Depression as an independent risk factor for mortality in critically ill patients.

OBJECTIVE: Mortality on medical intensive care units (ICU) is approximately 25%. It is associated with age, severity of illness, and comorbidities. Preexisting depression is a risk factor for worse outcome in many diseases. The impact of depression on outcome of ICU patients has not been investigated. We assessed a possible association between mortality and preexisting depressive mood at the time of ICU admission. The primary end point was 28-day mortality. METHODS: This single-center cohort study was conducted in a tertiary medical ICU. Two hundred patients were evaluated for preexisting depressive mood at ICU admission, determined by Hospital Anxiety and Depression Scale (HADS) score ≥8 in the depression dimension in patients with appropriate cognitive function. Patients with insufficient cognitive function were assessed using observer rating by next of kin by Hammond scale (cutoff ≥4) and/or a modified version of the Hospital Anxiety and Depression Scale for observer rating (cutoff ≥10). RESULTS: In total, 66 (33%) of 200 patients were classified with preexisting depressive mood. Forty-nine (24.5%) of 200 patients had died by day 28. Of these, 23 (47%) had preexisting depressive mood as compared with 43 of 151 (29%) 28-day survivors (p = .017). Multiple logistic regression analysis revealed that preexisting depressive mood at the time of ICU admission is an independent risk factor for 28-day (odds ratio = 2.2, 95% confidence interval = 1.08-4.5, p = .030) and in-hospital mortality (median time till death = 20.5 [2-186] days, odds ratio = 2.58, 95% confidence interval = 1.31-5.1, p = .006). CONCLUSION: Preexisting depressive mood might be an independent risk factor for 28-day mortality in medical ICU patients. This could have diagnostic and therapeutic implications for critically ill patients.

Randomized multicenter comparison of 2 IMZ and 4 TPS screw implants supporting bar-retained overdentures in 425 edentulous mandibles.

PURPOSE: Two treatment concepts for implant-supported bar retention of mandibular overdentures-2 intramobile cylinder (IMZ) implants and a Dolder bar and 4 titanium plasma-sprayed (TPS) screw implants and an angulated bar-were compared in a randomized controlled clinical trial with respect to postprosthetic efficacy and safety. MATERIALS AND METHODS: Four hundred twenty-five patients with edentulous mandibles were enrolled; 212 were randomized to TPS implants (control group) and 213 to IMZ implants (test group). Endpoints were occurrences of postprosthetic integration deficiency (ID), functional deficiency (FD), and complications. The trial was sized to detect a 10% difference in 5-year ID-free postprosthetic system lifetime with a power of 80%. RESULTS: With 340 protocol-completed cases, the trial achieved its predetermined power. The 2 systems did not show statistically significant differences in occurrences of postprosthetic ID and FD; 5-year occurrence-free postprosthetic system lifetime probabilities were estimated as 42.5% with IMZ and 42.8% with TPS, for ID; and as 82.6% with IMZ and 87.2% with TPS, for FD. However, at 3 to 6 months after surgery, mean Periotest values were significantly higher (P = .0001 without adjustment) with IMZ implants (5.6, SD 4.2) than with TPS implants (0.8, SD 4.3). TPS implants showed a higher incidence of inflammation and recession, while IMZ implants had a higher incidence of implant fracture after functional loading. DISCUSSION: The system-wise approach overcomes potential bias with implant-wise analyses. A combination of radiographic and clinical criteria distinguishes between desirable integration and functional anchorage. The in situ survival rates at 5 years in this study (95% for IMZ, 92% for TPS) match rates reported in the literature. CONCLUSION: This study demonstrated equivalent efficacy of 2 IMZ cylinders and 4 TPS screws in implant-supported, bar-retained mandibular overdentures and indicated a higher rate of complications with the TPS screw implants.

Randomized multicenter comparison of two coatings of intramobile cylinder implants in 313 partially edentulous mandibles followed up for 5 years.

Intramobile cylinder (IMZ) implants with either of two coatings, hydroxyapatite (HA) or titanium plasma-flame (TPF), as distal abutments for combined tooth implant-supported restorations, were compared in 313 partially edentulous mandibles with respect to postprosthetical failure patterns and complication frequencies in a randomized multicenter clinical trial. Within the treatment protocols, the two coatings do not show evidence of different efficacy with respect to occurrence of postprosthetical integration deficiency (ID) or functional deficiency (FD). Statistical equivalence for an absolute effect of +/-15% in event-free survival could only be demonstrated for FD, not for ID, however. Intent-to-treat and per-protocol population analyses gave consistent results. Hazards of occurrence of ID and FD, adjusted for years of follow-up, were estimated for ID as 7% per year (95%CI 4-10% per year) with HA and 5% per year (95%CI 3-7% per year) with TPF, and for FD as 5% per year (95%CI 3-7% per year) with HA and 4% per year (95%CI 2-6% per year) with TPF. The 5-year cumulative success rates for no ID were 69.5% (95%CI 58-81%) with HA and 82.2% (95%CI 74-91%) with TPF. With respect to frequencies of complications, there was no relevant statistically significant difference between the two coatings.