Publications by authors named "Iwan van der Horst"

Objective: To describe the 12-month mortality of Dutch COVID-19 intensive care unit patients, the total COVID-19 population and various subgroups on the basis of the number of comorbidities, age, sex, mechanical ventilation, and vasoactive medication use.

Methods: We included all patients admitted with COVID-19 between March 1, 2020, and March 29, 2022, from the Dutch National Intensive Care (NICE) database. The crude 12-month mortality rate is presented via Kaplan-Meier survival curves for each patient subgroup.

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Background: Left atrial (LA) strain reflects not only LA function but also systolic and diastolic left ventricular function. We therefore hypothesize that LA strain may be a comprehensive predictor of heart failure related endpoints after ST-elevation myocardial infarction (STEMI). We aim to assess the impact of LA reservoir strain on the long-term prognosis following ST-elevation myocardial infarction (STEMI).

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  • * A secondary analysis found that patients in the CPPopt-targeted group had better autoregulation, indicated by a significantly lower median ΔPRx during preserved autoregulation periods compared to the control group.
  • * The study concludes that while there was no noticeable difference in overall PRx averages, targeting CPPopt appears to enhance cerebrovascular reactivity in TBI patients.
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Background And Objectives: Mortality prediction models are promising tools for guiding clinical decision-making and resource allocation in intensive care units (ICUs). Clearly specified predictor and outcome variables are necessary to enable external validation and safe clinical application of prediction models. The objective of this study was to identify the predictor and outcome variables used in different mortality prediction models in the ICU and investigate their reporting.

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Most published prediction models for Coronavirus Disease 2019 (COVID-19) were poorly reported, at high risk of bias, and heterogeneous in model performance. To tackle methodological challenges faced in previous prediction studies, we investigated whether model updating and extending improves mortality prediction, using the Intensive Care Unit (ICU) as a proxy. All COVID-19 patients admitted to seven ICUs in the Euregio-Meuse Rhine during the first pandemic wave were included.

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  • The study aimed to compare the transfusion recommendations of two treatment protocols: Quantra QPlus and ROTEM, specifically in patients undergoing elective cardiopulmonary bypass surgery.
  • Researchers analyzed 100 samples from patients post-surgery, finding that the transfusion advice from the two protocols showed poor agreement overall and for specific transfusion needs like fibrinogen.
  • The results indicate that the Quantra QPlus protocol may recommend unnecessary transfusions in non-bleeding patients, while it occasionally suggests transfusions when ROTEM does not, highlighting the need for adjustments in the Quantra QPlus protocol.
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Background: The number of quality indicators for which clinicians need to record data is increasing. For many indicators, there are concerns about their efficacy. This study aimed to determine whether working with only a consensus-based core set of quality indicators in the intensive care unit (ICU) reduces the time spent on documenting performance data and administrative burden of ICU professionals, and if this is associated with more joy in work without impacting the quality of ICU care.

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  • The study focuses on improving the detection of periprocedural myocardial infarction (PMI) after coronary artery bypass grafting (CABG) by analyzing the changes in cardiac biomarker CK-MB over time.
  • It involved 635 patients with 1589 CK-MB measurements, where the majority showed no signs of PMI, pinpointing key factors like patient sex and surgical specifics that influence CK-MB levels.
  • A web-based application was developed to model CK-MB kinetics; the model achieved notable diagnostic accuracy, indicating its potential for wider use in monitoring and validating other cardiac biomarkers.
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Galectin-3 and Suppression of tumorigenicity-2 (ST2) are known markers of cardiac fibrosis. We investigated the prognostic value of fibrotic markers for the development of diastolic dysfunction and long-term outcome in patients suffering an ST-elevated myocardial infarction (STEMI). We analyzed 236 patients from the GIPS-III cohort with available echocardiographic studies and plasma measurements at hospitalization and after 4 months follow-up.

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  • The PRECISe trial aimed to determine if providing critically ill patients on mechanical ventilation with higher protein intake (2.0 g/kg per day) would enhance their quality of life and functional recovery compared to standard protein intake (1.3 g/kg per day).
  • This double-blinded, multicentre trial included patients from 10 hospitals across the Netherlands and Belgium, focusing on those expected to need invasive ventilation for at least three days.
  • Key aspects of the study included random assignment to either the standard or high-protein group, with blinding of all involved personnel, and tracking the primary outcome through health utility scores at specified intervals (30, 90, and 180 days post-randomization).
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  • In out-of-hospital cardiac arrest (OHCA) cases without ST-elevation, researchers investigated the usefulness of troponin-T (cTnT) levels in predicting the risk of acute coronary syndrome and patient survival.
  • The study analyzed data from 352 patients, revealing that higher cTnT values were independent predictors for 90-day mortality and the presence of acute unstable lesions and thrombotic occlusions.
  • However, cTnT levels did not show a significant correlation with left ventricular function, highlighting its role primarily in assessing mortality risk and acute coronary issues in these patients.
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Objectives: Myocardial ischaemia following coronary artery bypass grafting (CABG) is a potentially devastating complication. Nevertheless, the incidence, aetiology and prognostic relevance of unplanned coronary angiography (uCAG) remain understudied. We aimed to investigate the prevalence and outcome of patients undergoing urgent, uCAG in the postoperative period following CABG.

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  • A Bayesian meta-analysis was conducted to evaluate the effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) compared to conventional CPR in patients who had a cardiac arrest outside of the hospital, focusing on neurological outcomes after 6 months.
  • The analysis included data from three randomized trials, with ECPR involving 209 patients and conventional CPR involving 211 patients, and aimed to clarify the probability of clinically significant treatment effects rather than relying solely on p-values.
  • Results showed that ECPR had a median relative risk of 1.47 for neurologically favorable survival in all rhythms and 1.54 for patients with shockable rhythms, indicating a potential benefit, but with wide credible intervals suggesting uncertainty
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  • Vascular calcification can increase death risk in heart disease patients, and calciprotein particles may contribute to this issue. * -
  • The study measured how long it took for these calciprotein particles to form in patients with serious heart attacks and compared it to healthy people. * -
  • Results showed that patients with heart attacks had a faster formation time for calciprotein particles, and this was linked to certain health factors like cholesterol levels and blood pressure.*
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  • A study examined health-related quality of life (HRQoL) in patients who survived out-of-hospital cardiac arrest (OHCA) treated with either extracorporeal cardiopulmonary resuscitation (ECPR) or conventional CPR (CCPR) during the first year post-incident.
  • Out of 134 enrolled patients, only 20% survived to hospital discharge, with HRQoL assessed for 25 survivors using the EQ-5D-5L questionnaire, revealing 68% had good HRQoL after one year.
  • Although there was no significant statistical difference in HRQoL scores between ECPR and CCPR groups, results suggested that ECPR survivors experienced numerically better outcomes,
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Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used as a supportive treatment for refractory out-of-hospital cardiac arrest (OHCA). Still, there is a paucity of data evaluating favorable and unfavorable prognostic characteristics in patients considered for ECPR.

Methods: We performed a previously unplanned post-hoc analysis of the multicenter randomized controlled INCEPTION-trial.

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Background: Neurological complications in COVID-19 patients admitted to an intensive care unit (ICU) have been previously reported. As the pandemic progressed, therapeutic strategies were tailored to new insights. This study describes the incidence, outcome, and types of reported neurological complications in invasively mechanically ventilated (IMV) COVID-19 patients in relation to three periods during the pandemic.

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Aims: When out-of-hospital cardiac arrest (OHCA) becomes refractory, extracorporeal cardiopulmonary resuscitation (ECPR) is a potential option to restore circulation and improve the patient's outcome. However, ECPR requires specific materials and highly skilled personnel, and it is unclear whether increased survival and health-related quality of life (HRQOL) justify these costs.

Methods And Results: This cost-effectiveness study was part of the INCEPTION study, a multi-centre, pragmatic randomized trial comparing hospital-based ECPR to conventional CPR (CCPR) in patients with refractory OHCA in 10 cardiosurgical centres in the Netherlands.

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Background: Critically ill COVID-19 patients are at risk for venous thromboembolism (VTE). Therefore, they receive thromboprophylaxis and, when appropriate, therapeutic unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH). To monitor heparins in COVID-19 disease, whole-blood rotational thromboelastometry (ROTEM) may be a promising alternative to the aPTT and anti-Xa assays.

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Objectives: Data-driven decision support tools have been increasingly recognized to transform health care. However, such tools are often developed on predefined research datasets without adequate knowledge of the origin of this data and how it was selected. How a dataset is extracted from a clinical database can profoundly impact the validity, interpretability and interoperability of the dataset, and downstream analyses, yet is rarely reported.

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Background: Facial appearance, whether consciously or subconsciously assessed, may affect clinical assessment and treatment strategies in the Intensive Care Unit (ICU). Nevertheless, the association between objective clinical measurement of facial appearance and multi-organ failure is currently unknown. The objective of this study was to examine whether facial appearance at admission is associated with longitudinal evaluation of multi-organ failure.

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