ORCID Profile
0000-0002-5723-2676
Current Organisation
National University of Malaysia
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Publisher: Springer Science and Business Media LLC
Date: 02-06-2021
DOI: 10.1007/S40620-021-01071-5
Abstract: Acute kidney injury (AKI) is a major cause of morbidity and mortality in critically ill children. The aim of this paper was to describe the prevalence and course of AKI in critically ill children and to compare different AKI classification criteria. We conducted a retrospective observational study in our multi-disciplinary Pediatric Intensive Care Unit (ICU) from January 2015 to December 2018. All patients from birth to 16 years of age who were admitted to the pediatric ICU were included. The Kidney Disease Improving Global Outcomes (KDIGO) definition was considered as the reference standard. We compared the incidence data assessed by KDIGO, pediatric risk, injury, failure, loss of kidney function and end- stage renal disease (pRIFLE) and pediatric reference change value optimised for AKI (pROCK). Out of 7505 patients, 9.2% developed AKI by KDIGO criteria. The majority (59.8%) presented with stage 1 AKI. Recovery from AKI was observed in 70.4% of patients within 7 days from diagnosis. Both pRIFLE and pROCK were less sensitive compared to KDIGO criteria for the classification of AKI. Patients who met all three-KDIGO, pRIFLE and pROCK criteria had a high mortality rate (35.0%). Close to one in ten patients admitted to the pediatric ICU met AKI criteria according to KDIGO. In about 30% of patients, AKI persisted beyond 7 days. Follow-up of patients with persistent kidney function reduction at hospital discharge is needed to reveal the long-term morbidity due to AKI in the pediatric ICU.
Publisher: Cambridge University Press (CUP)
Date: 28-04-2023
DOI: 10.1017/ICE.2023.69
Abstract: To identify central-line (CL)–associated bloodstream infection (CLABSI) incidence and risk factors in low- and middle-income countries (LMICs). From July 1, 1998, to February 12, 2022, we conducted a multinational multicenter prospective cohort study using online standardized surveillance system and unified forms. The study included 728 ICUs of 286 hospitals in 147 cities in 41 African, Asian, Eastern European, Latin American, and Middle Eastern countries. In total, 278,241 patients followed during 1,815,043 patient days acquired 3,537 CLABSIs. For the CLABSI rate, we used CL days as the denominator and the number of CLABSIs as the numerator. Using multiple logistic regression, outcomes are shown as adjusted odds ratios (aORs). The pooled CLABSI rate was 4.82 CLABSIs per 1,000 CL days, which is significantly higher than that reported by the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC NHSN). We analyzed 11 variables, and the following variables were independently and significantly associated with CLABSI: length of stay (LOS), risk increasing 3% daily (aOR, 1.03 95% CI, 1.03–1.04 P .0001), number of CL days, risk increasing 4% per CL day (aOR, 1.04 95% CI, 1.03–1.04 P .0001), surgical hospitalization (aOR, 1.12 95% CI, 1.03–1.21 P .0001), tracheostomy use (aOR, 1.52 95% CI, 1.23–1.88 P .0001), hospitalization at a publicly owned facility (aOR, 3.04 95% CI, 2.31–4.01 P .0001) or at a teaching hospital (aOR, 2.91 95% CI, 2.22–3.83 P .0001), hospitalization in a middle-income country (aOR, 2.41 95% CI, 2.09–2.77 P .0001). The ICU type with highest risk was adult oncology (aOR, 4.35 95% CI, 3.11–6.09 P .0001), followed by pediatric oncology (aOR, 2.51 % CI, 1.57–3.99 P .0001), and pediatric (aOR, 2.34 95% CI, 1.81–3.01 P .0001). The CL type with the highest risk was internal-jugular (aOR, 3.01 95% CI, 2.71–3.33 P .0001), followed by femoral (aOR, 2.29 95% CI, 1.96–2.68 P .0001). Peripherally inserted central catheter (PICC) was the CL with the lowest CLABSI risk (aOR, 1.48 95% CI, 1.02–2.18 P = .04). The following CLABSI risk factors are unlikely to change: country income level, facility ownership, hospitalization type, and ICU type. These findings suggest a focus on reducing LOS, CL days, and tracheostomy using PICC instead of internal-jugular or femoral CL and implementing evidence-based CLABSI prevention recommendations.
Publisher: Elsevier BV
Date: 06-2023
DOI: 10.1016/J.AJIC.2022.08.024
Abstract: The International Nosocomial Infection Control Consortium has found a high ICU mortality rate. Our aim was to identify all-cause mortality risk factors in ICU-patients. Multinational, multicenter, prospective cohort study at 786 ICUs of 312 hospitals in 147 cities in 37 Latin American, Asian, African, Middle Eastern, and European countries. Between 07/01/1998 and 02/12/2022, 300,827 patients, followed during 2,167,397 patient-days, acquired 21,371 HAIs. Following mortality risk factors were identified in multiple logistic regression: Central line-associated bloodstream infection (aOR:1.84 P<.0001) ventilator-associated pneumonia (aOR:1.48 P<.0001) catheter-associated urinary tract infection (aOR:1.18 P<.0001) medical hospitalization (aOR:1.81 P<.0001) length of stay (LOS), risk rises 1% per day (aOR:1.01 P<.0001) female gender (aOR:1.09 P<.0001) age (aOR:1.012 P<.0001) central line-days, risk rises 2% per day (aOR:1.02 P<.0001) and mechanical ventilator (MV)-utilization ratio (aOR:10.46 P<.0001). Coronary ICU showed the lowest risk for mortality (aOR: 0.34 P<.0001). Some identified risk factors are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified Central line-associated bloodstream infection, ventilator-associated pneumonia, catheter-associated urinary tract infection, LOS, and MV-utilization. So, to lower the risk of death in ICUs, we recommend focusing on strategies to shorten the LOS, reduce MV-utilization, and use evidence-based recommendations to prevent HAIs.
Publisher: Cambridge University Press (CUP)
Date: 2023
DOI: 10.1017/ASH.2022.339
Abstract: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those of high-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs. Prospective cohort study. This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and Middle Eastern countries. The study included patients admitted to ICUs across 24 years. In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent variables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22 95% confidence interval [CI], 1.16–1.28 P .0001) longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07 95% CI, 1.07–1.08 P .0001) mechanical ventilation (MV) utilization ratio (aOR, 1.27 95% CI, 1.23–1.31 P .0001) continuous positive airway pressure (CPAP), which was associated with the highest risk (aOR, 13.38 95% CI, 11.57–15.48 P .0001) tracheostomy connected to a MV, which was associated with the next-highest risk (aOR, 8.31 95% CI, 7.21–9.58 P .0001) endotracheal tube connected to a MV (aOR, 6.76 95% CI, 6.34–7.21 P .0001) surgical hospitalization (aOR, 1.23 95% CI, 1.17–1.29 P .0001) admission to a public hospital (aOR, 1.59 95% CI, 1.35-1.86 P .0001) middle-income country (aOR, 1.22 95% CI, 15–1.29 P .0001) admission to an adult-oncology ICU, which was associated with the highest risk (aOR, 4.05 95% CI, 3.22–5.09 P .0001), admission to a neurologic ICU, which was associated with the next-highest risk (aOR, 2.48 95% CI, 1.78–3.45 P .0001) and admission to a respiratory ICU (aOR, 2.35 95% CI, 1.79–3.07 P .0001). Admission to a coronary ICU showed the lowest risk (aOR, 0.63 95% CI, 0.51–0.77 P .0001). Some identified VAP RFs are unlikely to change: sex, hospitalization type, ICU type, facility ownership, and country income level. Based on our results, we recommend focusing on strategies to reduce LOS, to reduce the MV utilization ratio, to limit CPAP use and implementing a set of evidence-based VAP prevention recommendations.
Publisher: Cambridge University Press (CUP)
Date: 24-10-2022
DOI: 10.1017/ICE.2022.245
Abstract: To identify risk factors for mortality in intensive care units (ICUs) in Asia. Prospective cohort study. The study included 317 ICUs of 96 hospitals in 44 cities in 9 countries of Asia: China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam. Patients aged >18 years admitted to ICUs. In total, 157,667 patients were followed during 957,517 patient days, and 8,157 HAIs occurred. In multiple logistic regression, the following variables were associated with an increased mortality risk: central-line-associated bloodstream infection (CLABSI aOR, 2.36 Some variables associated with an increased mortality risk are unlikely to change, such as age, sex, national economy, hospitalization type, and ICU type. Some other variables can be modified, such as LOS, central-line use, urinary catheter use, and mechanical ventilation as well as and acquisition of CLABSI, VAE, or CAUTI. To reduce mortality risk, we shall focus on strategies to reduce LOS strategies to reduce central-line, urinary catheter, and mechanical ventilation use and HAI prevention recommendations.
Publisher: Springer Science and Business Media LLC
Date: 25-05-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-06-2020
DOI: 10.1097/PCC.0000000000002411
Abstract: Up to 37% of children admitted to the PICU develop acute kidney injury as defined by Kidney Disease: Improving Global Outcomes criteria. We describe the prevalence of acute kidney injury in a mixed pediatric intensive care cohort using this criteria. As tools to stratify patients at risk of acute kidney injury on PICU admission are lacking, we explored the variables at admission and day 1 that might predict the development of acute kidney injury. Single-center retrospective observational study. Thirty-six–bed surgical/medical tertiary PICU. Children from birth to less than or equal to 16 years old admitted between 2015 and 2018. None. Clinical data were extracted from the PICU clinical information system. Patients with baseline creatinine at admission greater than 20 micromol/L above the calculated normal creatinine level were classified as “high risk of acute kidney injury.” Models were created to predict acute kidney injury at admission and on day 1. Out of the 7,505 children admitted during the study period, 738 patients (9.8%) were classified as high risk of acute kidney injury at admission and 690 (9.2%) developed acute kidney injury during PICU admission. Compared to Kidney Disease: Improving Global Outcomes criteria as the reference standard, high risk of acute kidney injury had a lower sensitivity and higher specificity compared with renal angina index greater than or equal to 8 on day 1. For the admission model, the adjusted odds ratio of developing acute kidney injury for high risk of acute kidney injury was 4.2 (95% CI, 3.3–5.2). The adjusted odds ratio in the noncardiac cohort for high risk of acute kidney injury was 7.3 (95% CI, 5.5–9.7). For the day 1 model, odds ratios for high risk of acute kidney injury and renal angina index greater than or equal to 8 were 3.3 (95% CI, 2.6–4.2) and 3.1 (95% CI, 2.4–3.8), respectively. The relationship between high risk of acute kidney injury and acute kidney injury needs further evaluation. High risk of acute kidney injury performed better in the noncardiac cohort.
No related grants have been discovered for Chian Wern Tai.