To examine long-term survival and causes of death among working-age patients with acute pancreatitis (AP) compared with the normal population.
Few studies have investigated long-term survival after ...AP and recurrent AP compared with the normal population; moreover, results from those studies are difficult to compare, due to suboptimal control populations and wide variations in follow-up times.
This retrospective, registry-based study included 1644 patients with AP, aged 18 to 64 years, admitted to Oulu University Hospital in 1995 to 2012. Patient data were compared with data from 8220 age- and sex-matched controls that resided in the hospital district area.
Alcohol was the main etiologic factor causing 71.4% of the cases. During the median follow-up time of 9.5 years, mortality was 24.2% in the study group and 6.3% in the control group (P < 0.001). Alcohol-related factors caused 39.4% of deaths and alcohol AP was the main single cause of death (16.3%) in the study group. Of all fatal AP cases, 42.9% were related to recurrence. Survival was similar among patients with nonalcohol AP and controls.
The long-term mortality among patients admitted to the hospital due to (mainly alcohol induced) AP was 4 times higher than that in the age- and sex-matched control population. The significant difference in the causes of death between patients with alcohol AP and controls could be explained by alcohol-related diseases. Occurrences of AP without an alcohol etiology had a minimal impact on survival.
Head and neck cancer requiring free-flap reconstruction is associated with relatively high mortality. We aimed to evaluate perioperative risk factors for 1-year mortality in this patient group.
This ...is a single-center retrospective analysis of 204 patients operated during 2008 to 2018.
A total of 47 (23.0%) patients died within 1 year. In univariate analysis, there were no differences in the intraoperative course between 1-year survivors and nonsurvivors. Among the 1-year nonsurvivors, preoperative albumin level was lower (39 36 to 43 vs 42 39 to 44, P = .032) and the Sequential Organ Failure Assessment admission score was higher (4 3 to 5 vs 3 2 to 4, P = .003) than those of the 1-year survivors. Among the nonsurvivors, the preoperative and postoperative levels of leukocytes were higher (7.6 6.7 to 9.5 vs 6.9 5.5 to 8.4, P = .002; 11.4 9.0 to 14.2 vs 8.7 7.2 to 11.3, P < .001). The highest odds ratios for 1-year mortality in multivariate analysis were American Society of Anesthesiologists A classification greater than 2 (3.9 CI 1.4 to 10.5), male gender (4.0 CI 1.5 to 11), and increase in leukocyte count (1.3 CI 1.1 to 1.5).
One-year nonsurvivors had higher American Society of Anesthesiologists classification and were more often men. The postoperative inflammatory markers were higher in nonsurvivors, while the intraoperative course did not have a significant impact on the 1-year mortality.
Pancreatic duct disruption is common and is associated with high morbidity in cases of acute necrotizing pancreatitis (ANP). In this study, we tested the feasibility and safety of prophylactic ...pancreatic duct stenting (PPDS) in ANP and compared PPDS with conservative treatment.
We prospectively enrolled patients (aged 18 - 75 years) diagnosed with ANP between February 2011 and July 2015. These patients were prospectively randomized to receive PPDS or conservative treatment at two tertiary centers. PPDS was performed as soon as possible after randomization.
Concern regarding iatrogenic infections with pancreatic necrosis in the PPDS group prompted interim analysis, which confirmed a highly elevated risk. Thus, the trial was terminated prematurely for ethical reasons. Of the 11 patients in the PPDS group, all patients with successful pancreatic duct placement (5/5, 100 %) presented with infection, compared with only 3 of the 13 patients (23.1 %) in the conservative treatment group (
= 0.01). Analysis revealed success rates of 63.6 % for pancreatic duct cannulation, 45.5 % for pancreatic duct stenting, and 18.2 % for placement of a stent bridging the necrosis. Cannulation and stenting failures were due to duodenal edema and pancreatic duct stenosis.
PPDS in ANP is associated with an unacceptably high risk of pancreatic necrosis infection. In addition, the procedure is technically challenging due to duodenal edema and ductal stenosis.
Purpose
Long-term data are urgently needed in children after intensive care. The aim of this study was to measure health-related quality of life 6 years after intensive care in a paediatric intensive ...care population.
Methods
This national, multicentre study enrolled all children and young people admitted to intensive care units (ICUs) in Finland in 2009 and 2010. The data concerning ICU stay were collected retrospectively from the ICU data registries and combined with prospective data from Paediatric Quality of Life Inventory (PedsQL 4.0) questionnaires, the generic 15D, 16D or 17D instrument, and data regarding children’s chronic diagnoses and need for healthcare support.
Results
The questionnaires were answered by 1109 of 3682 living children and adolescents admitted to an ICU, response rate was 30.1%. Among the responders, 90 children (8.4%) had poor (under − 2 SD) PedsQL scores. Children with low scores had a higher rate of chronic diagnoses (94.4% vs. 47.6%), medication on a daily basis (78.7% vs. 29.4%) and a greater need for healthcare services (97.7% vs. 82.2%) than those with normal scores. Diagnoses associated with poor quality of life were asthma, epilepsy, cerebral palsy and other neurological diseases, chromosomal alterations, cancer and long-term pain. These children were mostly admitted electively, and less frequently on an emergency basis, but no other significant differences were found during the intensive care stay.
Conclusions
The long-term quality of life after paediatric intensive care is good for the majority of children and young people, and it is dependent on the number of chronic diagnoses and the burden of the chronic disease, especially neurological diseases.
Purpose
Treatment of head and neck cancers (HNC) often leads to impairment in speech and swallowing functions. This study evaluated swallowing problems and the impact of complications on ...swallowing-related QOL after free flap surgery for HNC.
Methods
Swallowing-related QOL was assessed using MDADI and SWAL questionnaires.
Results
Of 45 assessed patients, 25 (45.5%) had at least one postoperative complication. Patients reported less than < 86 points in 8/9 SWAL-QOL domains. The SWAL-QL total score or MDADI composite scores were not related to surgical complications. Those with medical complications had lower scores in SWAL-QOL domains of mental health (82.8 (21.8) vs 65.5 (24.2),
p
= 0.024) and sleep (77.6 (23.0) vs 52.3 (24.3),
p
= 0.003).
Conclusions
In conclusion, swallowing related QOL is significantly impaired after 2 years of the tumor resection and free flap reconstruction for cancer of the head and neck, when using the cut-off value of 86 points in SWAL-QOL assessment tool. Surgical complications did not have an impact on swallowing-related QOL but medical complications were related to impairment in general QOL-related domains.
Background
The delays in transferring patients from emergency department (ED) to intensive care unit (ICU) are known to be linked with several adverse events, including prolonged ICU stay and ...increased hospital mortality. The factors associated with delayed ICU admission include shortage of ICU beds, organizational factors, ED overcrowding, and patient‐related factors, including sepsis as admission diagnosis. The aim of this study was to examine ED‐related factors associated with prolonged ED stay.
Methods
The study population consisted of adult patients admitted (n = 479) from ED to ICU between 31 May 2016 and 19 March 2017 in Oulu University Hospital. A patient's ED length of stay (LOS) exceeding 180 minutes was considered delayed.
Results
Most of the patients (380, 79.3%) were admitted to the ICU within 3 hours of hospital admission. In a logistic regression analysis, odds ratios (ORs) for ED LOS > 180 minutes were as follows: for Glasgow Coma Scale score > 9, 2.73 (1.39‐5.32); for thrombocytes < 100 × 109/mmol, 6.69 (2.32‐19.26); for absence of pre‐arrival notification, 5.27 (3.04‐9.14); and for radiological examination, 3.95 (1.72‐9.10). Trauma and intoxicated patients had shorter ED LOS while patients with medical conditions had more often prolonged admissions.
Conclusion
The delays in ICU admissions were linked to therapeutic and diagnostic procedures and absence of pre‐arrival notification. Patients were admitted to the ICU on the basis of diagnosis instead of clinical risk. However, the delays were not associated with worsening outcome, which indicates that sufficient care can be provided at the ED while the ICU admission is pending.
Discrepancy between prescribed and administered enteral nutrition (EN) is a common problem during intensive care. The aim of this study was to find out the success rate and factors associated with ...inadequacy of enteral nutrition in a mixed general intensive care unit (ICU).
This was a retrospective single-center study of 892 patients with ICU length of stay (LOS) ≥4 days. The factors associated with adequacy of enteral nutrition on day 4 were analyzed. These included disease-specific factors, patient-related factors, severity of illness, and procedural factors.
Of the 892 patients, 349 (39.1%) had an EN success rate of ≥70%, which was associated with a lower amount of prescribed enteral energy (500 kcal 500-800 vs. 800 kcal 500-1200, p < 0.001) and bolus administration of enteral nutrition (41 of 349 vs. 27 of 543, p < 0.001). Other factors impairing successful EN were severe inflammation, surgery, and GI-related admission diagnosis.
On the fourth day during ICU stay discrepancy between prescribed and administered enteral nutrition was associated to severe inflammation, GI-related diagnosis, and prescribing policy.
Neuroinflammation often develops in sepsis along with increasing permeability of the blood-brain barrier (BBB), which leads to septic encephalopathy. The barrier is formed by tight junction ...structures between the cerebral endothelial cells. We investigated the expression of tight junction proteins related to endothelial permeability in brain autopsy specimens in critically ill patients deceased with sepsis and analyzed the relationship of BBB damage with measures of systemic inflammation and systemic organ dysfunction.
The case series included all (385) adult patients deceased due to sepsis in the years 2007-2015 with available brain specimens taken at autopsy. Specimens were categorized according to anatomical location (cerebrum, cerebellum). The immunohistochemical stainings were performed for occludin, ZO-1, and claudin. Patients were categorized as having BBB damage if there was no expression of occludin in the endothelium of cerebral microvessels.
Brain tissue samples were available in 47 autopsies, of which 38% (18/47) had no expression of occludin in the endothelium of cerebral microvessels, 34% (16/47) developed multiple organ failure before death, and 74.5% (35/47) had septic shock. The deceased with BBB damage had higher maximum SOFA scores (16 vs. 14, p = 0.04) and more often had procalcitonin levels above 10 μg/L (56% vs. 28%, p = 0.045) during their ICU stay. BBB damage in the cerebellum was more common in cases with C-reactive protein (CRP) above 100 mg/L as compared with CRP less than 100 (69% vs. 25%, p = 0.025).
In fatal sepsis, damaged BBB defined as a loss of cerebral endothelial expression of occludin is related with severe organ dysfunction and systemic inflammation.
The aim of the study was to compare long-term mortality and causes of death in children post admission to an ICU with a control population of same age.
Longitudinal follow-up study.
Registry study of ...a national ICU register and hospital registries.
Children admitted to an ICU in the years 2009 and 2010.
None.
The mortality and causes of death following ICU discharge were analyzed retrospectively. The median follow-up period was 4.9 years (25-75th percentiles, 4.4-5.5 yr). The causes of death in survivors 30 days after ICU discharge were compared with a cohort of 1 million children of the general population of same age. In total, 2,792 children were admitted to an ICU during the study period. Of those, 53 (1.9%) died in the ICU and 2,739 were discharged. Thirteen children died within 30 days of discharge, and 68 died between 30 days and the end of follow-up (December 31, 2014). In the control population (n = 1,020,407 children), there were 1,037 deaths (0.10%) from 2009 to 2014. The standardized mortality rate for the children admitted to the ICU during the study period was 53.4 (95% CI, 44.7-63.2). The standardized mortality rate for those children alive 1 year after discharge was 16.7 (12.1-22.6). One-year cumulative mortality was 3.3%. The most common causes of death in subjects alive 30 days post ICU were cancer (35.3%), neurologic (17.6%), and metabolic diseases (11.7%), whereas trauma was the most common cause in the control group (45.3%).
There was an increased risk of death in a cohort of ICU-admitted children even 3 years after discharge. In those who survived 30 days after discharge, medical causes of death were dominant, whereas deaths due to trauma were most common in the control group.
Abstract
Background
Hospital-treated poisonings have a good outcome in general. The role of regional differences and socioeconomic status has been established in intensive care admissions and various ...causes of death, but not yet in hospital-treated poisonings. We set out to determine whether the incidence of hospital-treated poisonings is affected by the annual income of the residential area.
Methods
All poisonings in Northern Ostrobothnia region of Finland treated in Oulu University Hospital during 2013–2016 were studied. Oulu University Hospital is the primary hospital in the area. Postal code areas of the county were categorized on the basis of their median annual net income as low-, middle- and high-income areas.
Results
A total of 2142 poisoning cases were studied. The number of individual patients was 1525. In the low-income areas, the crude incidence of poisonings was more than 2-fold when compared with the middle- and high-income areas. In adolescents aged 13 to 17 years, the incidence in the low-income areas was almost 3-fold compared with the other two categories at 335/100 000/year (95% CI, 236–463). Four patients (0.2%) died during the hospital stay and 50 patients (2.3%) died within 6 months from the last admission.
Conclusions
The incidence of hospital-treated poisoning was at least 2-fold in low-income areas when compared with middle- or high-income areas. For adolescent population from 13 to 17 years, the incidence in low-income areas was almost 3-fold when compared with other areas.
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