Internal and Emergency Medicine最新文献_第9页

Association of reverse dipping blood pressure with mortality among critically ill patients with ischemic stroke. 缺血性脑卒中危重患者血压反向下降与死亡率的关系。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-30 DOI: 10.1007/s11739-024-03853-8

Tao Tang, Guang Zhang, Zhongjun Chen, Aline M Thomas, Jianxin Zhou, Shen Li

{"title":"Association of reverse dipping blood pressure with mortality among critically ill patients with ischemic stroke.","authors":"Tao Tang, Guang Zhang, Zhongjun Chen, Aline M Thomas, Jianxin Zhou, Shen Li","doi":"10.1007/s11739-024-03853-8","DOIUrl":"https://doi.org/10.1007/s11739-024-03853-8","url":null,"abstract":"Reverse dipping blood pressure, generally regarded as a pathological condition, is frequently observed in patients with acute stroke. We aimed to assess the association of reverse dipping blood pressure with in-hospital mortality among critically ill patients with ischemic stroke. This is a retrospective study of patients in the Medical Information Mart for Intensive Care IV database with ischemic stroke requiring intensive care unit admission. Diurnal (9:00-21:00) and nocturnal (1:00-6:00) mean arterial pressures (MAPs) were collected. Reverse dipping was defined as having an average nocturnal MAP higher than the average diurnal MAP. Multivariable binary logistic regression analysis was used to assess the association of reverse dipping with in-hospital mortality. A total of 2080 patients (median age, 73 years; 50.3% female) were enrolled, among which 681 patients (32.7%) had reverse dipping. Patients with reverse dipping blood pressure had a higher in-hospital mortality compared to those without (19.8% vs. 11.4%, p < 0.001). After adjusting for potential confounders, reverse dipping was associated with a higher likelihood of in-hospital mortality (adjusted OR, 1.59; 95% CI 1.21-2.11; p = 0.001). Reverse dipping blood pressure was associated with a higher mortality rate among critically ill patients with ischemic stroke. The circadian rhythm of blood pressure should warrant more attention in cerebrovascular neurocritical care.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Development and validation of a multivariable predictive model for Emergency Department Overcrowding based on the National Emergency Department Overcrowding Study (NEDOCS) score. 基于国家急诊科过度拥挤研究（NEDOCS）评分的急诊科过度拥挤多变量预测模型的开发和验证

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-30 DOI: 10.1007/s11739-024-03848-5

Diego Hernán Giunta, Diego Sanchez Thomas, Lucrecia Bustamante, Maria Florencia Grande Ratti, Bernardo Julio Martinez

{"title":"Development and validation of a multivariable predictive model for Emergency Department Overcrowding based on the National Emergency Department Overcrowding Study (NEDOCS) score.","authors":"Diego Hernán Giunta, Diego Sanchez Thomas, Lucrecia Bustamante, Maria Florencia Grande Ratti, Bernardo Julio Martinez","doi":"10.1007/s11739-024-03848-5","DOIUrl":"https://doi.org/10.1007/s11739-024-03848-5","url":null,"abstract":"Background Predicting potential overcrowding is a significant tool in efficient emergency department (ED) management. Our aim was to develop and validate overcrowding predictive models using accessible and high quality information. Methods Retrospective cohort study of consecutive days in the Hospital Italiano de Buenos Aires ED from june 2016 to may 2018. We estimated hourly NEDOCS score for the entire period, and defined the outcome as Sustained Critical ED Overcrowding (EDOC) equal to occurrence of 8 or more hours with a NEDOCS score ≥ 180. We generated 3 logistic regression predictive models with different related outcomes: beginning, ending or occurrence of Sustained Critical EDOC. We estimated calibration and discrimination as internal (random validation group and bootstrapping) and external validation (different period and different ED). Results The main model included both the beginning and occurrence of NEDOCS, including weather variables, variables related to NEDOCS itself and patient flow variables. The second model considered only the beginning of Sustained Critical EDOC and included variables related to NEDOCS. The last model considered the end of Sustained Critical EDOC and it included variables related to NEDOCS, weather, bed occupancy and management. Discrimination for the main model had an area under the receiveroperator curve of 0.997 (95% CI 0.994 - 1) in the validation group. Calibration for the model was very high on internal validation and acceptable on external validation. Conclusion The Sustained Critical EDOC predictive model includes variables that are easily obtained and can be used for effective resource management in situations of overcrowding.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Predictors of high-flow nasal cannula (HFNC) failure in severe community-acquired pneumonia or COVID-19. 重度社区获得性肺炎或COVID-19患者高流量鼻插管失败的预测因素

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-28 DOI: 10.1007/s11739-024-03844-9

Achim Grünewaldt, Matthieu Gaillard, Gernot Rohde

{"title":"Predictors of high-flow nasal cannula (HFNC) failure in severe community-acquired pneumonia or COVID-19.","authors":"Achim Grünewaldt, Matthieu Gaillard, Gernot Rohde","doi":"10.1007/s11739-024-03844-9","DOIUrl":"https://doi.org/10.1007/s11739-024-03844-9","url":null,"abstract":"The aim was to identify predictors for early identification of HFNC failure risk in patients with severe community-acquired (CAP) pneumonia or COVID-19. Data from adult critically ill patients admitted with CAP or COVID-19 and the need for ventilatory support were retrospectively analysed. HFNC failure was defined as the need for invasive ventilation or death before intubation. 60 patients with CAP and 185 with COVID-19 were included. 27 (45%) patients with CAP and 69 (37.3%) patients with COVID-19 showed HFNC failure. Lower oxygenation index, lower respiratory oxygenation (ROX) index, and higher respiratory rate at the start of HFNC were significantly associated with HFNC failure. ROC-analysis identified a respiratory rate of 27/min as the optimal cut-off for predicting HFNC failure, with a specificity of 59% and a sensitivity of 75%, and an oxygenation index after HFNC initiation of 99.6 (specificity 81%, sensitivity 74%). In COVID-19, an elevated CRB65-score at hospital admission and at HFNC-initiation was significantly associated with HFNC failure. In CAP and COVID patients an oxygenation index < 99.6, a respiratory rate > 27/min and a ROX index < 4.88 were predictors for HFNC failure whereas a CRB65 score > 3 at hospital admission and > 2 at HFNC start was predictive for HFNC failure in COVID-19.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assessing modified HEART scores with high-sensitivity troponin for low-risk chest pain in the emergency department. 用高敏感性肌钙蛋白评价急诊低危胸痛的改良HEART评分

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-28 DOI: 10.1007/s11739-024-03845-8

Katherine A Holmes, Samuel A Ralston, Daniel Phillips, Jeffy Jose, Liana Milis, Radhika Cheeti, Timothy Muirheid, Hao Wang

{"title":"Assessing modified HEART scores with high-sensitivity troponin for low-risk chest pain in the emergency department.","authors":"Katherine A Holmes, Samuel A Ralston, Daniel Phillips, Jeffy Jose, Liana Milis, Radhika Cheeti, Timothy Muirheid, Hao Wang","doi":"10.1007/s11739-024-03845-8","DOIUrl":"https://doi.org/10.1007/s11739-024-03845-8","url":null,"abstract":"The accuracy of using HEART (history, electrocardiogram, age, risk factors, and troponin) scores with high-sensitivity cardiac troponin (hs-cTn) to risk stratify emergency department (ED) chest pain patients remains uncertain. We aim to compare the performance accuracy of determining major adverse cardiac event (MACE) among three modified HEART (mHEART) scores with the use of hs-cTn to risk stratify ED chest pain patients. This retrospective single-center observational study included ED patients with suspected acute coronary syndrome who had HEAR scores calculated and at least one hs-cTnI result. Various hs-cTnI parameters, including 99th percentile upper reference limit (URL, i.e., positive, ≥ 53 ng/l for females and ≥ 78 ng/l for males), limit of quantitation (LoQ, i.e., negative: < 20 ng/l), and limit of detection (LoD, < 3 ng/l), were used to calculate a troponin score (T-score). Patients with a T-score of 0 or mHEART score of 0-3 were considered low risk. The study compared the accuracy of different mHEART scores in predicting 30-day and 180-day MACE outcomes. A total of 10,495 patients were included, with 337 (3.21%) and 647 (6.16%) experiencing 30-day and 180-day MACE. The 30-day MACE rates were 0.53%, 1.37%, and 2.00% for patients whose hs-cTnI was beyond the cutoffs of LoD, LoQ, and URL, respectively. However, when low risk was defined as an mHEART score of 0-3, the 30-day MACE rates ranged from 0.33 to 0.62% across different mHEART scores. The mHEART score for risk stratification of low-risk chest pain patients shows acceptable accuracy in predicting MACE outcomes.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Eosinophilic oesophagitis in adults: from symptoms to therapeutic options. 成人嗜酸性食管炎：从症状到治疗选择

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-27 DOI: 10.1007/s11739-024-03846-7

Carlo Maria Rossi, Marco Vincenzo Lenti, Giovanni Santacroce, Stefania Merli, Alessandro Vanoli, Antonio Di Sabatino

{"title":"Eosinophilic oesophagitis in adults: from symptoms to therapeutic options.","authors":"Carlo Maria Rossi, Marco Vincenzo Lenti, Giovanni Santacroce, Stefania Merli, Alessandro Vanoli, Antonio Di Sabatino","doi":"10.1007/s11739-024-03846-7","DOIUrl":"https://doi.org/10.1007/s11739-024-03846-7","url":null,"abstract":"Eosinophilic oesophagitis (EoE) is a chronic and progressive immune-mediated condition, typically affecting young atopic male adults and potentially leads to organ dysfunction and fibrosis. The clinical spectrum widely varies -from non-troublesome dysphagia to food impaction- and hence the rate of misdiagnosis and diagnostic delay are high, especially when presenting with minor symptoms, such as heartburn and acid regurgitation. There have been several major therapeutic breakthroughs for the management of EoE in recent years. Highly effective conventional agents with oesophagus-specific formulations (i.e. orodispersible budesonide) and a biological agent (i.e. dupilumab) now have a formal indication. Oesophageal dilation may be indicated in case of strictures, which are more common in longstanding and untreated disease. Therefore, the early diagnosis of this disorder and specialist referral is if of great importance. The evaluation of alarm signs and typical presentation patterns should allow a more straightforward recognition. The emergency and internal medicine doctors should actively be involved in this process and take part to the multidisciplinary care of patients with EoE, to allow better patient care and clinical outcomes.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Acute aortic syndrome as an early complication of giant cell arteritis. 急性主动脉综合征作为巨细胞动脉炎的早期并发症。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-24 DOI: 10.1007/s11739-024-03850-x

Kanza Mirza, Lillian Barra, Andreu Fernández-Codina

引用次数: 0

Subclinical hypothyroidism: a new predictor of heart failure with improved ejection fraction in HFrEF patients. 亚临床甲状腺功能减退：HFrEF患者射血分数改善的心力衰竭的新预测因子。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-17 DOI: 10.1007/s11739-024-03827-w

Haiqing Zhou, Qi Wang, Zhiquan Liu, Guohong Wu, Wenqing Zhou, Dongmei Yang, Kangyu Chen

{"title":"Subclinical hypothyroidism: a new predictor of heart failure with improved ejection fraction in HFrEF patients.","authors":"Haiqing Zhou, Qi Wang, Zhiquan Liu, Guohong Wu, Wenqing Zhou, Dongmei Yang, Kangyu Chen","doi":"10.1007/s11739-024-03827-w","DOIUrl":"https://doi.org/10.1007/s11739-024-03827-w","url":null,"abstract":"Heart failure (HF) with improved ejection fraction (HFimpEF) has gradually attracted widespread attention in recent years for its better clinical prognosis. In this study, we attempted to investigate the relationship between subclinical hypothyroidism (SCH) and HFimpEF. This study retrospectively collected clinical data on patients with HF with reduced ejection fraction (HFrEF) hospitalized at the First Affiliated Hospital of USTC from March 2015 to September 2023, and divided into two groups as euthyroidism or SCH according to the baseline thyroid function. Then patients were further categorized into HFimpEF (follow-up LVEF > 40% and absolute increase ≥ 10%) and persistent HFrEF based on their LVEF on the echocardiograms during the follow-up period. Afterward, logistic regression was used to estimate the effect of SCH on HFimpEF. A total of 916 patients with HFrEF met the inclusion and exclusion criteria, and 396 patients (43.2%) progressed to HFimpEF status during the follow-up period. Compared with HFrEF patients, the prevalence of SCH is lower in HFimpEF patients (9.3% vs. 14.4%, P = 0.020). Univariate logistic regression analysis indicates that SCH was a potential predictor for HFimpEF (OR: 0.612 [95% CI 0.403-0.928], P = 0.021). After adjusting for multiple factors in logistic regression, the odds ratios of HFrEF patients with SCH progressing to HFimpEF decreased by 37.8% (OR: 0.622 [95% CI 0.397-0.974], P = 0.038) compared with patients with euthyroidism. This study suggests that thyroid function affects the improvement of cardiac function in patients with HFrEF and SCH is an independent predictor for HFimpEF.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142835622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hypoglycemia: one size does not fit all! 低血糖症：一个尺码不适合所有人！

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-17 DOI: 10.1007/s11739-024-03842-x

Laura Tomaino, Valerio Di Maio, Susanna Contucci, Lorenzo Falsetti, Gianluca Moroncini

引用次数: 0

Diaphragmatic ultrasound: approach, emerging evidence, and future perspectives in non-ICU patients. 膈超声：在非icu患者中的方法、新证据和未来展望。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-13 DOI: 10.1007/s11739-024-03835-w

Sigmund J Kharasch, Andrea Loewen, Kevin J Solverson, Tara Lohmann, Irene W Y Ma

引用次数: 0

Bundle compliance patterns in septic shock and their association with patient outcomes: an unsupervised cluster analysis. 脓毒性休克的束依从性模式及其与患者预后的关系：一项无监督聚类分析。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-12-12 DOI: 10.1007/s11739-024-03836-9

Aysun Tekin, Balázs Mosolygó, Nan Huo, Guohui Xiao, Amos Lal

{"title":"Bundle compliance patterns in septic shock and their association with patient outcomes: an unsupervised cluster analysis.","authors":"Aysun Tekin, Balázs Mosolygó, Nan Huo, Guohui Xiao, Amos Lal","doi":"10.1007/s11739-024-03836-9","DOIUrl":"https://doi.org/10.1007/s11739-024-03836-9","url":null,"abstract":"Adhering to bundle-based care recommendations within stringent time constraints presents a profound challenge. Elements within these bundles hold varying degrees of significance. We aimed to evaluate the Surviving Sepsis Campaign (SSC) hour-one bundle compliance patterns and their association with patient outcomes. Utilizing the Medical Information Mart for Intensive Care-IV 1.0 dataset, this retrospective cohort study evaluated patients with sepsis who developed shock and were admitted to the intensive care unit between 2008 and 2019. The execution of five hour-one bundle interventions were assessed. Patients with similar treatment profiles were categorized into clusters using unsupervised machine learning. Primary outcomes included in-hospital and 1-year mortality. Four clusters were identified: C#0 (n = 4716) had the poorest bundle compliance. C#1 (n = 1117) had perfect antibiotic adherence with modest fluid and serum lactate measurement adherence. C#2 (n = 850) exhibited full adherence to lactate measurement and low adherence to fluid administration, blood culture, and vasopressors, while C#3 (n = 381) achieved complete adherence to fluid administration and the highest adherence to vasopressor requirements in the entire cohort. Adjusting for covariates, C#1 and C#3 were associated with reduced odds of in-hospital mortality compared to C#0 (adjusted odds ratio [aOR] = 0·83; 95% confidence interval [CI] 0·7-0·97 and aOR = 0·7; 95% CI 0·53-0·91, respectively). C#1 exhibited significantly better 1-year survival (adjusted hazard ratio [aHR] = 0·9; 95%CI 0·81-0·99). We were able to identify distinct clusters of SSC hour-one bundle adherence patterns using unsupervised machine learning techniques, which were associated with patient outcomes.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0