Abstract Study objective The aim of the present study was to investigate the prognostic value of the initial serum lactate level in patients with community-acquired pneumonia (CAP). Methods We ...collected data on hospitalized adult patients with CAP via the study hospital emergency department between October 2012 and September 2013. Demographics, comorbidities, and physiologic and laboratory variables including initial C-reactive protein (CRP) and serum lactate level were extracted from the electronic medical record. The primary outcome was inpatient mortality. Comparisons between survivors and nonsurvivors were performed, and multivariable logistic regression analyses were constructed as dependent variables of both continuous and categorical varieties. Results A total of 397 patients were enrolled, and the mortality cases were 46 (11.6%). The mean lactate level was 1.7 ± 1.4 mmol/L and was significantly higher in the nonsurvivor group than in the survivor group (2.4 ± 2.2 mmol/L vs 1.6 ± 1.2 mmol/L). In the multivariable logistic regression model for inpatient mortality constructed using lactate, CRP, and laboratory variables of pneumonia severity index (PSI), lactate and CRP remained as significant factors, but laboratory variables of PSI were not. In other multivariable logistic regression models for the outcome constructed using collected laboratory variables and PSI, lactate remained as a significant factor (adjusted odds ratio, 1.24; 95% confidence interval, 1.01-1.53; P = .042 by continuous variable; adjusted odds ratio of third tertile, 2.60; 95% confidence interval, 1.02-6.66; P = .046 by category variable). C-reactive protein and albumin were also left as significant factors. Conclusions The initial serum lactate level is independently associated with mortality in hospitalized patients with CAP. However, laboratory variables of PSI or others were not, except CRP and albumin.
Abstract Background To measure emergency department (ED) crowding, the emergency department occupancy ratio (EDOR) was introduced. Objective Our aim was to determine whether the EDOR is associated ...with mortality in adult patients who visited the study hospital ED. Methods We reviewed data on all patients who visited the ED of an urban tertiary academic hospital in Korea for 2 consecutive years. The EDOR is defined by the total number of patients in the ED divided by the number of licensed ED beds. We tested the association between the EDOR (quartile) and each outcome using a multivariable logistic regression analysis adjusted for potential confounders: age, sex, emergency medical services transport, transferred case, weekend visit, shift, triage acuity, visit cause of injury, operation, vital signs, intensive care unit or ward admission, and ED length of stay (quartile). The main outcome measures were survival status at discharge and at 1–7 days. Results A total of 54,410 adult patients were enrolled. The EDOR ranged from 0.41 to 2.31 and the median was 1.24. On multivariable analyses, in comparison with the lowest (first) quartile, the highest (fourth) quartile of the EDOR was associated with 1-day mortality (adjusted odds ratio OR = 1.42; 95% confidence interval CI 1.08–1.88), 2-day mortality (adjusted OR = 1.31; 95% CI 1.04–1.67), and 3-day mortality (adjusted OR = 1.27; 95% CI 1.02–1.58). The EDOR was not significantly associated with 4- to 7-day mortalities and overall mortality at discharge. Conclusions The EDOR is associated with increased 1- to 3-day mortality even after controlling for potential confounders.
OBJECTIVEThe aim of the study was to compare the mortality rates of patients with early-identified (EI) sepsis and late-identified (LI) sepsis. METHODSWe performed a retrospective chart review of ...patients admitted to the emergency department and diagnosed with sepsis. EI sepsis was defined as patients with a Sequential Organ Failure Assessment (SOFA) score ≥2, based on 3 parameters of the SOFA score (Glasgow coma scale, mean arterial pressure, and partial pressure of oxygen/fraction of inspired oxygen ratio), measured within an hour of emergency department admission. The remaining patients were defined as LI sepsis. The primary outcome was in-hospital mortality. RESULTSOf the total 204 patients with sepsis, 113 (55.4%) had EI sepsis. Overall mortality rate was 15.7%, and EI sepsis group had significantly higher mortality than LI sepsis (23.0% vs. 6.6%, P=0.003). The patients with EI sepsis, compared to those with LI sepsis, had higher SOFA score (median: 4 vs. 2, P<0.001); Acute Physiology and Chronic Health Evaluation (APACHE) II score (median: 14 vs. 10, P<0.001); were more likely to progress to septic shock within 6 hours after admission (17.7% vs. 1.1%, P<0.001); were more likely to be admitted to the intensive care unit (2.2% vs. 1.1%, P=0.001). CONCLUSIONMortality was significantly higher in the EI sepsis group than in the LI sepsis group.
도코로(Tokoro)마 중독과 관련한 저 칼슘혈증 윤재철; Jae Chol Yoon; 이재백 ...
대한임상독성학회지,
06/2019, Letnik:
17, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Dioscorea tokoro has long been used in Korean traditional medicine as a pain killer and anti-inflammatory agent. A 53-year-old male who consumed water that had been boiled with raw tubers of D. ...tokoro as tea presented with numbness and spasm of both hands and feet. Laboratory results showed hypocalcemia, hypoparathyroidism, and vitamin D insufficiency. During his hospital stay, colitis, acute kidney injury, and toxic encephalopathy developed. The patient received calcium gluconate intravenous infusion and oral calcium carbonate with alfacalcidol. His symptoms improved gradually, but hypocalcemia persisted despite the calcium supplementation. We suggest that ingestion of inappropriately prepared D. tokoro can cause symptomatic hypocalcemia in patients with unbalanced calcium homeostasis.
ABSTRACT
Isolated and reversible lesion restricted to the splenium of the corpus callosum, known as reversible splenial lesion syndrome, have been reported in patients with infection, high‐altitude ...cerebral edema, seizures, antiepileptic drug withdrawal, or metabolic disturbances. Here, we report a 39‐year‐old female patient with glufosinate ammonium (GLA) poisoning who presented with confusion and amnesia. Diffusion‐weighted magnetic resonance imaging of the brain revealed cytotoxic edema of the splenium of the corpus callosum. The lesion was not present on follow‐up MR imaging performed 9 months later. We postulate that a GLA‐induced excitotoxic mechanism was the cause of this reversible splenial lesion.
We compared the predictive value of the National Early Warning Score+Lactate (NEWS+L) score with those of other parameters such as the pre-endoscopic Rockall score (PERS), Glasgow-Blatchford score ...(GBS), and albumin, international normalized ratio, altered mental status, systolic blood pressure, age older than 65 years score (AIMS65) among patients with upper gastrointestinal bleeding (UGIB).
We conducted a retrospective study of patients with UGIB during 2 consecutive years. The primary outcome was the composite of in-hospital death, intensive care unit admission, and the need for ≥5 packs of red blood cell transfusion within 24 hours.
Among 530 included patients, the composite outcome occurred in 59 patients (19 in-hospital deaths, 13 intensive care unit admissions, and 40 transfusions of ≥5 packs of red blood cells within 24 hours). The area under the receiver operating characteristic curve of the NEWS+L score for the composite outcome was 0.76 (95% confidence interval, 0.70 to 0.82), which demonstrated a significant difference compared to PERS (0.66, 0.59-0.73, P=0.004), but not to GBS (0.70, 0.64-0.77, P=0.141) and AIMS65 (0.76, 0.70-0.83, P=0.999). The sensitivities of NEWS+L scores of 3 (n=34, 6.4%), 4 (n=92, 17.4%), and 5 (n=171, 32.3%) were 100%, 98.3%, and 96.6%, respectively, while the sensitivity of an AIMS65 score of 0 (n=159, 30.0%) was 91.5%.
The NEWS+L score showed better discriminative performance than the PERS and comparable discriminative performance to the GBS and AIMS65. The NEWS+L score may be used to identify low-risk patients among patients with UGIB.
Abstract Background Hyperglycemia and hyperosmolality are associated with poor outcomes among acute ischemic stroke (AIS) patients. Objectives We evaluated the association between hyperglycemia and ...hyperosmolality, as a combination measure, with poor outcome among AIS patients. Methods We conducted a retrospective study of AIS patients admitted to the study hospital emergency department between January and December, 2014. Hyperglycemia was defined as serum glucose >144 mg/dL, and hyperosmolality was defined as a serum osmolality >295 mOsm/kg. After excluding hypoglycemia and hypoosmolality, the enrolled patients were classified into four subgroups: normoglycemia-normoosmolality (NGNO), hyperglycemia-normoosmolality (HGNO), normoglycemia-hyperosmolality (NGHO), and hyperglycemia-normoosmolality (HGHO). The primary outcome was poor neurologic status at 6 months, which was defined as a modified Rankin scale score (mRS) ≥ 2. Results 607 patients were included. The primary outcome was 336 (55.4%), and it was highest in the HGNO group (69.6%, 103/148), followed by the HGHO group (67.9%, 53/78), the NGHO group (57.3%, 43/75) and the NGNO group (44.7%, 137/306). The multivariable logistic regression analysis revealed that HGNO and HGHO remained significant factors, with primary outcomes (AOR (95% CI) of 2.08 (1.16–3.71) and 2.93 (1.45–5.91), respectively), whereas NGHO was not a significant factor. Cases of extremely high sodium levels were few in the NGHO and HGHO groups, while considerable cases of extremely high glucose level were observed in the HGHO group. Conclusion Hyperglycemia was associated with poor outcome, even after excluding the effect of hyperosmolality. However, hyperosmolality without hyperglycemia was not associated with poor outcome. An additive effect, likely reflecting severe hyperglycemia, was observed.
Procalcitonin (PCT) is commonly employed in medical practice as a diagnostic biomarker of bacterial infection and also as a monitoring biomarker for antimicrobial therapy. There have been a few ...published reports concerning elevated PCT levels in people with acute liver injury caused by an overdose of acetaminophen. We report here on a case of PCT elevation in an adolescent with acute acetaminophen poisoning without any bacterial infection or liver injury. A 15-year-old girl had deliberately ingested 20 tablets of 650 mg acetaminophen (13 g) and she presented to our emergency department. The PCT level on admission was elevated to 65.64 ng/mL (reference range: 0-0.5 ng/mL). Her PCT level on the second day peaked up to 100 ng/mL and then it gradually decreased. There was no evidence of liver injury or infection on the computed tomography examination and other lab tests. The patient regained her good health and was discharged on the sixth day of hospitalization.
Abstract Objectives The purpose of the present study was to investigate the diagnostic value of lactate for predicting bacteremia in female patients with acute pyelonephritis (APN). Methods We ...conducted a retrospective study of female patients with APN who visited the study hospital emergency department. The demographics, comorbidities, physiologies, and laboratory variables including white blood cell count and segmented neutrophil count, C-reactive protein, and initial serum lactate levels were collected and analyzed to identify associations with the presence of bacteremia. Results During the study period, a total of 314 patients were enrolled. One hundred twenty-three patients (39.2%) had bacteremia. Escherichia coli was the most frequent pathogen. Logistic regression analysis demonstrated that the lactate level was independently associated with the presence of bacteremia (odds ratio, 1.39 95% confidence interval, 1.08-1.78). The C-statistic of the lactate level was 0.67 (95% CI, 0.60-0.73). At a cutoff value of 1.4 mmol/L, the lactate level predicted bacteremia with a sensitivity (53.7%), specificity (72.3%), positive predictive value (55.5%), negative predictive value (70.8%), positive likelihood ratio (1.93), and negative likelihood ratio (0.64). Conclusion The initial serum lactate level showed poor discriminative performance for predicting bacteremia in female patients with APN.
PDF
