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Critical Care 04/2012; 8:1-1. · 4.93 Impact Factor
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ABSTRACT: Healthcare-associated pneumonia (HCAP) is considered to represent a category of disease distinct from community-acquired pneumonia (CAP). We describe the incidence and characteristics of HCAP compared with CAP in patients hospitalised through the emergency department (ED). Pneumonia diagnosed at the ED of Ghent University Hospital from 1 November 2006 to 31 October 2007 was retrospectively categorised as CAP or HCAP according to the definition of the American Thoracic Society/Infectious Diseases Society of America. We categorised 287 episodes of pneumonia, diagnosed in 269 patients, as CAP [159 (55%)] or HCAP [128 (45%)]. Patients with HCAP were older [75 years (range: 64-83) vs 68 (41-78); P < 0.001], had more comorbidity, and had more severe pneumonia [CURB-65: 2 (1-3) vs 1 (0-2); P < 0.001] in comparison to patients with CAP. Patients with HCAP had more frequently an unfavourable clinical course (27% vs 15%; P < 0.01) and a longer hospital stay (12 days vs 9 days; P<0.001) compared with patients with CAP. In multivariate regression analysis, nursing home residence (odds ratio: 2.96; 95% confidence interval: 1.12-7.84; P = 0.03) but not HCAP was an independent predictor for in-hospital mortality. In conclusion, a high percentage (45%) of patients hospitalised with pneumonia through the ED was classified as HCAP. Classification as HCAP was associated with an unfavourable clinical course. Nursing home residence was an independent predictor for increased mortality.
The Journal of hospital infection 02/2011; 77(2):138-42. · 3.01 Impact Factor
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ABSTRACT: Outcome in haematological patients who develop critical illness has significantly improved over the last two decades, but less so in allogeneic BMT recipients. We prospectively investigated the outcome of 44 haematological patients with allogeneic BM or haematopoietic SCT (ABMT/AHSCT) requiring admission to the intensive care unit (ICU) of Ghent University Hospital between January 2000 and December 2007. We related outcome to the cause of critical illness, which was categorized as documented or clinically suspected bacterial infection, non-bacterial infection and non-infectious disease. Mechanical ventilation was required in 32 patients, and 12 patients received renal replacement therapy. Overall ICU-mortality, in-hospital mortality and 6-month mortality rates were 61, 75 and 80%, respectively. Hospital mortality rates in patients with bacterial infection (n=14), non-bacterial infection (n=13) and non-infectious disease (n=17) were 43, 85 and 94% (P=0.003). After adjustment for severity of illness sequential organ failure assessment (SOFA) score, bacterial infection (odds ratio 0.06, 0.01-0.36, P=0.002) was associated with significantly lower odds for hospital mortality. On the basis of our experience, ICU referral of ABMT/AHSCT patients is justifiable, as an acceptable fraction of these patients have longer-term survival. Documented or clinically suspected bacterial infection as the cause of critical illness is associated with better prognosis in comparison with other causes.
Bone marrow transplantation 11/2010; 46(9):1186-91. · 3.00 Impact Factor
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ABSTRACT: Echo-state networks (ESN) are part of a group of reservoir computing methods and are basically a form of recurrent artificial neural networks (ANN). These methods can perform classification tasks on time series data. The recurrent ANN of an echo-state network has an 'echo-state' characteristic. This 'echo-state' functions as a fading memory: samples that have been introduced into the network in a further past, are faded away. The echo-state approach for the training of recurrent neural networks was first described by Jaeger H. et al. In clinical medicine, until this moment, no original research articles have been published to examine the use of echo-state networks.
This study examines the possibility of using an echo-state network for prediction of dialysis in the ICU. Therefore, diuresis values and creatinine levels of the first three days after ICU admission were collected from 830 patients admitted to the intensive care unit (ICU) between May 31 th 2003 and November 17th 2007. The outcome parameter was the performance by the echo-state network in predicting the need for dialysis between day 5 and day 10 of ICU admission. Patients with an ICU length of stay <10 days or patients that received dialysis in the first five days of ICU admission were excluded. Performance by the echo-state network was then compared by means of the area under the receiver operating characteristic curve (AUC) with results obtained by two other time series analysis methods by means of a support vector machine (SVM) and a naive Bayes algorithm (NB).
The AUC's in the three developed echo-state networks were 0.822, 0.818, and 0.817. These results were comparable to the results obtained by the SVM and the NB algorithm.
This proof of concept study is the first to evaluate the performance of echo-state networks in an ICU environment. This echo-state network predicted the need for dialysis in ICU patients. The AUC's of the echo-state networks were good and comparable to the performance of other classification algorithms. Moreover, the echo-state network was more easily configured than other time series modeling technologies.
BMC Medical Informatics and Decision Making 01/2010; 10:4. · 1.48 Impact Factor
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ABSTRACT: Several models for mortality prediction have been constructed for critically ill patients with haematological malignancies in recent years. These models have proven to be equally or more accurate in predicting hospital mortality in patients with haematological malignancies than ICU severity of illness scores such as the APACHE II or SAPS II 1. The objective of this study is to compare the accuracy of predicting hospital mortality in patients with haematological malignancies admitted to the ICU between models based on multiple logistic regression (MLR) and support vector machine (SVM) based models.
352 patients with haematological malignancies admitted to the ICU between 1997 and 2006 for a life-threatening complication were included. 252 patient records were used for training of the models and 100 were used for validation. In a first model 12 input variables were included for comparison between MLR and SVM. In a second more complex model 17 input variables were used. MLR and SVM analysis were performed independently from each other. Discrimination was evaluated using the area under the receiver operating characteristic (ROC) curves (+/- SE).
The area under ROC curve for the MLR and SVM in the validation data set were 0.768 (+/- 0.04) vs. 0.802 (+/- 0.04) in the first model (p = 0.19) and 0.781 (+/- 0.05) vs. 0.808 (+/- 0.04) in the second more complex model (p = 0.44). SVM needed only 4 variables to make its prediction in both models, whereas MLR needed 7 and 8 variables in the first and second model respectively.
The discriminative power of both the MLR and SVM models was good. No statistically significant differences were found in discriminative power between MLR and SVM for prediction of hospital mortality in critically ill patients with haematological malignancies.
BMC Medical Informatics and Decision Making 01/2009; 8:56. · 1.48 Impact Factor
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ABSTRACT: To assess prediction of multidrug resistant (MDR) pathogens in ventilator-associated pneumonia (VAP) by systematic surveillance cultures (SC) and to assess the contribution of SC to initial antibiotic therapy.
Prospective cohort study of patients with microbiologically confirmed VAP. Comparison of actual early antibiotic coverage with three hypothetical empirical schemes.
A 50-bed university hospital ICU. SC consisted of oral, nasal, urinary and rectal samples upon admission, 3-weekly urinary and 1-weekly oral, nasal, and rectal samples in all patients, 3-weekly tracheal aspirates in intubated patients.
MDR pathogens were found in 86 of 199 VAP episodes. Sensitivity of SC to predict MDR pathogens was 69% (tracheal SC) and 82% (all SC); specificity was 96% (tracheal) and 91% (all), respectively. Appropriate antibiotic coverage within 24 h and 48 h following MDR VAP was 77% and 89%, respectively. A carbapenem-based empirical scheme would have been equally appropriate (83% vs. 77% at 24 h; 83% vs. 89% at 48 h), but a beta-lactam-fluoroquinolone empirical therapy would have been less (59% vs. 77% at 24 h; 59% vs. 89% at 48 h) as would have been beta-lactam-aminoglycoside therapy (68% vs. 77% at 24 h; 68% vs. 89% at 48 h). Empirical comparators would have resulted in significantly more prescription of broad-spectrum antibiotics within the first 48 h.
With MDR pathogens highly prevalent, systematic SC predicted MDR pathogens causing VAP in 69% to 82% and may have contributed to high rates of early appropriate antibiotic therapy with limited use of broad-spectrum antimicrobials.
Intensive Care Medicine 05/2008; 34(4):675-82. · 5.40 Impact Factor
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ABSTRACT: Assessment of short-term outcome in critically-ill patients who develop acute kidney injury (AKI) may underestimate the true burden of disease. It is important to focus on long-term survival, renal recovery and quality of life beyond hospital discharge. Although the majority of critically-ill patients with AKI die during hospital stay, there is only a minor increase in mortality after hospital discharge among AKI patients treated in the intensive care unit (ICU). Estimates of mortality rates at 1 year following hospital discharge range from 57% to 78% with an absolute difference between hospital mortality and 1-year mortality ranging from 4% to 18%. Renal recovery is another important measure of outcome since chronic renal replacement therapy (RRT) does not only significantly affect health-related quality of life (HRQoL), it is also costly. Fortunately, renal recovery occurs in most AKI survivors leading to independence of RRT at 1 year following hospital discharge. Potential factors associated with reduced recovery of renal function are female sex, high comorbidity, older age, a parenchymal aetiology of AKI, late initiation of RRT, and use of intermittent haemodialysis (IHD). HRQoL in survivors of critical illness and severe AKI is perceived as acceptable and good, despite the fact that HRQoL scores are lower than these of the general population.
Acta clinica Belgica. Supplementum 02/2007;
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American Journal of Respiratory and Critical Care Medicine 01/2006; 172(11):1472; author reply 1474. · 11.08 Impact Factor
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ABSTRACT: Background. Central venous catheters are universally used during the treatment of critically ill patients. Their use, however, is associated with a substantial infection risk, potentially leading to increased mortality and costs. We evaluate clinical and economic outcomes associated with nosocomial central venous catheter-related bloodstream infection (CR-BSI) in intensive care unit (ICU) patients.Methods. A retrospective (1992-2002), pairwise-matched (ratio of case patients to control subjects, 1 : 2 or 1 : 1), risk-adjusted cohort study was performed at a 54-bed general ICU at a university hospital. ICU patients with microbiologically documented CR-BSI (n=176) were matched with control subjects (n=315) on the basis of disease severity, diagnostic category, and length of ICU stay (equivalent or longer) before the onset of CR-BSI in the index case patient. Clinical outcome was principally evaluated by in-hospital mortality. Economic outcome was evaluated on the basis of duration of mechanical ventilation, length of ICU and hospital stays, and total hospital costs, as derived from the patient's hospital invoices.Results. The attributable mortality rate for CR-BSI was estimated to be 1.8% (95% confidence interval, -6.4% to 10.0%); in-hospital mortality rates for patients with CR-BSI and matched control subjects were 27.8% and 26.0%, respectively. CR-BSI was associated with significant excesses in duration of mechanical ventilation, duration of ICU and hospital stays, and a significant increase in total hospital cost. Linear regression analysis with adjustment for duration of hospitalization and clinical covariates, revealed that CR-BSI is independently associated with higher costs.Conclusions. In ICU patients, CR-BSI does not result in increased mortality. It is, however, associated with a significant economic burden, emphasizing the importance of continuous efforts in prevention.
Clin Infect Dis. 01/2005; 41(11):1591-8.
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ABSTRACT: Invasive aspergillosis is a rare disease in intensive care unit (ICU) patients and carries a poor prognosis. The aim of the present study was to determine the attributable mortality due to invasive aspergillosis in critically ill patients. In a retrospective, matched cohort study (July 1997-December 1999), 37 ICU patients with invasive aspergillosis were identified together with 74 control patients. Matching of control (1:2) patients was based on the acute physiology and chronic health evaluation (APACHE) II classification: an equal APACHE II score (+/-1 point) and diagnostic category. This matching procedure results in an equal expected in-hospital mortality for cases and controls. Additionally, control patients were required to have an ICU stay equivalent to or longer than the case before the first culture positive for Aspergillus spp. Patients with invasive aspergillosis were more likely to experience acute renal failure (43.2% versus 20.5%; P = 0.020). They also had a longer ICU stay (median: 13 days versus seven days; P < 0.001) as well as a more extended period of mechanical ventilator dependency (median: 13 days versus four days; P < 0.001). Hospital mortalities for cases and controls were 75.7% versus 56.8%, respectively (P=0.051). The attributable mortality was 18.9% (95% CI: 1.1-36.7). A multivariate survival analysis showed invasive aspergillosis [hazard ratio (HR): 1.9, 95% CI: 1.2-3.0; P = 0.004] and acute respiratory failure (HR: 6.5, 95%: 1.4-29.3; P < 0.016) to be independently associated with in-hospital mortality. In conclusion, it was found that invasive aspergillosis in ICU patients carries a significant attributable mortality of 18.9%. In a multivariate analysis, adjusting for other co-morbidity factors, invasive aspergillosis was recognized as an independent predictor of mortality.
Journal of Hospital Infection 04/2004; 56(4):269-76. · 3.39 Impact Factor
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European Journal of Clinical Microbiology 09/2000; 19(8):642-3. · 2.86 Impact Factor
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ABSTRACT: We report here details of a patient with Plasmodium falciparum malaria which was acquired in the vicinity of Ghent (Evergem) in July 1997. Indigenous malaria disappeared from Belgium in 1938. Due to an increase in international travel, the influx of migrant labor and the changing environmental conditions, there has been an upsurge of imported malaria. Airport- and port-malaria is acquired through the bite of a tropical anophelline mosquito by people whose geographical history excludes exposure to this vector in its natural habitat. As far as we know, only two cases of port-malaria have been reported: in Marseille. We describe here another possible case of port-malaria due to infection with P. falciparum in a 42-year-old woman with an underlying non-Hodgkin lymphoma.
Journal of Travel Medicine 02/2000; 7(1):48-9. · 1.75 Impact Factor
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ABSTRACT: Two cases of disseminated mucormycosis in patients with underlying hematological disease are described. Both patients presented with fever and pulmonary infiltrates which did not respond to empirical treatment with broad-spectrum antibiotics and antifungal agents, and in both patients there was rapid progression with a fatal outcome. All cultures were negative and the diagnosis was made postmortem. A review of the literature revealed only three recent reports of successful treatment of disseminated mucormycosis. Survival correlated with control of the underlying disease and early diagnosis based on histological examination of biopsy specimens from suspected lesions. Therapy consisted of surgical debridement and amphotericin B. Standard therapeutic schedules need to be defined for this infection.
European Journal of Clinical Microbiology 01/1999; 17(12):859-63. · 2.86 Impact Factor
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Intensive Care Medicine 11/1998; 24(10):1120-1. · 5.40 Impact Factor
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ABSTRACT: Candidemia and major organ candidiasis are problems that emerged in the past 2 decades and that are partially due to medical progress. Catheter-related thrombosis of the central veins is known to be a frequent but mostly subclinical complication of central venous lines. Although candidemia and catheter-related thrombosis are frequent, candida thrombophlebitis of the central veins is rarely reported. We recently successfully treated a 19-year-old polytrauma patient with candidal thrombophlebitis of the innominate vein. Despite catheter removal and therapy with amphotericin B, recurrent candidemia and signs of infection persisted, and a complete resection of the involved vein had to be performed. Only 16 well-documented cases of candidal thrombophlebitis of the central veins in adults have been reported over the past 20 years. An analysis of these 16 patients, together with our patient, is made in relation to risk factors, clinical features, diagnosis, therapy, and mortality.
Clinical Infectious Diseases 02/1998; 26(2):393-7. · 9.15 Impact Factor
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Intensive Care Medicine 01/1998; 24(1):88-9. · 5.40 Impact Factor
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Intensive Care Med. 01/1998; 24:88-89.
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ABSTRACT: To investigate outcome in patients who develop invasive aspergillosis in the ICU, and to evaluate whether specific risk factors for the acquisition of invasive aspergillosis are associated with mortality.
Retrospective cohort study (07/1997-12/1999) with screening of 8988 admissions.
54-bed ICU of the 1060-bed Ghent University Hospital.
38 ICU patients with invasive aspergillosis. Invasive aspergillosis was defined as proven by positive histology and tissue culture and as probable by a combination of clinical suspicion as well as microbiological and radiological data. Seventeen patients had risk factors (neutropenia, haematological malignancy, immunosuppressive therapy). In the other 21 apparently immunocompetent patients, invasive aspergillosis was a complication following ARDS, COPD, pneumonia, acute liver failure, burns, severe bacterial infection and malnutrition.
Population characteristics and outcome were compared for patients with and without risk factors for the acquisition of invasive aspergillosis.
Patients with risk factors had higher APACHE II scores. No difference was found between patients with and without risk factors in in-hospital mortality (82% vs. 71%; p=0.431). In patients with specific risk factors, the observed mortality was not different from the mortality as expected on basis of the APACHE II (p=0.940). In patients without risk factors the observed mortality exceeded the expected mortality (p<0.001).
The incidence of invasive aspergillosis in this series is 4/1000 admissions. No difference in mortality was found between patients with and without risk factors for the acquisition of invasive aspergillosis. Yet, the prognosis of the patients without risk factors seems to alter more seriously by the development of this infection.
Acta clinica Belgica 59(5):251-7. · 0.59 Impact Factor
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ABSTRACT: Previous research found that in noncritically ill patients, thoracocentesis has an unpredictable effect on oxygenation, possibly due to re-expansion pulmonary edema and systemic hypotension. The authors performed a retrospective analysis to study the effect of tube thoracostomy on oxygenation in ICU patients, and the complications associated with it. The authors reviewed the charts of 58 ICU patients in whom 74 procedures were performed. Demographic data, APACHE II score, and indication for thoracocentesis were retrieved from the patient's file. The P(a)O(2)/FiO(2) ratio was calculated before, 12, 24, and 48 hours after tube thoracostomy. P(a)O(2)/FiO(2) ratios at the mentioned time intervals were compared using 1-way analysis of variances (ANOVA) with repeated measures. Logistic regression analysis was used to identify factors associated with a good response to treatment. Age of the patients was 53 +/- 19.0 years (range, 17-88), APACHE II score was 21 +/- 8.3 (range, 6-38), and median length of stay was 13.5 days (interquartile range, 7-25). The volume drained during the first 24 hours was 1077 +/- 667 ml. P(a)O(2)/FiO(2) ratio was 185 +/- 79.3 before chest drainage, 197 +/- 79.1 at 12 hours, 217 +/- 88.9 at 24 hours, and 233 +/- 99.8 at 48 hours. In only 54% of the procedures, a response to therapy was present. Multivariate analysis identified a P(a)O(2)/FiO(2) below 180 to be independently associated with improvement in oxygenation. At 24 and 48 hours, the P(a)O(2)/FiO(2) ratio was significantly higher than before drainage (P <.001). There were 13 complications in 11 procedures (14.9%). The authors' results suggest that tube thoracostomy can be used as an adjunct in the treatment of selected patients with hypoxemic respiratory failure in the ICU. A low P(a)O(2)/FiO(2) seems to be a good predictor of response to therapy. However, the complication rate is considerable, especially in patients with a prolonged ICU stay.
Journal of Intensive Care Medicine 18(2):100-4.
