Decisions: does a patient with a thunderclap headache need a lumbar puncture?
CMAJ. 2012 Mar 20;184(5):555-6
Authors: Fine B, Singh N, Aviv R, Macdonald RL
PMID: 22392938 [PubMed - indexed for MEDLINE]
Link to Article at PubMedMay 242012
May 242012
Association of gender with outcomes in critically ill patients.
Crit Care. 2012 May 22;16(3):R92
Authors: Mahmood K, Eldeirawi K, Wahidi MM
Abstract
ABSTRACT: INTRODUCTION: The influence of gender on mortality and other outcomes of critically ill patients is not clear. Different studies have been performed in various settings and patient populations often yielding conflicting results. We wanted to assess the relationship of gender and intensive care unit (ICU) outcomes in the patients included in the acute physiology and chronic health evaluation (APACHE) IV database (Cerner Corporation, USA). METHODS: We performed a retrospective review of the data available in APACHE IV database. 261,255 consecutive patients admitted to adult ICUs in United States from 1/1/2004 to 12/31/2008 were included. The readmissions were excluded from the analysis. The primary objective of the study was to assess the relationship of gender with ICU mortality. The secondary objective was to evaluate the association of gender with the active therapy, mechanical ventilation, length of stay in ICU, readmission rate and the hospital mortality. The gender related outcomes for disease subgroups including acute coronary syndrome, coronary artery bypass graft (CABG) surgery, sepsis, trauma and chronic obstructive pulmonary disease (COPD) exacerbation were assessed as well. RESULTS: ICU mortality was 7.2% for men and 7.9% for women, odds ratio (OR) for death for women was 1.07 (95% confidence interval [CI]: 1.04-1.1). There was a statistically significant interaction between gender and age. In patients younger than 50 years of age, women had a reduced ICU mortality compared with men, after adjustment for acute physiology score, ethnicity, co-morbid conditions, pre-ICU length of stay, pre-ICU location and hospital teaching status (Adjusted OR 0.83, 95 % CI: 0.76-0.91). But among 50 years of age or older patients, there was no significant difference in ICU mortality between men and women (Adjusted OR 1.02, 95% CI: 0.98-1.06). A higher proportion of men received mechanical ventilation, emergent surgery, thrombolytic therapy and CABG surgery. Men had a higher readmission rate and longer length of ICU stay. The adjusted mortality of women compared to men was higher with CABG, while it was lower with COPD exacerbation. There was no significant difference in mortality in acute coronary syndrome, sepsis and trauma. CONCLUSIONS: Among the critically ill patients, women less than 50 years of age had a lower ICU mortality compared to men, while 50 years of age or older women did not have a significant difference compared to men. Women had a higher mortality compared to men after the CABG surgery, and lower mortality with COPD exacerbation. There was no difference in mortality in acute coronary syndrome, sepsis and trauma.
PMID: 22617003 [PubMed - as supplied by publisher]
Link to Article at PubMedMay 242012
Acute kidney injury biomarkers: renal angina and the need for a renal troponin I.
BMC Med. 2011;9:135
Authors: Goldstein SL
Abstract
Acute kidney injury (AKI) in hospitalized patients is independently associated with increased morbidity and mortality in pediatric and adult populations. Continued reliance on serum creatinine and urine output to diagnose AKI has resulted in our inability to provide successful therapeutic and supportive interventions to prevent and mitigate AKI and its effects. Research efforts over the last decade have focused on the discovery and validation of novel urinary biomarkers to detect AKI prior to a change in kidney function and to aid in the differential diagnosis of AKI. The aim of this article is to review the AKI biomarker literature with a focus on the context in which they should serve to add to the clinical context facing physicians caring for patients with, or at-risk for, AKI. The optimal and appropriate utilization of AKI biomarkers will only be realized by understanding their characteristics and placing reasonable expectations on their performance in the clinical arena.
PMID: 22189039 [PubMed - indexed for MEDLINE]
Link to Article at PubMedMay 242012
suPAR as a prognostic biomarker in sepsis.
BMC Med. 2012;10:2
Authors: Donadello K, Scolletta S, Covajes C, Vincent JL
Abstract
Sepsis is the clinical syndrome derived from the host response to an infection and severe sepsis is the leading cause of death in critically ill patients. Several biomarkers have been tested for use in diagnosis and prognostication in patients with sepsis. Soluble urokinase-type plasminogen activator receptor (suPAR) levels are increased in various infectious diseases, in the blood and also in other tissues. However, the diagnostic value of suPAR in sepsis has not been well defined, especially compared to other more established biomarkers, such as C-reactive protein (CRP) and procalcitonin (PCT). On the other hand, suPAR levels have been shown to predict outcome in various kinds of bacteremia and recent data suggest they may have predictive value, similar to that of severity scores, in critically ill patients. This narrative review provides a descriptive overview of the clinical value of this biomarker in the diagnosis, prognosis and therapeutic guidance of sepsis.
PMID: 22221662 [PubMed - indexed for MEDLINE]
Link to Article at PubMedMay 242012
The role of copeptin as a diagnostic and prognostic biomarker for risk stratification in the emergency department.
BMC Med. 2012;10:7
Authors: Nickel CH, Bingisser R, Morgenthaler NG
Abstract
The hypothalamic-pituitary-adrenal axis is activated in response to stress. One of the activated hypothalamic hormones is arginine vasopressin, a hormone involved in hemodynamics and osmoregulation. Copeptin, the C-terminal part of the arginine vasopressin precursor peptide, is a sensitive and stable surrogate marker for arginine vasopressin release. Measurement of copeptin levels has been shown to be useful in a variety of clinical scenarios, particularly as a prognostic marker in patients with acute diseases such as lower respiratory tract infection, heart disease and stroke. The measurement of copeptin levels may provide crucial information for risk stratification in a variety of clinical situations. As such, the emergency department appears to be the ideal setting for its potential use. This review summarizes the recent progress towards determining the prognostic and diagnostic value of copeptin in the emergency department.
PMID: 22264220 [PubMed - indexed for MEDLINE]
Link to Article at PubMedMay 242012
Drug-related problems identified in post-discharge medication reviews for patients taking warfarin.
Int J Clin Pharm. 2011 Aug;33(4):621-6
Authors: Stafford L, Stafford A, Hughes J, Angley M, Bereznicki L, Peterson G
Abstract
OBJECTIVE: To characterise the nature of the drug-related problems with warfarin therapy identified in pharmacist-conducted medication reviews during a collaborative post-discharge warfarin management service, with a focus on potentially serious drug interactions.
SETTING: Australian community pharmacy practice.
METHOD: Medication review reports submitted by pharmacists to patients' general practitioners as part of the service were reviewed and the type and clinical significance of the warfarin-associated drug-related problems, and the pharmacists' recommendations were classified. The prevalence of prescribing of 'potentially hazardous' warfarin drug interactions was investigated and compared with the frequency of documentation of these interactions in the medication review reports.
MAIN OUTCOME MEASURE: The number and nature of warfarin-associated drug-related problems identified and the rate of documentation of 'potentially hazardous' warfarin drug interactions in the reports from pharmacist-conducted medication reviews.
RESULTS: A total of 157 warfarin-associated drug-related problems were documented in 109 medication review reports (mean 1.4 per patient, 95% CI 1.3-1.6, range 0-5). Drug selection and Education or information were the most commonly identified warfarin-associated drug-related problems; most drug-related problems were of moderate clinical significance. Eight of 23 potentially serious warfarin drug interactions (34.8%) were identified in the medication review reports.
CONCLUSION: Pharmacists addressing drug selection and warfarin education drug-related problems during medication reviews may have contributed to the positive outcomes of the post-discharge service. Warfarin drug interactions were frequently identified; however, well-recognised potentially hazardous interactions were under-reported. Improved communication along the continuum of care would permit improved targeting of drug-related problem reporting, especially in relation to preventable drug interactions.
PMID: 21594591 [PubMed - indexed for MEDLINE]
Link to Article at PubMed