The outcome of critically ill Indigenous patients

Ho, Kwok M.; Finn, Judith; Dobb, Geoffrey; Webb, Steven A R

doi:10.5694/j.1326-5377.2006.tb00341.x

Cited by 24 publications

(40 citation statements)

References 18 publications

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“…Patients in the cohort had experienced a wide range of acute diseases or conditions, including sepsis, respiratory failure, cardiogenic shock, cardiac arrest, drug overdose, intracranial haemorrhage, acute surgical emergencies and cardiothoracic surgery. Some details of this cohort have been described in our previous publications 13 , 14 …”

Section: Methodsmentioning

confidence: 99%

The effect of socioeconomic status on outcomes for seriously ill patients: a linked data cohort study

Dobb

Knuiman

et al. 2008

Medical Journal of Australia

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Objective: To investigate the association between socioeconomic status (SES) and outcomes for seriously ill patients. Design and setting: A retrospective cohort study based on data from an intensive care unit clinical database linked with data from the Western Australian hospital morbidity and mortality databases over a 16‐year period (1987–2002). Main outcome measures: In‐hospital and long‐term mortality. Results: Data on 15 619 seriously ill patients were analysed. The in‐hospital mortality rate for all seriously ill patients was 14.8%, and the incidence of death after critical illness was 7.4 per 100 person‐years (4.8 per 100 person‐years after hospital discharge). Patients from the most socioeconomically disadvantaged areas were more likely to be younger, to be Indigenous, to live in a remote area, to be admitted non‐electively, and to have more severe acute disease and comorbidities. SES was not significantly associated with in‐hospital mortality, but long‐term mortality was significantly higher in patients from the lowest SES group than in those from the highest SES group, after adjusting for age, ethnicity, comorbidities, severity of acute illness, and geographical accessibility to essential services (hazard ratio for death in lowest SES group v highest SES group was 1.21 [95% CI, 1.04–1.41]; P = 0.014). The attributable incidence of death after hospital discharge between patients from the lowest and highest SES groups was 1.0 per 100 person‐years (95% CI, 0.3–1.6 per 100 person‐years). Conclusion: Lower SES was associated with worse long‐term survival after critical illness over and above the background effects of age, acuity of acute illness, comorbidities, Indigenous status and geographical access to essential services.

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Section: Methodsmentioning

confidence: 99%

The effect of socioeconomic status on outcomes for seriously ill patients: a linked data cohort study

Dobb

Knuiman

et al. 2008

Medical Journal of Australia

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“…Critically ill and septic Indigenous Australians have high hospital morbidity and mortality rates 1 . Empirical vancomycin therapy is commonly used in Indigenous patients presenting with sepsis in rural and remote health centres.…”

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confidence: 99%

Optimised Dosing of Vancomycin in Critically Ill Indigenous Australian Patients with Severe Sepsis

Tsai

Stewart

Hewagama

et al. 2018

Anaesth Intensive Care

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Vancomycin is a commonly used antibiotic due to the high burden of methicillin-resistant Staphylococcus aureus infections. This study aimed to describe the pharmacokinetics (PK) of vancomycin in Australian Indigenous patients with severe sepsis, and advise an optimal dosing strategy. A population PK study was conducted in a remote Australian intensive care unit (ICU). Serial plasma samples were collected over one to two dosing intervals and assayed by validated chromatography. Concentration-time data collected were analysed using Pmetrics® software. The final population PK model was then used for Monte Carlo dosing simulations to determine optimal loading and intermittent maintenance doses. Fifteen Indigenous subjects were included for analysis with a median (interquartile range, IQR) age, weight and creatinine clearance (CrCL) of 43 (34-46) years, 73 (66-104) kg and 99 (56-139) ml/minute respectively. A two-compartment model described the data adequately. Vancomycin clearance (CL) and volume of distribution of the central compartment (Vc) were described by CrCL and patient weight respectively. Median (IQR) CL, Vc, distribution rate constants from central to peripheral, and from peripheral to central compartments were 4.6 (3.8-5.6) litres per hour, 25.4 (16.1-31.3) litres, 0.46 (0.28-0.52)/hour and 0.25 (0.12-0.37)/hour respectively. No significant interethnic PK differences were observed in comparison to published data. Therapeutic loading doses were significantly dependent on both weight and CrCL, whereas maintenance doses were dependent on CrCL. In the absence of severe renal impairment, initiation of maintenance dose eight hours post-loading dose achieved higher probability of target attainment at 24 hours. This is the first report of vancomycin PK in this patient group.

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“…Cardiovascular disease is the main driving force behind this discrepancy in life expectancy 7 ; however, the contribution of liver disease is also significant. A disproportionately higher prevalence of chronic liver disease has been reported in ATSIs, and this appears to be increasing . Chronic liver disease in ATSIs is driven by the endemicity of chronic hepatitis B and an increased prevalence of obesity, diabetes, and harmful levels of alcohol consumption .…”

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confidence: 99%

“…A disproportionately higher prevalence of chronic liver disease has been reported in ATSIs, and this appears to be increasing. 8 Chronic liver disease in ATSIs is driven by the endemicity of chronic hepatitis B 9 and an increased prevalence of obesity, 10 diabetes, 10 and harmful levels of alcohol consumption. 11 ATSIs are more likely to be hospitalized across all age groups in comparison with the non-ATSI population.…”

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confidence: 99%

Liver transplantation outcomes for Australian Aboriginal and Torres Strait Islanders

et al. 2014

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An increased liver disease burden has been reported for Aboriginal and Torres Strait Islanders (ATSIs) in Australia; however, few proceed to liver transplantation (LT). We aimed to compare overall survival and graft survival after LT between ATSI and non-ATSI populations, assess the factors influencing survival within ATSIs, and finally examine the proportion of ATSIs undergoing LT. This study was a retrospective review of the Australia and New Zealand Liver Transplant Registry from 1985 to 2012 and examined consecutive primary LT performed in Australia. Overall and graft survival were compared between ATSI and non-ATSI groups. The Accessibility/Remoteness Index of Australia (ARIA) was used to calculate the remoteness of individuals. There were 3493 primary LT performed, and 45 patients (1.3%; 14 children and 31 adults) were ATSIs. The median (range) ages of the ATSI children and adults at the time of LT were 9.6 (0.2-15.3) years and 44.5 (19.5-65.5) years, respectively. There were 10 deaths in the ATSI cohort. The median (range) overall survival was similar for ATSI and non-ATSI children [6.5 (0.1-23.5) years versus 9.0 (0-28.2) years, P 5 0.9] and adults [7.1 (0.1-15.7) years versus 6.3 0-26.7) years, P 5 0.8]. The cumulative graft survival was similar for ATSI and non-ATSI children (P 5 0.8) and adults (P 5 0.8). High ARIA scores [hazard ratio (HR) 5 1.2, 95% confidence interval (CI) 5 1.01-1.53, P 5 0.03] in children and blood group O (HR 5 3.8, 95% CI 5 1.1-12.7, P 5 0.03) in adults predicted worse outcomes for ATSIs. Although ATSIs accounted for 4.7% and 1.8% of the Australian pediatric and adult populations, respectively, they represented only 2.2% of pediatric LT recipients (v 2 5 8.2, P 5 0.004) and 1.1% of adult LT recipients (v 2 5 7.9, P 5 0.005). In conclusion, overall survival and graft survival after LT are comparable in ATSIs and non-ATSIs. There is a trend toward increased death/retransplantation in ATSIs from remote areas. ATSI children and adults appear to be underrepresented in the Australian LT population.

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The outcome of critically ill Indigenous patients

Cited by 24 publications

References 18 publications

The effect of socioeconomic status on outcomes for seriously ill patients: a linked data cohort study

The effect of socioeconomic status on outcomes for seriously ill patients: a linked data cohort study

Optimised Dosing of Vancomycin in Critically Ill Indigenous Australian Patients with Severe Sepsis

Liver transplantation outcomes for Australian Aboriginal and Torres Strait Islanders

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