The International Society of Thrombosis and Hemostasis (ISTH) criteria in intensive care units.

BACKGROUND: Disseminated Intravascular Coagulation (DIC) has been assessed by the International Society of Thrombosis and Hemostasis (ISTH) 2001 and the ISTH 2018-modified version. More investigations are needed to assess usability and visibility of those DIC scoring systems in the intensive care units (ICU). AIMS: This study investigated the predictive performance of the ISTH-Overt DIC versions of 28-day mortality in ICUs compared to SOFA as a gold standard assessment tool of sepsis. METHODS: A retrospective design (2015-2017) included 220 adult patients enrolled from medical and surgical ICUs in two major hospitals in Jordan. We calculated ISTH-Overt DIC scores and SOFA score on time of DIC diagnosis. Overt DIC was categorized based on a score of ≥ five for ISTH DIC 2001; and ≥ 4 for ISTH DIC 2018. Provided, a score > 12 was categorized as Multiple-Organ- Dysfunction-Syndrome (MODS) for Sequential Organ Failure Assessment (SOFA) score. Then, 28-day mortality follow-up was performed. RESULTS: More than half of sample died before 28-days of follow-up. The analysis of Receiver Operating Characteristic (ROC) showed that higher scores of ISTH DIC 2001(≥ 5), ISTH DIC 2018 (≥ 4), and SOFA score (>12) were highly associated with 28-day mortality. The ISTH DIC 2001 and SOFA score were superior on the modified ISTH 2018 in predicting 28-day mortality, with an Area Under the Curve (AUC) of (0.724 vs. 0.822 vs. 0.507, respectively). Yet, the accuracy of the SOFA score was better than the ISTH DIC 2001. CONCLUSION: This study suggests that ISTH DIC 2001 score is helpful when applied on medical and surgical ICU Jordanian populations. It showed better results compared to the Modified ISTH DIC 2018 in mortality prediction, regardless of the underlying diseases.

Disseminated Intravascular Coagulopathy in Critically Ill Patients in Amman, Jordan.

BACKGROUND: The disseminated intravascular coagulation (DIC) is under-recognized in critically ill patients. The International Society of Thrombosis and Haemostasis (ISTH; DIC) provides a useful scoring system for accurate DIC identification. The study investigated the period prevalence of ISTH DIC from 2015 to 2017 in critically ill patients. METHODS: In this multi-center, retrospective observational study, we included all patients identified with a DIC code or medically diagnosed with DIC during all admissions. Based on ISTH DIC scores ≥ 5, patients were classified with overt DIC. RESULTS: A total of 220 patients were included in this study. The period prevalence of DIC was 4.45%. The point prevalence of DIC has increased from 3.49% to 5.58% from 2015 to 2017 (27.7% female; median age 61.6 years). Based on the ISTH-Overt DIC criteria, 45.2% of the sample had sepsis. Overt DIC patients had significantly lower baseline hemoglobin (HB; t = 2.137, df = 193, p = 0.034), platelet count (t = 3.591, df = 193, p < 0.001) and elevated serum creatinine level (M = 2.1, SD = 1.5, t = 2.203, df = 193, p = 0.029) compared to non-Overt DIC. There was a statistically significant elevation in FDPs among Overt DIC compared to non-Overt DIC (χ2 = 30.381, df = 1, p < 0.001). Overt DIC patients had significantly prolonged PT (U = 2,298, z = 5.7, p < 0.001), PTT (U = 2,334, z = 2.0, p = 0.045) and INR (U = 2,541, z = 5.1, p < 0.001) compared to those with non-Overt DIC. CONCLUSION: The ISTH overt-DIC score can be used in critically ill patients regardless of the underlying disease. Efforts are required to predict and identify overt DIC using a valid scoring system on admission and follow-up of adult patients admitted to ICU.

Incidence, Risk Factors and Prognosis of Acute Kidney Injury Following Hematopoietic Stem Cell Transplant: A Pilot Study.

BACKGROUND AND OBJECTIVES: The burden of acute kidney injury (AKI) has not been explored in Jordanian patients who receive hematopoietic stem cell transplant (HSCT). The aim of this study was to evaluate the frequency, risk factors, and mortality of AKI among patients who underwent HSCT. METHODS: A retrospective pilot study included 70 adult patients who received peripheral HSCT was conducted. Weekly measurement of serum creatinine (SCr) was obtained for 3 months after chemotherapy and HSCT. Then, stages of Risk, Injury, and Failure of Kidney were determined based on the Kidney Disease for Improving Global Outcomes (KDIGO). RESULTS: The median follow-up was 41 months. Mortality was reported in 16 patients (23%). Out of 60 patients that had SCr values, 19 patients (31.6%) had AKI in 90 days after chemotherapy. Allogeneic HSCT, male donors, high-dose melphalan protocols and values of blood urea nitrogen (BUN) were significantly higher among patients with AKI. CONCLUSIONS: Combining many nephrotoxic drugs and dosing adjustments should be considered in uniform protocols. Multidisciplinary care should be utilized to assess early kidney dysfunction that decreases adverse events and improves outcomes.

The association of spiritual well-being and depression among patients receiving hemodialysis.

PURPOSE: The purpose of this study was to identify the relationship between spiritual well-being (meaning/peace, and faith) and depression among Jordanian patients receiving hemodialysis. METHODS: Cross-sectional descriptive correlation design was used to carry out on a nationally representative convenience sample of 158 patients receiving hemodialysis at five different hospitals in Jordan. RESULTS: The mean total score of the depression was 17.8 of the 40. While the mean total score of the spiritual well-being was 36.9 of the 48. The Pearson's correlation coefficient test showed significant negative correlation between spiritual well-being and depression (r = -.64, p < .005). CONCLUSION: Healthcare providers should consider spiritual well-being in their assessment and interventions by helping the patients to establish meaning, peace, and faith to reduce patients' depression.

Depressive symptoms and dietary nonadherence in patients with end-stage renal disease receiving hemodialysis: a review of quantitative evidence.

Patients with end-stage renal disease (ESRD) who receive hemodialysis have high rates of psychosocial distress and nonadherence to diet prescription. The purpose of this study was to examine the quantitative research evidence about the effect of depressive symptoms on dietary adherence. A systematic search of the literature using MEDLINE, CINAHL, PubMed, and PsycINFO databases was performed for quantitative research studies. Forty-four studies met inclusion criteria and were included in this review. Nearly all studies supported an association between depressive symptoms and dietary adherence in patients with ESRD. Depressive symptoms were associated with dietary nonadherence in patients with ESRD.