization before MET activation and patient mortality. We compared cases of MET activation for early, intermediate, and late deterioration to patient characteristics, activation characteristics, and patient outcomes. We also aimed to determine the relationship, after adjusting for confounders, between the duration of hospitalization before MET activation and patient mortality. Materials and methods We retrospectively evaluated patients who triggered MET activation in general wards from March 2009 to February 2015 at the Asan Medical Center in Seoul. Patients were categorized as those with early deterioration (less than 2 days after admission), intermediate deterioration (2–7 days after admission), and late deterioration (more than 7 days after admission) and compared them to patient characteristics, activation characteristics, and patient outcomes. Results Overall, 7114 patients were included. Of these, 1793 (25.2%) showed early deterioration, 2113 (29.7%) showed intermediate deterioration, and 3208 (45.1%) showed late deterioration. Etiologies of MET activation were similar among these groups. The clinical outcomes significantly differed among the groups (intensive care unit transfer: 34.1%, 35.6%, and 40.4%; p < 0.001 and mortality: 26.3%, 31.5%, and 41.2%; p < 0.001 for early, intermediate, and late deterioration, respectively). Compared with early deterioration and adjusted for confounders, the odds ratio of mortality for late deterioration was 1.68 (1.46–1.93). Conclusions Nearly 50% of the acute clinically-deteriorating patients who activated the MET had been hospitalized for more than 7 days. Furthermore, they presented with higher rates of mortality and ICU transfer than patients admitted for less than 7 days before MET activation and had mortality as an independent risk factor.

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Section: Introductionmentioning

confidence: 99%

Impact of hospitalization duration before medical emergency team activation: A retrospective cohort study

et al. 2021

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“…The COVID-19 and MERS patients had comparable symptoms, a short duration from disease onset to hospitalization, and similar degrees of disease severity. Patients who present with comorbidities tend to deteriorate faster than healthy patients, so this was not unexpected [ 18 ]. Also, numbers of lymphopenia cases were not surprising in either group; however, we found remarkably higher CRP levels among COVID-19 patients than MERS patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome

Khalid¹,

Yamani

Imran³

et al. 2021

Acute Crit Care

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Background: Both coronavirus disease 2019 and middle east respiratory syndrome (MERS) can cause acute respiratory distress syndrome (ARDS); however, the former is postulated to lead to an atypical ARDS course and characteristics. We directly compare COVID-19 and MERS patients with ARDS to evaluate this issue.Methods: MERS patients with ARDS seen during the March to May 2014 outbreak and COVID-19 patients with ARDS seen between March and December 2020 in our hospital were included, and their clinical characteristics, ventilatory course, and outcomes were compared.Results: Among 1,091 confirmed cases, 133 were admitted to the intensive care unit. Forty-nine and 14 patients met the inclusion criteria for ARDS in the COVID-19 and MERS groups, respectively. Both groups had a median of four comorbidities with a high Charlson comorbidity index value of 5 points (P>0.22).COVID-19 patients were older, more obese, with significantly higher initial C-reactive protein (CRP) level and more likely to obtain a trial of high-flow oxygen and delayed intubation (P≤0.04). The postintubation course was similar between the groups. Patients in both groups experienced a prolonged duration of mechanical ventilation, and the majority received paralytics, dialysis, and vasopressor agents (P>0.28). The respiratory and ventilatory parameters after intubation (including tidal volume, FiO2, and peak and plateau pressures) and their progression over 3 weeks were similar (P>0.05). Rates of mortality in the intensive care unit (53% vs. 64%) and hospital (59% vs. 64%) among COVID-19 and MERS patients (P≥0.54) were high and reflective of their baseline comorbid status.Conclusions: Despite some distinctive differences between COVID-19 and MERS patients prior to intubation, the respiratory and ventilatory parameters postintubation were not different. The higher initial CRP level in COVID-19 patients might explain the greater steroid responsiveness in this population.

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“…Intuitively, the requirement of CV and even intensive care expertise in this setting is very compelling (40).…”

Section: Cardio-oncology Education and Trainingmentioning

confidence: 99%

Cardio-Oncology Education and Training

Alvarez-Cardona¹,

Ray²,

Carver³

et al. 2020

Journal of the American College of Cardiology

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The innovative development of cancer therapies has led to an unprecedented improvement in survival outcomes and a wide array of treatment-related toxicities, including those that are cardiovascular in nature. Aging of the population further adds to the number of patients being treated for cancer, especially those with comorbidities. Such pre-existing and developing cardiovascular diseases pose some of the greatest risks of morbidity and mortality in patients with cancer. Addressing the complex cardiovascular needs of these patients has become increasingly important, resulting in an imperative for an intersecting discipline: cardio-oncology. Over the past decade, there has been a remarkable rise of cardio-oncology clinics and service lines. This development, however, has occurred in a vacuum of standard practice and training guidelines, although these are being actively pursued. In this council perspective document, the authors delineate the scope of practice in cardio-oncology and the proposed training requirements, as well as the necessary core competencies. This document also serves as a roadmap toward confirming cardio-oncology as a subspecialty in medi

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Factors Associated With Clinical Deterioration Among Patients Hospitalized on the Wards at a Tertiary Cancer Hospital

Cited by 18 publications

References 47 publications

Impact of hospitalization duration before medical emergency team activation: A retrospective cohort study

Impact of hospitalization duration before medical emergency team activation: A retrospective cohort study

Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome

Cardio-Oncology Education and Training

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