External validation of the ISARIC 4C Mortality Score to predict in-hospital mortality among patients with COVID-19 in a Canadian intensive care unit: a single-centre historical cohort study.

Purpose: With uncertain prognostic utility of existing predictive scoring systems for COVID-19-related illness, the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) 4C Mortality Score was developed by the International Severe Acute Respiratory and Emerging Infection Consortium as a COVID-19 mortality prediction tool. We sought to externally validate this score among critically ill patients admitted to an intensive care unit (ICU) with COVID-19 and compare its discrimination characteristics to that of the Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores.

Methods: We enrolled all consecutive patients admitted with COVID-19-associated respiratory failure between 5 March 2020 and 5 March 2022 to our university-affiliated and intensivist-staffed ICU (Jewish General Hospital, Montreal, QC, Canada).

High-flow nasal oxygen as first-line therapy for COVID-19-associated hypoxemic respiratory failure: a single-centre historical cohort study.

Purpose: The optimal noninvasive modality for oxygenation support in COVID-19-associated hypoxemic respiratory failure and its association with healthcare worker infection remain uncertain. We report here our experience using high-flow nasal oxygen (HFNO) as the primary support mode for patients with COVID-19 in our institution.

Methods: We conducted a single-centre historical cohort study of all COVID-19 patients treated with HFNO for at least two hours in our university-affiliated and intensivist-staffed intensive care unit (Jewish General Hospital, Montreal, QC, Canada) between 27 August 2020 and 30 April 2021.

Outcomes and clinical practice in patients with COVID-19 admitted to the intensive care unit in Montréal, Canada: a descriptive analysis.

Background: The coronavirus disease 2019 (COVID-19) pandemic is responsible for millions of infections worldwide, and a substantial number of these patients will be admitted to the intensive care unit (ICU). Our objective was to describe the characteristics, outcomes and management of critically ill patients with COVID-19 pneumonia at a single designated pandemic centre in Montréal, Canada.

Methods: A descriptive analysis was performed on consecutive critically ill patients with COVID-19 pneumonia admitted to the ICU at the Jewish General Hospital, a designated pandemic centre in Montréal, between Mar.

Early reversible acute kidney injury is associated with improved survival in septic shock.

Introduction: The fact that acute kidney injury (AKI) is associated with worse clinical outcomes forms the basis of most AKI prognostic scoring systems. However, early reversibility of renal dysfunction in acute illness is not considered in such systems. We sought to determine whether early (≤24 hours after shock documentation) reversibility of AKI was independently associated with in-hospital mortality in septic shock.

Antihypertensive agents acting on the renin-angiotensin system and the risk of sepsis.

Aims: In response to safety concerns from two large randomized controlled trials, we investigated whether the use of telmisartan, an angiotensin receptor blocker (ARB), ARBs as a class and angiotensin-converting enzyme inhibitors (ACEIs) increase the risk of sepsis, sepsis-associated mortality and renal failure in hypertensive patients.

Methods: We performed a nested case-control study from a retrospective cohort of adults with hypertension from the UK General Practice Research Database diagnosed between 1 January 2000 and 30 June 2009. All subjects hospitalized with sepsis during follow-up were matched for age, sex, practice and duration of follow-up with 10 control subjects.

Activated protein C and septic shock: a propensity-matched cohort study*.

Background: Septic shock is a highly inflammatory and procoagulant state associated with significant mortality. In a single randomized controlled trial, recombinant human activated protein C (drotrecogin alfa) reduced mortality in patients with severe sepsis at high risk of death. Further clinical trials, including a recently completed trial in patients with septic shock, failed to reproduce these results.

Antimicrobial therapeutic determinants of outcomes from septic shock among patients with cirrhosis.

Unlabelled: It is unclear whether practice-related aspects of antimicrobial therapy contribute to the high mortality from septic shock among patients with cirrhosis. We examined the relationship between aspects of initial empiric antimicrobial therapy and mortality in patients with cirrhosis and septic shock. This was a nested cohort study within a large retrospective database of septic shock from 28 medical centers in Canada, the United States, and Saudi Arabia by the Cooperative Antimicrobial Therapy of Septic Shock Database Research Group between 1996 and 2008.

Non-steroidal anti-inflammatory drugs and the risk of Clostridium difficile-associated disease.

Aim: Several case reports have linked diclofenac, a non-steroidal anti-inflammatory drug (NSAID), with Clostridium difficile associated disease (CDAD). We assessed whether NSAID use in general, and diclofenac use in particular, is associated with an increased risk of CDAD.

Methods: We used the United Kingdom's General Practice Research Database (GPRD) to conduct a population-based case-control study.

The relationship between inotrope exposure, six-hour postoperative physiological variables, hospital mortality and renal dysfunction in patients undergoing cardiac surgery.

Introduction: Acute haemodynamic complications are common after cardiac surgery and optimal perioperative use of inotropic agents, typically guided by haemodynamic variables, remains controversial. The aim of this study was to examine the relationship of inotrope use to hospital mortality and renal dysfunction.

Material And Methods: A retrospective cohort study of 1,326 cardiac surgery patients was carried out at two university-affiliated ICUs.

Risk factors for mortality following emergency colectomy for fulminant Clostridium difficile infection.

Purpose: This study evaluated risk factors for mortality after emergency colectomy for fulminant Clostridium difficile infection.

Methods: Retrospective study of 130 cases of Clostridium difficile infection that required a colectomy between 1994 and 2007 in four hospitals of Quebec, Canada. Primary outcome was 30-day mortality.

Proton pump inhibitor use and enteric infections.

Proton pump inhibitors (PPIs) and H2 receptor antagonists (H2RAs) are very commonly prescribed drugs and are routinely used in the chronic management of gastro-esophageal reflux disease. Concerns have been raised about the possible association of PPIs with enteric infections. This article reviews the studies that have examined the associations of proton pump inhibitors in particular, and enteric infections.

Acute kidney injury in septic shock: clinical outcomes and impact of duration of hypotension prior to initiation of antimicrobial therapy.

Objective: To describe the incidence and outcomes associated with early acute kidney injury (AKI) in septic shock and explore the association between duration from hypotension onset to effective antimicrobial therapy and AKI.

Design: Retrospective cohort study.

Subjects: A total of 4,532 adult patients with septic shock from 1989 to 2005.

Patterns of antibiotic use and risk of hospital admission because of Clostridium difficile infection.

Background: Previous observations have indicated that infection with Clostridium difficile occurs almost exclusively after exposure to antibiotics, but more recent observations have suggested that prior antibiotic exposure may be less frequent among cases of community-acquired disease.

Methods: We used 2 linked health databases to perform a matched, nested case-control study of elderly patients admitted to hospital with community-acquired C. difficile infection.

Antimicrobial drugs and community-acquired methicillin-resistant Staphylococcus aureus, United Kingdom.

We report results of a case-control study of the association between receipt of antimicrobial agents and diagnosis of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) in the United Kingdom. Eligible adults, selected from the General Practice Research Database, had no previous diagnosis of MRSA, no hospitalization in the past 2 years, and > or = 2 years of follow-up recorded in the database. For 2000-2004, we identified 1,981 MRSA case-patients and 19,779 matched control-patients.

Is there a role for mask continuous positive airway pressure in acute respiratory failure due to COPD? Lessons from a retrospective audit of 3 different cohorts.

Exacerbations of COPD that result in acute respiratory failure requiring intubation and mechanical ventilation have high morbidity and mortality. This study is a retrospective observational study that compared the outcomes of 237 patients with COPD and acute respiratory failure requiring intensive care unit (ICU) admission according to modality of initial therapy: mask continuous positive airway pressure (CPAP), medical therapy, or intubation. Of the patients treated with CPAP initially, only 16% failed and required intubation compared with 62% of those treated medically (p = 0.

Antimicrobial drugs and community-acquired Clostridium difficile-associated disease, UK.

In a population-based case-control study of community acquired Clostridium difficile-associated disease (CDAD), we matched 1,233 cases to 12,330 controls. CDAD risk increased 3-fold with use of any antimicrobial agent and 6-fold with use of fluoroquinolones. Prior use of antimicrobial agents did not affect risk for CDAD after 6 months.

Proton pump inhibitor use and risk of community-acquired Clostridium difficile-associated disease defined by prescription for oral vancomycin therapy.

Background: The association between the use of proton pump inhibitors and the risk of Clostridium difficile-associated disease (CDAD) is controversial. In this study we re-examined a previously reported association between the use of proton pump inhibitors and the development of community-acquired CDAD, this time using an alternative case definition of the disease.

Methods: We performed a case-control study of community-acquired CDAD using a United Kingdom clinical research database.

Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease.

Context: Recent reports suggest an increasing occurrence and severity of Clostridium difficile-associated disease. We assessed whether the use of gastric acid-suppressive agents is associated with an increased risk in the community.

Objective: To determine whether the use of gastric acid-suppressive agents increases the risk of C difficile-associated disease in a community population.

Hemodilution and surgical hemostasis contribute significantly to transfusion requirements in patients undergoing coronary artery bypass.

Objective: We sought to determine the incidence of and risk factors for the development of low intraoperative hematocrit levels and of excessive postoperative bleeding in patients undergoing coronary artery bypass grafting, whether the risk factors are the same, and their effect on blood product transfusions.

Methods: We performed a prospective cohort study of 613 adult patients who underwent coronary artery bypass grafting in 3 tertiary, university-affiliated hospitals during the period from October 1, 2000, to March 31, 2001.

Results: Low intraoperative hematocrit levels (<19%) were found in 131 (24%) patients who had operations performed with extracorporeal circulation compared with in 3 (4%) patients with operations performed off pump.

Invasive aspergillosis in patients with chronic obstructive pulmonary diseases.

Objectives: To determine the outcomes, and clinical and therapeutic factors associated with the development of invasive pulmonary aspergillosis (IPA) in patients with obstructive pulmonary diseases.

Design: A case control study examining patients who developed IPA while hospitalized, and controls who were matched by year of hospitalization and type of obstructive lung disease.

Setting: A tertiary care university-affiliated respiratory hospital.

Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies.

Background: Antibiotic disruption of the normal intestinal flora is a well-known risk factor for Clostridium difficile-associated diarrhea. Reduced gastric acidity has been suggested as a risk factor, and we hypothesized that proton pump inhibitors, because of their potency, may be an independent risk factor for this problem.

Methods: For the cohort study we identified from a pharmacy database 1187 inpatients at a Montreal teaching hospital who received antibiotics over a 9-month period beginning in August 2002.

Autotransfusion of shed mediastinal blood: a risk factor for mediastinitis after cardiac surgery? Results of a cluster investigation.

Rationale: After the introduction of autotransfusion of shed mediastinal blood following cardiac surgery, the incidence of mediastinitis increased. The role of autotransfusion in the increased occurrence of this serious complication was examined.

Methods: Using a case-control design, the preoperative, intraoperative, and postoperative characteristics of 11 patients with mediastinitis were compared to those of 33 randomly selected patients undergoing cardiac surgery between September 1, 2000, and April 15, 2001 (control subjects).