Predicting need for intensive care unit admission in adult emphysematous pyelonephritis patients at emergency departments: comparison of five scoring systems

Seo

et al. 2021

JCM

(1) Background: The emergency department provides lifesaving treatment and has become an entry point to hospital admission. The purpose of our study was to describe the characteristics and outcomes of patients who were admitted through the emergency department to the intensive care unit or general ward. (2) Methods: We performed a retrospective, cross-sectional, descriptive analysis using the National Emergency Department Information System, analyzing patient data including disease category, diagnosis, and mortality from 1 January 2016, to 31 December 2018. (3) Results: During the study period, about 13.6% were admitted through the emergency department. Of these, the overall in-hospital mortality was 4.6%. The frequent disease class for the intensive care unit admissions was the cardiovascular system, and the classes for the general ward admissions were as follows: injury and toxicology, digestive system, and respiratory system. Cardiovascular system-related emergencies were the predominant cause of death among patients admitted to the intensive care unit; however, oncologic complications were the leading cause of death in the general ward. (4) Conclusions: Emergency departments are incrementally utilized as the entry point for hospital admission. Health care providers need to understand emergency department admission epidemiology and prepare for managing patients with certain common diagnoses.

Section: Introductionmentioning

confidence: 99%

Emergency Department as the Entry Point to Inpatient Care: A Nationwide, Population-Based Study in South Korea, 2016–2018

Seo

et al. 2021

JCM

“…Saleh et al [ 24 ] compared APACHE II and III, SAPS II, and SOFA and showed that APACHE II and III demonstrated better performance than the others. However, Yap et al [ 26 ] verified that the National Early Warning Score demonstrated the best performance for predicting the severity status of patients with emphysematous pyelonephritis patients. Tan et al [ 27 ] explored the ability of the scoring systems to predict sepsis mortality in the short term (less than 30 days in the hospital) and long term (more than 30 days).…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Real-Time Mortality Prediction in Intensive Care Units Based on Gradient Boosting Method: Model Development and Validation Study

Jiang¹,

Su²,

Wang³

et al. 2021

JMIR Med Inform

Background Monitoring critically ill patients in intensive care units (ICUs) in real time is vitally important. Although scoring systems are most often used in risk prediction of mortality, they are usually not highly precise, and the clinical data are often simply weighted. This method is inefficient and time-consuming in the clinical setting. Objective The objective of this study was to integrate all medical data and noninvasively predict the real-time mortality of ICU patients using a gradient boosting method. Specifically, our goal was to predict mortality using a noninvasive method to minimize the discomfort to patients. Methods In this study, we established five models to predict mortality in real time based on different features. According to the monitoring, laboratory, and scoring data, we constructed the feature engineering. The five real-time mortality prediction models were RMM (based on monitoring features), RMA (based on monitoring features and the Acute Physiology and Chronic Health Evaluation [APACHE]), RMS (based on monitoring features and Sequential Organ Failure Assessment [SOFA]), RMML (based on monitoring and laboratory features), and RM (based on all monitoring, laboratory, and scoring features). All models were built using LightGBM and tested with XGBoost. We then compared the performance of all models, with particular focus on the noninvasive method, the RMM model. Results After extensive experiments, the area under the curve of the RMM model was 0.8264, which was superior to that of the RMA and RMS models. Therefore, predicting mortality using the noninvasive method was both efficient and practical, as it eliminated the need for extra physical interventions on patients, such as the drawing of blood. In addition, we explored the top nine features relevant to real-time mortality prediction: invasive mean blood pressure, heart rate, invasive systolic blood pressure, oxygen concentration, oxygen saturation, balance of input and output, total input, invasive diastolic blood pressure, and noninvasive mean blood pressure. These nine features should be given more focus in routine clinical practice. Conclusions The results of this study may be helpful in real-time mortality prediction in patients in the ICU, especially the noninvasive method. It is efficient and favorable to patients, which offers a strong practical significance.

“…Nuestra investigación busca esclarecer los factores asociados a gravedad en los casos de pie-lonefritis enfisematosa para optimizar el tratamiento y pronóstico de estos pacientes, siendo de suma relevancia para contar con evidencia científica que nos permita establecer consenso nacional e internacional para el manejo más eficaz y seguro de PE como se ha intentado en estudios previos. (5)(6)(7) Históricamente, se ha buscado determinar cuáles son estos indicadores de severidad asociados a un peor desenlace, siendo así que Huang et al, (2) , aportaron una clasificación radiológica directamente proporcional a la severidad que actualmente sirve para estadificar y dirigir el tratamiento de la PE. Escherichia coli, que cuando presenta resistencia a beta lactamasa redirige el curso de estos pacientes a un peor pronóstico.…”

Section: Discussionunclassified

“…(2) Conocer las condiciones clínicas del paciente, sus comorbilidades, la clasificación de Huang entre otras variables son fundamentales para esclarecer el pronóstico de la PE. (2,(5)(6)(7) El manejo integral de la PE incluye: la reanimación hídrica, la cobertura antimicrobiana de amplio espectro y el manejo del proceso necrotizante mediante algún tipo de derivación urinaria o nefrectomía. (2,(8)(9)(10)(11) Existen múltiples estudios que han validado los factores pronósticos de morbimortalidad, sin embargo la creciente resistencia antimicrobiana y las condiciones de inmunosupresión han convertido a esta entidad nosológica en una enfermedad agresiva que implica mayor acuciosidad en la toma de decisiones terapéuticas para optimizar su pronóstico debido a la persistencia de una alta mortalidad (25-40%).…”

Section: Introductionunclassified

Características clínicas y factores pronósticos de la pielonefritis enfisematosa: experiencia terapéutica en un centro hospitalario de tercer nivel en México

Sánchez-Núñez

Rico-Frontana

Hernández-Calderón

et al. 2021

rmu

Introducción: La Pielonefritis Enfisematosa (PE) es una infección necrotizante del tracto urinario superior, asociada a enterobacterias con una evolución subaguda e insidiosa. El diagnóstico es clínico, corroborándose y estadificándose mediante estudio tomográfico. El manejo dependerá de la gravedad del caso, puede ameritar manejo antimicrobiano y vigilancia hasta nefrectomía de urgencia. Objetivo: Describir los factores asociados a gravedad para PE en la población atendida en el servicio de Urología del Hospital General de México. Material y métodos: Estudio observacional, retrospectivo, analítico, obteniéndose para variables cualitativas frecuencias simples y distribución porcentual; para variables cuantitativas, se obtuvieron medidas de tendencia central; para variables con distribución no normal, se obtuvieron mediana y rango intercuartil. La comparación entre grupos se realizó mediante prueba exacta de Fisher (variables cualitativas), y test de U de Mann Whitney e intervalos de confianza al 95% (IC 95%) (variables cuantitativas). La estadística inferencial utilizó razón de momios (RM) para obtener la relación de cada factor para gravedad. Los cálculos fueron realizados con un nivel de confiabilidad de 95% y error alfa de 5%. Resultados: Los factores asociados a gravedad para PE son: bilateralidad (RM 7.5, IC 95 % 1.56-36.8, p 0.011), cólico nefrítico (RM 2.9, IC 95 % 0.70-12.4, p 0.01), leucocitosis (RM 1.5, IC 95 % 0.44-4.92, p 0.04), trombocitopenia (RM 3.2, IC 95% 0.29-34.7, p 0.04), Glasgow <15 (RM 1.3, IC 95 % 0.31-3.39, p 0.001) y Azoemia (RM 1.5, IC 95% 0.44-4.92, p 0.04). Conclusión: La temprana identificación de estos factores permitirá disminuir el riesgo de complicaciones y mejorar la evolución de los pacientes con PE.