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BACKGROUND AND OBJECTIVES: The application of prognostic scoring systems to identify risk of death within 24 h of CICU admission has significant consequences for clinical decision-making. Previous score of parameters collected after 24 h was considered too late to predict mortality. As a result, we attempted to develop a CICU admission risk score to predict hospital mortality using indicators collected within 24 h. METHODS: Data were obtained from SCIENCE registry from January 1, 2021 to December 21, 2021. Outcomes of 657 patients (mean age 58.91 ± 12.8 years) were recorded retrospectively. Demography, risk factors, comorbidities, vital signs, laboratory and echocardiography data at 24-h of patient admitted to CICU were analysed by multivariate logistic regression to create two models of scoring system (probability and cut-off model) to predict in-hospital mortality of any cause. RESULTS: From a total of 657 patients, the hospital mortality was 15%. The significant predictors of mortality were male, acute heart failure, hemodynamic instability, pneumonia, baseline creatinine ≥1.5 mg/dL, TAPSE <17 mm, and the use of mechanical ventilator within first 24-h of CICU admission. Based on Receiver Operating Characteristic (ROC) curve analysis a cut off of ≥3 is considered to be a high risk of in-hospital mortality (sensitivity 75% and specificity 65%). CONCLUSION: The initial 24-h SCIENCE admission risk rating system can be used to predict in-hospital mortality in patients admitted to the CICU with a high degree of sensitivity and specificity.
Subject(s)
Coronary Care Units , Intensive Care Units , Humans , Male , Middle Aged , Aged , Female , Retrospective Studies , Risk Assessment , Critical Care , Risk Factors , Hospital MortalityABSTRACT
Rotational atherectomy (RA) is a proven technique to modify a heavily calcified coronary lesion if balloon angioplasty failed. RA is frequently avoided in ST-elevation myocardial infarction (STEMI) as it may increase the risk of slow or no-reflow. It is also considered to be relatively contraindicated in lesions with a visible thrombus, by its manufacturer. Regardless, RA may be a life-saving procedure in cases where no other percutaneous coronary intervention (PCI) technique is available to modify the lesion adequately. This case reports successful use of RA to facilitate dilation and stent delivery of a previously non-dilatable lesion in a patient with sub-acute anterior STEMI complicated by cardiogenic shock.
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INTRODUCTION: Central venous catheter (CVC) insertion is the most commonly performed clinical procedure when a patient initiates hemodialysis. Despite its clinical benefits, CVC insertion has several risks of complications. Thrombosis, venous stenosis, infection, arrhythmia, pneumothorax, and bleeding are among these complications. Malposition of the tip of the CVC can also occur with an incidence of up to 7%. One of several factors that could contribute to malposition is venous anatomy variation. Persistent left superior vena cava (PLSVC) is an extremely rare venous anatomical disorder but might have a significant clinical impact. CASE PRESENTATION: Here we report a PLSVC case that was identified in chest radiography after the insertion of a CVC catheter in a patient with end-stage renal disease (ESRD). A 40-year-old woman with a history of type 2 diabetes mellitus, hypertension, dyslipidemia, and obesity was presented in the emergency room with dyspnea for 1 week. Acute hemodialysis was required because of the ESRD and pulmonary edema. The PLSVC condition accompanied by various complications that occurred in this patient became a dilemma for the nephrologist in determining the diagnosis and proper CVC management. DISCUSSION: PLSVC is the most common congenital abnormality of the vena cava, even though it has a very small incidence. PLSVC occurs in about 0.1-0.5% of the total population and reaches 10% in individuals with congenital heart abnormalities. Most PLSVC presents along with normal superior vena cava and drains into the right atrium, which makes it very difficult to see the clinical signs and symptoms. Almost all PLSVC conditions are found incidentally during or after invasive procedures such as CVC insertion. CVC insertion in the PLSVC condition needs proper management to minimize the risk of complications. CONCLUSION: This case shows the importance of understanding the PLSVC condition, which, although very rare, is expected to increase the awareness of the nephrologist in making the diagnosis, determining appropriate management, and preventing complications, thereby improving patient safety.
ABSTRACT
BACKGROUND: Cardiovascular intensive care unit (CICU) is an area with high mortality rates globally. The prediction of inpatients mortality risk at CICU needs a simplified scoring systems. Hence, this study aims to analyze the predictors for in-hospital mortality of patients whom hospitalized at CICU of Sardjito General Hospital Yogyakarta and to create a mortality risk score based on the results of this analysis. METHODS: Data were obtained from SCIENCE (Sardjito Cardiovascular Intensive Care) registry. Outcomes of 595 consecutive patients (mean age 59.92 ± 13.0 years) from January to November 2017 were recorded retrospectively. Demography, risk factor, comorbidities, laboratory result and other examinations were analyzed by multivariate logistic regression to create two models of scoring system (probability and cut-off model) to predict in-hospital mortality of any cause. RESULTS: A total of 595 subjects were included in this research; death was found in 55 patients (9.2%). Multiple logistic regression analysis showed some variables that became independent predictor of mortality, i.e. age ≥ 60 years, pneumonia, the use of ventilator machine, and increased of serum glutamate-pyruvate transaminase level, an increased of creatinine level and an ejection fraction < 40%. Receiver operating characteristic (ROC) curve analysis showed a cut-off model scoring system with score 3 to 9 predicting mortality compared to score 0 - 2. This model yielded sensitivity of 80% and specificity 74%. While the probability scoring system (score 0 to 9) showed that the higher the score, the higher the mortality probability (e.g. the mortality of patient with score 2 is 5.27%; while the mortality of patient with score 8 is 87.5%). CONCLUSIONS: Scoring system derived from this study can be used to predict the in-hospital mortality of patients whom hospitalized in our CICU and show a favorable sensitivity and specificity result.
