| 1. |
- Gudnadottir, Gudny Stella, et al.
(författare)
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Outcomes after STEMI in old multimorbid patients with complex health needs and the effect of invasive management
- 2019
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Ingår i: American Heart Journal. - : MOSBY-ELSEVIER. - 0002-8703 .- 1097-6744. ; 211, s. 11-21
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to assess one-year outcomes of invasive and non-invasive strategies in ST-elevation myocardial infarction (STEMI) among multimorbid older people with complex health needs.Methods: We included patients, registered between 2006 and 2013 in the SWEDEHEART registry, who were 70 years old or older with STEMI, had multimorbidily and complex health needs and were discharged alive. The one-year outcomes of patients who underwent invasive strategy (examined with coronary angiography <= 14 days) were compared to those who did not. The primary event was a composite of all-cause death, admission due to new acute coronary syndrome, stroke or transient ischemic attack.Results: We identified patients, and 1089 were managed invasively and 570 non-invasively. The mean age was 79 years and 83 years in the 2 groups, respectively. After multivariable adjustment for baseline differences between the groups, including propensity scores, the primary event occurred in 31% of patients in the invasive group and 55% in the non-invasive group, adjusted hazard ratio (95% confidence intervals): 0.67 (0.54-0.83). One-year mortality was 18% in the invasive group and 45% in the non-invasive group, adjusted hazard ratio 0.51 (0.39-0.65).Conclusions: Multimorbid older people with complex health needs and STEMI had high rates of new ischemic events and death. In this cohort of older, high risk STEMI patients, an invasive strategy was associated with lower event rates. Randomized studies are needed to clarify whether these high risk patients who might benefit from invasive care are being managed too conservatively.
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| 2. |
- Helmersson, Johanna, et al.
(författare)
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Addition of cystatin C predicts cardiovascular death better than creatinine in intensive care.
- 2022
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Ingår i: Heart. - : BMJ Publishing Group Ltd. - 1355-6037 .- 1468-201X. ; 108:4, s. 279-284
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Decreased kidney function increases cardiovascular risk and predicts poor survival. Estimated glomerular filtration rate (eGFR) by creatinine may theoretically be less accurate in the critically ill. This observational study compares long-term cardiovascular mortality risk by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation; Caucasian, Asian, paediatric and adult cohort (CAPA) cystatin C equation and the CKD-EPI combined creatinine/cystatin C equation.METHODS: The nationwide study includes 22 488 intensive care patients in Uppsala, Karolinska and Lund University Hospitals, Sweden, between 2004 and 2015. Creatinine and cystatin C were analysed with accredited methods at admission. Reclassification and model discrimination with C-statistics was used to compare creatinine and cystatin C for cardiovascular mortality prediction.RESULTS: During 5 years of follow-up, 2960 (13 %) of the patients died of cardiovascular causes. Reduced eGFR was significantly associated with cardiovascular death by all eGFR equations in Cox regression models. In each creatinine-based GFR category, 17%, 19% and 31% reclassified to a lower GFR category by cystatin C. These patients had significantly higher cardiovascular mortality risk, adjusted HR (95% CI), 1.55 (1.38 to 1.74), 1.76 (1.53 to 2.03) and 1.44 (1.11 to 1.86), respectively, compared with patients not reclassified. Harrell's C-statistic for cardiovascular death for cystatin C, alone or combined with creatinine, was 0.73, significantly higher than for creatinine (0.71), p<0.001.CONCLUSIONS: A single cystatin C at admission to the intensive care unit added significant predictive value to creatinine for long-term cardiovascular death risk assessment. Cystatin C, alone or in combination with creatinine, should be used for estimating GFR for long-term risk prediction in critically ill.
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| 3. |
- Martensson, Johan, et al.
(författare)
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Association of plasma neutrophil gelatinase-associated lipocalin (NGAL) with sepsis and acute kidney dysfunction
- 2013
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Ingår i: Biomarkers. - 1354-750X .- 1366-5804. ; 18:4, s. 349-356
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Neutrophil gelatinase-associated lipocalin (NGAL) is secreted by injured kidney cells as well as by activated neutrophils in response to bacterial infections. We assessed the influence of acute renal dysfunction on the association between plasma NGAL and sepsis. Methods: NGAL was measured daily in 138 critically ill patients. Simultaneous recordings of sepsis status and fluctuations in renal function were made. Results: Elevated NGAL was associated with sepsis independent of level of acute renal dysfunction. A cut-off value of 98 ng/mL distinguished sepsis from systemic inflammation with high sensitivity (0.77) and specificity (0.79). Conclusions: Plasma NGAL can help clinicians to identify bacterial infections in critically ill patients.
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| 4. |
- Ravn, Bo
(författare)
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Acute kidney injury : a study of function markers
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Acute Kidney Injury (AKI) is defined as a sudden decrease in the kidneys' ability to filtrate waste products and excrete excess water. Detecting AKI primarily relies on measuring the increased concentration of function markers (i.e., creatinine and cystatin C) and even measuring urine output. This thesis aimed to investigate the performance of kidney function markers in patients during critical illness. To study the variations of the function markers in an ICU population and to examine the performance of the most commonly used estimated glomerular filtration equations. In addition, to investigate the associations between creatinine and cystatin C and long-term mortality and to identify factors predictive of renal dysfunction after ICU discharge. Both creatinine and cystatin C are within the normally acceptable limits of daily variation which means that changes in function markers between sampling-times during the day are likely to indicate a change in the biomarker levels due to the disease or treatment. Combination of both creatinine and cystatin C enables the best agreement between estimated and measured glomerular filtration rate. Levels of cystatin C after critical illness is strongly associated with 90-day and 1-year mortality in both AKI and non-AKI patients. Creatinine, on the other hand, has little value as a prognostic marker in the majority of patients. The incidence of CKD (eGFR<60) in ICU patients three months after AKI was 25.8% when using creatinine-based eGFR and 63.7% using cystatin C-based eGFR. Creatinine-defined CKD at follow-up was predicted by age, discharge cystatin C, discharge creatinine, and female sex. Cystatin C-defined CKD at follow-up was predicted by age, discharge cystatin C, CRRT in ICU, and diabetes.
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| 5. |
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| 6. |
- Ravn, Bo, et al.
(författare)
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Intra-day variability of cystatin C, creatinine and estimated GFR in intensive care patients
- 2016
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Ingår i: Clinica Chimica Acta. - : Elsevier BV. - 0009-8981 .- 1873-3492. ; 460, s. 1-4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Markers of renal function are widely used in intensive care and sudden changes are important indicators of acute kidney injury. The problem is to distinguish between disease progression/improvement from the natural variation in the patient. The aim of the present study was thus to study the normal intraday variation in ICU patients.METHODS: We studied the intra-day variation of creatinine, cystatin C and estimated GFR based on these two markers in 28 clinically stable ICU patients.RESULTS: The median diurnal coefficient of variation sCV) for creatinine was 3.70% (1.92-9.25%) while the median CV for cystatin C was 3.66% (1.36-8.11%). The corresponding CVs for the estimated GFRs were 2.00% (0.89-9.82%) for eGFRcreatinine and 4.60% (1.65-10.24%) for eGFRcystc.CONCLUSIONS: The eGFRcreatinine values in individual patients were clearly higher than the eGFRcystc values. The median CV for creatinine, cystatin C and the eGFR measurements were below 5% which means that 95% of the test results will vary by <10% between sampling times in stable ICU patients. Differences >10% between sampling times are thus likely to be an indication of changes in biomarker levels due to the disease/treatment.
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| 7. |
- Ravn-Fischer, Annica, 1974, et al.
(författare)
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Chain of care in chest pain-differenes beteen three hospitals in an urban area.
- 2013
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 166:2, s. 440-7
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe differences in treatment and delay times in acute chest pain at the three hospitals in Göteborg, Sweden. METHODS: All patients admitted to the three hospitals within Sahlgrenska University (SU) (Sahlgrenska: SU/S, Östra: SU/Ö and Mölndal: SU/M) with acute chest pain during 3 months in 2008 were evaluated for diagnosis, early treatment and outcome. RESULTS: In all, 2588 visits by 2393 patients were included (visits n=1253 SU/S; n=853 SU/Ö; n=482 SU/M) of which 50%, 63% and 51% were hospitalised (p<0.0001). Among hospitalised patients, a diagnosis of ACS was reported in 26%, 9% and 22% respectively (p<0.0001). Among ACS patients, 83%, 66% and 57% respectively underwent coronary angiography (p=0.004). The median delay to coronary angiography in ST-elevation myocardial infarction (STEMI) was 42 min at SU/S, 3h 47 min at SU/Ö and 2h 34 min at SU/M (p=0.008). The corresponding values for coronary angiography in unstable coronary artery disease were 42h 7min, 48h 35 min and 123h 42 min (p=0.007). Overall mortality at 30 days was 3.6%, 3.2% and 1.5% (NS) and, at 1 year, it was 9.9%, 9.6% and 7.3% respectively (NS). CONCLUSION: In acute chest pain in the Municipality of Göteborg, there was a marked difference between hospitals in: 1) the percentage of hospitalised patients, 2) the percentage of ACS among hospitalised patients and 3) the delay to and rate of coronary angiography. The clinical consequences of these deviations remain to be proven.
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| 8. |
- Ravn-Fischer, Annica, 1974, et al.
(författare)
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Inequalities in the early treatment of women and men with acute chest pain?
- 2012
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Ingår i: American Journal of Emergency Medicine. - : W.B. Saunders Co.. - 0735-6757 .- 1532-8171. ; 30:8, s. 1515-1521
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to identify sex differences in the early chain of care for patients with chest pain. DESIGN: This is a retrospective study performed at 3 centers including all patients admitted to the emergency department because of chest pain, during a 3-month period in 2008, in the municipality of Göteborg. Chest pain or discomfort in the chest was the only inclusion criterion. There were no exclusion criteria. DATA SOURCES: Data were retrospectively collected from ambulance and medical records and electrocardiogram (ECG), echocardiography, and laboratory databases. MAIN FINDINGS: A total of 2588 visits (1248 women and 1340 men) made by 2393 patients were included. When adjusting for baseline variables, female sex was significantly associated with a prolonged delay time (defined as above median) between (a) admission to hospital and admission to a hospital ward (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.25-2.03), (b) first physical contact and first dose of aspirin (OR, 2.22; 95% CI, 1.30-3.82), and (c) admission to hospital and coronary angiography (OR, 2.50; 95% CI, 1.29-5.13). Delay time to the first ECG recording did not differ significantly between women and men. PRINCIPAL CONCLUSIONS: Among patients hospitalized due to chest pain, when adjusting for differences at baseline, female sex was associated with a prolonged delay time until admission to a hospital ward, to administration of aspirin, and to performing a coronary angiography. There was no difference in delay to the first ECG recording.
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| 9. |
- Santos, Marco, 1978, et al.
(författare)
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Is early treatment of ac ute chest pain provided sooner to patients who speak the national language
- 2013
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 25:5, s. 582-589
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Tidskriftsartikel (refereegranskat)abstract
- Objective Identify differences in the early treatment of acute chest pain patients with regard to the language proficiency of patients and thus identify opportunities for improving equity in cardiac care. Design Retrospective cross-sectional study comparing care delivered to Swedish-speaking (SS) and non-Swedish-speaking (NSS) patients. Setting A Swedish university hospital that provides highly specialized care to 1.6 million inhabitants. Participants All patients with acute chest pain or symptoms suggestive of acute coronary syndrome who sought care between mid-September and mid-December 2008 (2588 visits). Missing data on the patient group to which study subjects belonged were 2% (45 visits). NSS represented 8% of the 2543 visits (NSS = 2334; NNSS = 209). Main Outcome Measure(s) Delay times from arrival in hospital to admission to catheterization laboratory or ward (ΔTHOSP-PCI), first physical contact to first electrocardiogram (ΔTCONTACT-ECG), first physical contact to first aspirin (ΔTCONTACT-ASA) and arrival in hospital to coronary angiography (ΔTHOSP-ANGIO). Also included baseline characteristics of patients, diagnosis and findings in hospital and secondary preventive activities. Results The median ΔTHOSP-PCI was longer for NSS by 43 min [254 versus 211, 95% confidence interval (CI), odds ratio (OR) = (1.3; 2.8)]. The median ΔTCONTACT-ECG and ΔTHOSP-ANGIO were longer for NSS by 4 min [17 versus 13, 95% CI, OR = (0.8; 1.8)] and 14 h [44 versus 30, 95% CI, OR = (0.6; 3.6)], respectively. Conversely, the median ΔTCONTACT-ASA was longer for SS by 20 min [81 versus 61, 95% CI, OR = (0.3; 1.6)]. Conclusions Poorer language proficiency was associated with longer delay time from arrival in hospital to admission to catheterization laboratory or ward. No other delay times were found to be statistically significantly different with respect to the language proficiency of patients.
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