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Wyświetlanie 1-10 z 16
Tytuł:
COVID-19 machine learning model predicts outcomes in older patients from various European countries, between pandemic waves, and in a cohort of Asian, African, and American patients
Autorzy:
Bruno, Raphael Romano
Guidet, Bertrand
Szczeklik, Wojciech
De Lange, Dylan W.
Pinto, Bernardo Bollen
Schefold, Joerg C.
Leaver, Susannah
Wolff, Georg
Fjolner, Jesper
Wernly, Bernhard
Flaatten, Hans
Beil, Michael
Osmani, Venet
Sigal, Sviri
Jung, Christian
Artigas, Antonio
Kelm, Malte
Mamandipoor, Behrooz
Opis:
Background: COVID-19 remains a complex disease in terms of its trajectory and the diversity of outcomes rendering disease management and clinical resource allocation challenging. Varying symptomatology in older patients as well as limitation of clinical scoring systems have created the need for more objective and consistent methods to aid clinical decision making. In this regard, machine learning methods have been shown to enhance prognostication, while improving consistency. However, current machine learning approaches have been limited by lack of generalisation to diverse patient populations, between patients admitted at different waves and small sample sizes. Objectives: We sought to investigate whether machine learning models, derived on routinely collected clinical data, can generalise well i) between European countries, ii) between European patients admitted at different COVID-19 waves, and iii) between geographically diverse patients, namely whether a model derived on the European patient cohort can be used to predict outcomes of patients admitted to Asian, African and American ICUs. Methods: We compare Logistic Regression, Feed Forward Neural Network and XGBoost algorithms to analyse data from 3,933 older patients with a confirmed COVID-19 diagnosis in predicting three outcomes, namely: ICU mortality, 30-day mortality and patients at low risk of deterioration. The patients were admitted to ICUs located in 37 countries, between January 11, 2020, and April 27, 2021. Results: The XGBoost model derived on the European cohort and externally validated in cohorts of Asian, African, and American patients, achieved AUC of 0.89 (95% CI 0.89–0.89) in predicting ICU mortality, AUC of 0.86 (95% CI 0.86–0.86) for 30-day mortality prediction and AUC of 0.86 (95% CI 0.86–0.86) in predicting low-risk patients. Similar AUC performance was achieved also when predicting outcomes between European countries and between pandemic waves, while the models showed high calibration quality. Furthermore, saliency analysis showed that FiO2 values of up to 40% do not appear to increase the predicted risk of ICU and 30-day mortality, while PaO2 values of 75 mmHg or lower are associated with a sharp increase in the predicted risk of ICU and 30-day mortality. Lastly, increase in SOFA scores also increase the predicted risk, but only up to a value of 8. Beyond these scores the predicted risk remains consistently high. Conclusion: The models captured both the dynamic course of the disease as well as similarities and differences between the diverse patient cohorts, enabling prediction of disease severity, identification of low-risk patients and potentially supporting effective planning of essential clinical resources.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Tytuł:
ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock
Autorzy:
De Lange, Dylan W.
Wernly, Bernhard
Dankl, Daniel
Binnebossel, Stephan
Flaatten, Hans
Guidet, Bertrand
Baldia, Philipp Heinrich
Danninger, Thomas
Rezar, Richard
Sigal, Sviri
Bruno, Raphael Romano
Osmani, Venet
Szczeklik, Wojciech
Mamandipoor, Behrooz
Leaver, Susannah
Fjolner, Jesper
Wolff, Georg
Kokofer, Andreas
Beil, Michael
van Heerden, Peter Vernon
Kelm, Malte
Jung, Christian
Opis:
Purpose: Old (>64 years) and very old (>79 years) intensive care patients with sepsis have a high mortality. In the very old, the value of critical care has been questioned. We aimed to compare the mortality, rates of organ support, and the length of stay in old vs. very old patients with sepsis and septic shock in intensive care. Methods: This analysis included 9,385 patients, from the multi-center eICU Collaborative Research Database, with sepsis; 6184 were old (aged 65–79 years), and 3,201 were very old patients (aged 80 years and older). A multi-level logistic regression analysis was used to fit three sequential regression models for the binary primary outcome of ICU mortality. A sensitivity analysis in septic shock patients (n = 1054) was also conducted. Results: In the very old patients, the median length of stay was shorter (50 ± 67 vs. 56 ± 72 h; p < 0.001), and the rate of a prolonged ICU stay was lower (>168 h; 9 vs. 12%; p < 0.001) than the old patients. The mortality from sepsis was higher in very old patients (13 vs. 11%; p = 0.005), and after multi-variable adjustment being very old was associated with higher odds for ICU mortality (aOR 1.32, 95% CI 1.09–1.59; p = 0.004). In patients with septic shock, mortality was also higher in the very old patients (38 vs. 36%; aOR 1.50, 95% CI 1.10–2.06; p = 0.01). Conclusion: Very old ICU-patients suffer from a slightly higher ICU mortality compared with old ICU-patients. However, despite the statistically significant differences in mortality, the clinical relevance of such minor differences seems to be negligible.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Tytuł:
Differences in mortality in critically ill elderly patients during the second COVID-19 surge in Europe
Autorzy:
Moreno, Rui
Wernly, Bernhard
Andersen, Finn
Oeyen, Sandra
Jung, Christian
Artigas, Antonio
Leaver, Susannah
Wolff, Georg
Fjolner, Jesper
Czuczwar, Miroslaw
Joannidis, Michael
Bollen Pinto, Bernardo
Zafeiridis, Tilemachos
Bruno, Raphael Romano
Guidet, Bertrand
Szczeklik, Wojciech
Boumendil, Ariane
Schefold, Joerg C.
Flaatten, Hans
Beil, Michael
Sviri, Sigal
De Lange, Dylan
van Heerden, Peter Vernon
Kelm, Malte
Opis:
Background: The primary aim of this study was to assess the outcome of elderly intensive care unit (ICU) patients treated during the spring and autumn COVID-19 surges in Europe. Methods: This was a prospective European observational study (the COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to December 2020 to 159 ICUs in 14 European countries. An electronic database was used to register a number of parameters including: SOFA score, Clinical Frailty Scale, co-morbidities, usual ICU procedures and survival at 90 days. The study was registered at ClinicalTrials.gov (NCT04321265). Results: In total, 2625 patients were included, 1327 from the first and 1298 from the second surge. Median age was 74 and 75 years in surge 1 and 2, respectively. SOFA score was higher in the first surge (median 6 versus 5, p < 0.0001). The PaO2/FiO2 ratio at admission was higher during surge 1, and more patients received invasive mechanical ventilation (78% versus 68%, p < 0.0001). During the first 15 days of treatment, survival was similar during the first and the second surge. Survival was lower in the second surge after day 15 and differed after 30 days (57% vs 50%) as well as after 90 days (51% vs 40%). Conclusion: An unexpected, but significant, decrease in 30-day and 90-day survival was observed during the second surge in our cohort of elderly ICU patients. The reason for this is unclear. Our main concern is whether the widespread changes in practice and treatment of COVID-19 between the two surges have contributed to this increased mortality in elderly patients. Further studies are urgently warranted to provide more evidence for current practice in elderly patients.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Tytuł:
The impact of frailty on survival in elderly intensive care patients with COVID-19 : the COVIP study
Autorzy:
De Lange, Dylan W.
Wernly, Bernhard
Flaatten, Hans
Moreno, Rui
Guidet, Bertrand
Bruno, Raphael Romano
Artigas, Antonio
Czuczwar, Miroslaw
Szczeklik, Wojciech
Andersen, Finn H.
Leaver, Susannah
Zafeiridis, Tilemachos
Fjolner, Jesper
Wolff, Georg
Joannidis, Michael
Cecconi, Maurizio
Marsh, Brian
Oeyen, Sandra
Schefold, Joerg C.
Beil, Michael
Sviri, Sigal
van Heerden, Peter Vernon
Bollen Pinto, Bernardo
Kelm, Malte
Jung, Christian
Boumendil, Ariane
Elhadi, Muhammed
Opis:
Background: The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients. Methods: A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded. Results: The study included 1346 patients (28% female) with a median age of 75 years (IQR 72–78, range 70–96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56–62), with 66% (63–69) in fit, 53% (47–61) in vulnerable and 41% (35–47) in frail patients (p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival. Conclusion: Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Tytuł:
The association of prior paracetamol intake with outcome of very old intensive care patients with COVID-19 : results from an international prospective multicentre trial
Autorzy:
Wernly, Bernhard
de Lange, Dylan W.
Binnebossel, Stephan
Flaatten, Hans
Moreno, Rui
Baldia, Philipp Heinrich
Guidet, Bertrand
Sigal, Sviri
Erkens, Ralf
Artigas, Antonio
Bruno, Raphael Romano
Szczeklik, Wojciech
Andersen, Finn H.
Leaver, Susannah
Fjolner, Jesper
Wolff, Georg
Joannidis, Michael
Marsh, Brian
Oeyen, Sandra
Schefold, Joerg C.
Beil, Michael
van Heerden, Peter Vernon
Bollen Pinto, Bernardo
Kelm, Malte
Jung, Christian
Elhadi, Muhammed
Opis:
Background: In the early COVID-19 pandemic concerns about the correct choice of analgesics in patients with COVID-19 were raised. Little data was available on potential usefulness or harmfulness of prescription free analgesics, such as paracetamol. This international multicentre study addresses that lack of evidence regarding the usefulness or potential harm of paracetamol intake prior to ICU admission in a setting of COVID-19 disease within a large, prospectively enrolled cohort of critically ill and frail intensive care unit (ICU) patients. Methods: This prospective international observation study (The COVIP study) recruited ICU patients ≥ 70 years admitted with COVID-19. Data on Sequential Organ Failure Assessment (SOFA) score, prior paracetamol intake within 10 days before admission, ICU therapy, limitations of care and survival during the ICU stay, at 30 days, and 3 months. Paracetamol intake was analysed for associations with ICU-, 30-day- and 3-month-mortality using Kaplan Meier analysis. Furthermore, sensitivity analyses were used to stratify 30-day-mortality in subgroups for patient-specific characteristics using logistic regression. Results: 44% of the 2,646 patients with data recorded regarding paracetamol intake within 10 days prior to ICU admission took paracetamol. There was no difference in age between patients with and without paracetamol intake. Patients taking paracetamol suffered from more co-morbidities, namely diabetes mellitus (43% versus 34%, p < 0.001), arterial hypertension (70% versus 65%, p = 0.006) and had a higher score on Clinical Frailty Scale (CFS; IQR 2–5 versus IQR 2–4, p < 0.001). Patients under prior paracetamol treatment were less often subjected to intubation and vasopressor use, compared to patients without paracetamol intake (65 versus 71%, p < 0.001; 63 versus 69%, p = 0.007). Paracetamol intake was not associated with ICU-, 30-day- and 3-month-mortality, remaining true after multivariate adjusted analysis. Conclusion: Paracetamol intake prior to ICU admission was not associated with short-term and 3-month mortality in old, critically ill intensive care patients suffering from COVID-19.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Tytuł:
A retrospective cohort study comparing differences in 30-day mortality among critically ill patients aged ? 70 years treated in European tax-based healthcare systems (THS) versus social health insurance systems
Autorzy:
Moreno, Rui
Wernly, Bernhard
Sigal, Sviri
Oeyen, Sandra
Artigas, Antonio
Jung, Christian
Perings, Stefan
Pinto, Bernardo Bollen
Wernly, Sarah
Leaver, Susannah
Rezar, Richard
Marsh, Brian
Wolff, Georg
Fjolner, Jesper
Andersen, Finn H.
Joannidis, Michael
Elhadi, Muhammed
Bruno, Raphael Romano
Guidet, Bertrand
Szczeklik, Wojciech
Boumendil, Ariane
Schefold, Joerg C.
Flaatten, Hans
Beil, Michael
van Heerden, Peter Vernon
de Lange, Dylan W.
Kelm, Malte
Opis:
In Europe, tax-based healthcare systems (THS) and social health insurance systems (SHI) coexist. We examined differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in intensive care units in a THS or SHI. Retrospective cohort study. 2406 (THS n = 886; SHI n = 1520) critically ill ≥ 70 years patients in 129 ICUs. Generalized estimation equations with robust standard errors were chosen to create population average adjusted odds ratios (aOR). Data were adjusted for patient-specific variables, organ support and health economic data. The primary outcome was 30-day-mortality. Numerical differences between SHI and THS in SOFA scores (6 ± 3 vs. 5 ± 3; p = 0.002) were observed, but clinical frailty scores were similar (> 4; 17% vs. 14%; p = 0.09). Higher rates of renal replacement therapy (18% vs. 11%; p < 0.001) were found in SHI (aOR 0.61 95%CI 0.40–0.92; p = 0.02). No differences regarding intubation rates (68% vs. 70%; p = 0.33), vasopressor use (67% vs. 67%; p = 0.90) and 30-day-mortality rates (47% vs. 50%; p = 0.16) were found. Mortality remained similar between both systems after multivariable adjustment and sensitivity analyses. The retrospective character of this study. Baseline risk and mortality rates were similar between SHI and THS. The type of health care system does not appear to have played a role in the intensive care treatment of critically ill patients ≥ 70 years with COVID-19 in Europe.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Wyświetlanie 1-10 z 16

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