Johan Decruyenaere's research while affiliated with Ghent University and other places

Publications (356)

Article
The optimal moment to start renal replacement therapy in a patient with acute kidney injury (AKI) remains a challenging problem in intensive care nephrology. Multiple randomized controlled trials have tried to answer this question, but these contrast only a limited number of treatment initiation strategies. In view of this, we use routinely collect...
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The combination of “Big Data” and Artificial Intelligence (AI) is frequently promoted as having the potential to deliver valuable health benefits when applied to medical decision-making. However, the responsible adoption of AI-based clinical decision support systems faces several challenges at both the individual and societal level. One of the feat...
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Background There is increasing interest in incorporating clinical decision support (CDS) into electronic healthcare records (EHR). Successful implementation of CDS systems depends on acceptance of them by healthcare workers. We used a mix of quantitative and qualitative methods starting from Qsort methodology to explore expectations and perceptions...
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Research regarding the drivers of acceptance of clinical decision support systems (CDSS) by physicians is still rather limited. The literature that does exist, however, tends to focus on problems regarding the user-friendliness of CDSS. We have performed a thematic analysis of 24 interviews with physicians concerning specific clinical case vignette...
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BACKGROUND AND AIMS Routinely collected data (RCD) are readily available at most ICUs. Their secondary analysis is expected to improve medical decision-making by providing expedited answers to clinical questions that would otherwise require conducting costly and less generalizable RCTs. However, doubts remain whether RCD can produce sound answers t...
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BACKGROUND AND AIMS The optimal moment to start renal replacement therapy (RRT) in patients with acute kidney injury (AKI) in the intensive care unit (ICU) remains a challenging problem. Evidence is lacking that, in absence of absolute criteria for pH or serum potassium, timing of RRT initiation (early versus delayed) affects survival. The optimal...
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PurposeTo critically analyse the literature on the antenatal corticosteroids (ACS)-to-birth interval from a causal point of view and to present a solution to the problem of bias caused by post hoc analysis.Methods Due to the post hoc nature of the ACS-to-birth interval, a randomised controlled trial (RCT) of ACS versus placebo is not able to examin...
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Objectives: Intensive care unit (ICU) survivors are often left with impairments in physical, mental and cognitive functioning (Post-Intensive Care Syndrome (PICS)). We evaluated the organization, the feasibility for caregivers and patients and the patients' appreciation of a post-ICU consultation aiming to detect these PICS-symptoms. Methods: A...
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In this correspondence, we highlight general and domain-specific caveats in the development and validation of prediction models. Development and use of the “QUiPP” application, a tool for preterm birth prediction which is supported by the United Kingdom National Health Service, is scrutinised and commented on. We highlight and elaborate ten points...
Article
The optimal moment to start renal replacement therapy in a patient with acute kidney injury (AKI) remains a challenging problem in intensive care nephrology. Multiple randomised controlled trials have tried to answer this question, but these contrast only a limited number of treatment initiation strategies. In view of this, we use routinely collect...
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Full-text available
Background Baseline characteristics and disease severity of patients with septic shock according to the new Sepsis-3 definition may differ from patients that only comply with the Sepsis-2 definition. We conducted a retrospective cohort study on the ICU of a Belgian tertiary care facility to seek out differences between these two patient groups and...
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Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods In thi...
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Objective - To compare neonatal magnesemia in the first fifteen days of neonatal life between three groups: a control group not exposed to MgSO4, a neuroprotection group, and an eclampsia prevention group, and to explore its’ associations with child outcomes. Design - Retrospective single-centre cohort study. Setting - Tertiary care setting. Popula...
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Background In severe coronavirus diseases 2019 (COVID-19), a high and potentially excessive use of antimicrobials for suspected bacterial co-infection and intensive care unit (ICU)-acquired infections has been repeatedly reported. Objectives To compare an ICU cohort of community-acquired pneumonia (CAP) with a cohort of severe COVID-19 pertaining...
Preprint
Full-text available
The optimal moment to start renal replacement therapy in a patient with acute kidney injury (AKI) remains a challenging problem in intensive care nephrology. Multiple randomised controlled trials have tried to answer this question, but these can, by definition, only analyse a limited number of treatment initiation strategies. In view of this, we us...
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Full-text available
Most reports on AKI claim to use KDIGO guidelines but fail to include the urinary output (UO) criterion in their definition of AKI. We postulated that ignoring UO alters the incidence of AKI, may delay diagnosis of AKI, and leads to underestimation of the association between AKI and ICU mortality. Using routinely collected data of adult patients ad...
Preprint
Full-text available
Purpose - To critically analyse the literature on the antenatal corticosteroids (ACS)-to-birth interval from a causal point of view and to present a solution to the problem of bias caused by post-hoc analysis. Methods - Due to the post-hoc nature of the ACS-to-birth interval, a randomised controlled trial (RCT) of ACS versus placebo is not able to...
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Full-text available
Over the last decades, the face of health care has changed dramatically, with big improvements in what is technically feasible. However, there are indicators that the current approach to evaluating evidence in health care is not holistic and hence in the long run, health care will not be sustainable. New conceptual and normative frameworks for the...
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Digitalisering en artificiële intelligentie (AI) bieden mogelijkheden om de gezondheidszorg te optimaliseren. Vooral machine learning gebaseerd op neurale netwerktechnologie, waaronder deep learning of gebaseerd op beslisboomtechnologie, worden in die context naar voren geschoven. Succesvolle implementatie van dergelijke algoritmes vooronderstelt i...
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Bedrijven kunnen medische gegevens halen uit verschillende bronnen: Facebook-berichten, aankopen met kredietkaart, inhoud van e-mails of recent bekeken video’s op YouTube. In principe houden deze gegevens geen verband met de gezondheidstoestand van de gebruiker. Kunstmatige intelligentie-instrumenten en “big data”-algoritmen kunnen betekenisloze in...
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Information extracted from electrohysterography recordings could potentially prove to be an interesting additional source of information to estimate the risk on preterm birth. Recently, a large number of studies have reported near-perfect results to distinguish between recordings of patients that will deliver term or preterm using a public resource...
Article
Rationale: Estimating the impact of ventilator-associated pneumonia (VAP) from routinely collected ICU data is methodologically challenging. Objectives: We aim to replicate earlier findings of limited VAP-attributable ICU mortality in an independent cohort. By refining statistical analyses, we gradually tackle different sources of bias. Methods...
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Background: While obesity confers an increased risk of death in the general population, numerous studies have reported an association between obesity and improved survival among critically ill patients. This contrary finding has been referred to as the obesity paradox. In this retrospective study, two causal inference approaches were used to addre...
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Abstract Introduction Cardiopulmonary resuscitation (CPR) in patients with a poor prognosis increases the risk of perception of inappropriate care leading to moral distress in clinicians. We evaluated whether perception of inappropriate CPR is associated with intention to leave the job among emergency clinicians. Methods A cross-sectional multi-...
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The population-attributable fraction (PAF) expresses the percentage of events that could have been prevented by eradicating a certain exposure in a certain population. It can be strongly time-dependent because either exposure incidence or excess risk may change over time. Competing events may moreover hinder the outcome of interest from being obser...
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PurposePreterm birth (PTB) can be categorised according to aetiology into: spontaneous preterm labour (SPL), preterm prelabour rupture of membranes (PPROM), and iatrogenic (iatro) PTB. Outcomes could differ between these groups, which could be of interest in counselling. We aimed to explore differences between aetiologic groups of PTB in maternal d...
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Background Anisakiasis is an emerging zoonosis caused by the fish parasitic nematode Anisakis infecting the gastrointestinal tract. Case presentation We describe a case of a 58-year-old woman diagnosed with gastro-allergic anisakiasis, in which the patient developed an acute food-induced IgE-mediated hypersensitivity reaction as well as concurrent...
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This paper contributes to the pursuit of leveraging unstructured medical notes to structured clinical decision making. In particular, we present a pipeline for clinical information extraction from medical notes related to preterm birth, and discuss the main challenges as well as its potential for clinical practice. A large collection of medical not...
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Background and Aims The reported incidence of Acute Kidney Injury (AKI) at the intensive care unit (ICU) is variable. Although the Kidney Disease Improving Global Outcome (K-DIGO) improved harmonisation of this definition, there is remaining variability in the actual implementation of this AKI definition, with variable interpretation of the urinary...
Article
Background and Aims The reported associated mortality risks of Acute Kidney Injury (AKI) in the intensive care unit (ICU) are variable. Although the Kidney Disease Improving Global Outcome (K-DIGO) improved harmonisation of the definition, there is remaining variability in the actual implementation of this AKI definition, with variable use of the u...
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Objectives: The purpose of this study was to compare short-term outcomes in children born between 24 and 34 weeks’ gestation, according to observed antenatal corticosteroids (ACS)-to-birth intervals. Research question: ‘Is there a difference in short-term outcomes between observed ACS-to-birth intervals across a range of gestational ages at birth?’...
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Background: Machine learning (ML) is increasingly used in many areas of healthcare. Its use in infection management is catching up as identified in a recent review in this journal. We present a complementary review to this work. Objectives: To support clinicians and researchers to navigate through the methodological aspects of ML approaches in t...
Preprint
Full-text available
Information extracted from electrohysterography recordings could potentially prove to be an interesting additional source of information to estimate the risk on preterm birth. Recently, a large number of studies have reported near-perfect results to distinguish between recordings of patients that will deliver term or preterm using a public resource...
Article
Purpose: Identification of patients for epidemiologic research through administrative coding has important limitations. We investigated the feasibility of a search based on natural language processing (NLP) on the text sections of electronic health records for identification of patients with septic shock. Materials and methods: Results of an exp...
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Despite intensive research and constant medical progress, sepsis remains one of the most urgent unmet medical needs of today. Most studies have been focused on the inflammatory component of the disease; however, recent advances support the notion that sepsis is accompanied by extensive metabolic perturbations. During times of limited caloric intake...
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In 2017, regulatory approval was given in the US for a ‘digital pill’, a pill for which actual ingestion could be remotely monitored. The pill, Abilify Mycite is marketed by Otsuka but the monitoring system derives from Proteus Digital Health. In this paper, we focus on this digital pill and another equivalent system from AiCure which relies on fac...
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Purpose Apart from organizational issues, quality of inter-professional collaboration during ethical decision-making may affect the intention to leave one’s job. To determine whether ethical climate is associated with the intention to leave after adjustment for country, ICU and clinicians characteristics. Methods Perceptions of the ethical climate...
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Importance Norepinephrine, the first-line vasopressor for septic shock, is not always effective and has important catecholaminergic adverse effects. Selepressin, a selective vasopressin V1a receptor agonist, is a noncatecholaminergic vasopressor that may mitigate sepsis-induced vasodilatation, vascular leakage, and edema, with fewer adverse effects...
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We seek to clarify and assess the underlying moral reasons for opposing all medically unnecessary genital cutting of female minors, no matter how severe. We find that within a Western medicolegal framework, these reasons are compelling. However, they do not only apply to female minors, but rather to non-consenting persons of any age irrespective of...
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Purpose We evaluated the feasibility and robustness of three methods for propofol-to-bispectral index (BIS) post-operative intensive care sedation, a manually-adapted target controlled infusion protocol (HUMAN), a computer-controlled predictive control strategy (EPSAC) and a computer-controlled Bayesian rule-based optimized control strategy (BAYES)...
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Background: Long-term outcome and quality of life (QOL) in patients requiring prolonged mechanical ventilation after failure to wean in the ICU is scarcely documented. We aimed to evaluate long-term survival and QOL in patients discharged from the ICU with a tracheostomy for difficult weaning, and with or without ventilator dependency at ICU discha...
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Background: Hypoxic hepatitis (HH) is a type of acute hepatic injury that is histologically characterized by centrilobular liver cell necrosis and that is caused by insufficient oxygen delivery to the hepatocytes. Typical for HH is the sudden and significant increase of aspartate aminotransferase (AST) in response to cardiac, circulatory or respir...
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Background: Preparing an antibiotic stewardship program requires detailed information on overall antibiotic use, prescription indication and ecology. However, longitudinal data of this kind are scarce. Computerization of the patient chart has offered the potential to collect complete data of high resolution. To gain insight in our global antibioti...
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Introduction: Blood cultures are often performed in the intensive care unit (ICU) to detect bloodstream infections and identify pathogen type, further guiding treatment. Early detection is essential, as a bloodstream infection can give cause to sepsis, a severe immune response associated with an increased risk of organ failure and death. Problem s...
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Sepsis in humans and experimental animals is characterized by an acute inflammatory response. Glucocorticoids (GCs) are widely used for the treatment of many inflammatory disorders, yet their effectiveness in sepsis is debatable. One of the major anti-inflammatory proteins induced by GCs is GILZ (Glucocorticoid-Induced Leucine Zipper, coded by the...
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Purpose: Whether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown. Methods: In this prospective observational study, perceptions of excessive care (PECs) by clinicians working in 68 ICUs in Europe and the USA were collected...
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Background Literature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU). Objectives To better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates. Methods Using a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting o...
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Background: In intensive care unit (ICU) patients, many laboratory measurements can be deranged when compared with the standard reference interval (RI). The assumption that larger derangements are associated with worse outcome may not always be correct. The ICU-Labome study systematically evaluated the univariate association of routine laboratory...
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PURPOSE: To evaluate differences in the characteristics and outcomes of intensive care unit (ICU) patients over time. METHODS: We reviewed all epidemiological data, including comorbidities, types and severity of organ failure, interventions, lengths of stay and outcome, for patients from the Sepsis Occurrence in Acutely ill Patients (SOAP) study,...
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Objectives: Sepsis causes very high mortality and morbidity rates and remains one of the biggest medical challenges. This study investigates whether plasma levels of both matrix metalloproteinase 8 and tumor necrosis factor receptor 1 are associated with sepsis severity and also investigates the therapeutic applicability of simultaneous inhibition...
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Purpose: We developed a prediction model for quality of life (QOL) 1 year after intensive care unit (ICU) discharge based upon data available at the first ICU day to improve decision-making. Methods: The database of a 1-year prospective study concerning long-term outcome and QOL (assessed by EuroQol-5D) in critically ill adult patients consecuti...
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The presence of bacteria or fungi in the bloodstream of patients is abnormal and can lead to life-threatening conditions. A computational model based on a bidirectional long short-term memory artificial neural network, is explored to assist doctors in the intensive care unit to predict whether examination of blood cultures of patients will return p...