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Article ; Online: Association between piperacillin/tazobactam use and acute kidney injury in critically ill patients: a retrospective multicentre cohort study.

Tomazini, Bruno Martins / Besen, Bruno Adler Maccagnan Pinheiro / Taniguchi, Leandro Utino / Zampieri, Fernando Godinho / Cavalcanti, Alexandre Biasi

The Journal of antimicrobial chemotherapy

2024 Volume 79, Issue 3, Page(s) 552–558

Abstract: Background: Piperacillin/tazobactam is one of the most common antibiotics prescribed in the ICU and the combination of piperacillin/tazobactam with vancomycin has been associated with acute kidney injury (AKI) in critically ill patients. However, data ... ...

Abstract	Background: Piperacillin/tazobactam is one of the most common antibiotics prescribed in the ICU and the combination of piperacillin/tazobactam with vancomycin has been associated with acute kidney injury (AKI) in critically ill patients. However, data on the risk of AKI with piperacillin/tazobactam, despite vancomycin co-exposure, are lacking. Objectives: To investigate the association of piperacillin/tazobactam with AKI and renal replacement therapy (RRT) among adult ICU patients. Methods: We analysed data from patients included in two open access databases (MIMIC-IV and eICU). Critically ill patients who received piperacillin/tazobactam or cefepime (a cephalosporin with similar broad-spectrum activity to piperacillin/tazobactam) during their first ICU stay were eligible for the study. Marginal structural Cox models, accounting for time-fixed covariates and time-dependent covariates were performed. The primary outcomes were AKI and need of RRT. Results: A total of 20 107 patients were included, with 11 213 in the piperacillin/tazobactam group and 8894 in the cefepime group. Exposure to piperacillin/tazobactam was associated with AKI (HR 1.77; 95% CI 1.51-2.07; P < 0.001) and with need of RRT (HR 1.31; 95% CI 1.08-1.57; P = 0.005). Tests for interaction were not statistically significant for occurrence of AKI and RRT in the subgroup of patients exposed to vancomycin or not (P = 0.26 and P = 0.6, respectively). Conclusions: In critically ill patients, exposure to piperacillin/tazobactam was associated with increased risk of AKI and with increased risk of RRT, regardless of combination therapy with vancomycin.
MeSH term(s)	Adult ; Humans ; Cefepime/adverse effects ; Vancomycin/adverse effects ; Cohort Studies ; Critical Illness ; Retrospective Studies ; Piperacillin, Tazobactam Drug Combination/adverse effects ; Acute Kidney Injury/chemically induced
Chemical Substances	Cefepime (807PW4VQE3) ; Vancomycin (6Q205EH1VU) ; Piperacillin, Tazobactam Drug Combination (157044-21-8)
Language	English
Publishing date	2024-01-22
Publishing country	England
Document type	Multicenter Study ; Journal Article
ZDB-ID	191709-2
ISSN	1460-2091 ; 0305-7453
ISSN (online)	1460-2091
ISSN	0305-7453
DOI	10.1093/jac/dkae001
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Article ; Online: Comparison of SAPS 3 performance in patients with and without solid tumor admitted to an intensive care unit in Brazil: a retrospective cohort study.

Taniguchi, Leandro Utino / Siqueira, Ellen Maria Pires

Revista Brasileira de terapia intensiva

2021 Volume 32, Issue 4, Page(s) 521–527

Abstract: Objective: To compare the performance of the Simplified Acute Physiology Score 3 (SAPS 3) in patients with and without solid cancer who were admitted to the intensive care unit of a comprehensive oncological hospital in Brazil.: Methods: We performed ...

Title translation	Comparação do desempenho do SAPS 3 em pacientes com e sem tumor sólido admitidos a uma unidade de terapia intensiva no Brasil: um estudo de coorte retrospectiva.
Abstract	Objective: To compare the performance of the Simplified Acute Physiology Score 3 (SAPS 3) in patients with and without solid cancer who were admitted to the intensive care unit of a comprehensive oncological hospital in Brazil. Methods: We performed a retrospective cohort analysis of our administrative database of the first admission of adult patients to the intensive care unit from 2012 to 2016. The patients were categorized according to the presence of solid cancer. We evaluated discrimination using the area under the Receiver Operating Characteristic curve (AUROC) and calibration using the calibration belt approach. Results: We included 7,254 patients (41.5% had cancer, and 12.1% died during hospitalization). Oncological patients had higher hospital mortality than nononcological patients (14.1% versus 10.6%, respectively; p < 0.001). SAPS 3 discrimination was better for oncological patients (AUROC = 0.85) than for nononcological patients (AUROC = 0.79) (p < 0.001). After we applied the calibration belt in oncological patients, the SAPS 3 matched the average observed rates with a confidence level of 95%. In nononcological patients, the SAPS 3 overestimated mortality in those with a low-middle risk. Calibration was affected by the time period only for nononcological patients. Conclusion: SAPS 3 performed differently between oncological and nononcological patients in our single-center cohort, and variation over time (mainly calibration) was observed. This finding should be taken into account when evaluating severity-of-illness score performance.
MeSH term(s)	Adult ; Brazil ; Cohort Studies ; Hospitalization ; Humans ; Intensive Care Units ; Neoplasms ; Retrospective Studies ; Simplified Acute Physiology Score
Language	English
Publishing date	2021-01-13
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	2732162-9
ISSN	1982-4335 ; 1982-4335
ISSN (online)	1982-4335
ISSN	1982-4335
DOI	10.5935/0103-507X.20200089
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Article ; Online: Performance of NUTRIC score to predict 28-day mortality in critically ill patients after replacing APACHE II with SAPS 3.

Souza, Ivens Augusto Oliveira / Ribeiro, Paulo Cesar / Jonckheer, Joop / De Waele, Elisabeth / Taniguchi, Leandro Utino

PloS one

2022 Volume 17, Issue 7, Page(s) e0270455

Abstract: Objectives: The Nutrition Risk in the Critically Ill (NUTRIC) score has been advocated as a screening tool for nutrition risk assessment in critically ill patients. It was developed and validated to predict 28-day mortality using Acute Physiology and ... ...

Abstract	Objectives: The Nutrition Risk in the Critically Ill (NUTRIC) score has been advocated as a screening tool for nutrition risk assessment in critically ill patients. It was developed and validated to predict 28-day mortality using Acute Physiology and Chronic Health Evaluation II (APACHE II) score as one of its components. However, nowadays the Simplified Acute Physiology Score 3 (SAPS 3) demonstrates better performance. We aimed to test the performance of NUTRIC score in predicting 28-day mortality after replacement of APACHE II by SAPS 3, and the interaction between nutrition adequacy and mortality. Methods: Adult patients who received nutrition therapy and remained >3 days in intensive care unit were retrospectively evaluated. In order to replace APACHE II component, we used ranges of SAPS 3 with similar predicted mortality. Discrimination between these tools in predicting 28-day mortality was assessed using the ROC curve, calibration was evaluated with calibration belt, and correlation with intraclass correlation. The relationship between nutritional adequacy and mortality was assessed in a subgroup with available data. Results: 542 patients were analyzed (median age of 78 years old, 73.4% admitted for non-surgical reasons and 28-day mortality was 18.1%). Mortality prediction discrimination did not differ between tools (p>0.05), but showed a good agreement (intraclass correlation 0.86) with good calibration. In the subgroup analysis for nutritional adequacy (n = 99), no association with mortality was observed. Conclusion: Performance of NUTRIC score with SAPS 3 is similar to the original tool. Therefore, it might be used in settings where APACHE II is not available.
MeSH term(s)	APACHE ; Adult ; Aged ; Critical Illness ; Humans ; Nutritional Status ; Retrospective Studies ; Simplified Acute Physiology Score
Language	English
Publishing date	2022-07-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0270455
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Article ; Online: Endotracheal intubation in COVID-19 patients in Brazil: a nationwide survey.

Mendes, Pedro Vitale / Besen, Bruno Adler Maccagnan Pinheiro / Lacerda, Fábio Holanda / Ramos, João Gabriel Rosa / Taniguchi, Leandro Utino

Revista Brasileira de terapia intensiva

2022 Volume 34, Issue 1, Page(s) 202–204

Title translation	Intubação traqueal em paciente com COVID-19 no Brasil: um inquérito nacional.
MeSH term(s)	Brazil ; COVID-19 ; Humans ; Intubation, Intratracheal ; Surveys and Questionnaires
Language	Portuguese
Publishing date	2022-06-29
Publishing country	Brazil
Document type	Letter
ZDB-ID	2732162-9
ISSN	1982-4335 ; 1982-4335
ISSN (online)	1982-4335
ISSN	1982-4335
DOI	10.5935/0103-507X.20220015-pt
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Article ; Online: Comparison of the accuracy of residents, senior physicians and surrogate decision-makers for predicting hospital mortality of critically ill patients.

Carneiro, Bárbara Vieira / Crozatti, Lucas Lonardoni / Mendes, Pedro Vitale / Nassar Júnior, Antonio Paulo / Taniguchi, Leandro Utino

Revista Brasileira de terapia intensiva

2022 Volume 34, Issue 2, Page(s) 220–226

Abstract: Objective: To compare the predictive performance of residents, senior intensive care unit physicians and surrogates early during intensive care unit stays and to evaluate whether different presentations of prognostic data (probability of survival versus ...

Title translation	Comparação da acurácia de residentes, médicos seniores e decisores substitutos na previsão da mortalidade hospitalar de pacientes críticos.
Abstract	Objective: To compare the predictive performance of residents, senior intensive care unit physicians and surrogates early during intensive care unit stays and to evaluate whether different presentations of prognostic data (probability of survival versus probability of death) influenced their performance. Methods: We questioned surrogates and physicians in charge of critically ill patients during the first 48 hours of intensive care unit admission on the patient's probability of hospital outcome. The question framing (i.e., probability of survival versus probability of death during hospitalization) was randomized. To evaluate the predictive performance, we compared the areas under the ROC curves (AUCs) for hospital outcome between surrogates and physicians' categories. We also stratified the results according to randomized question framing. Results: We interviewed surrogates and physicians on the hospital outcomes of 118 patients. The predictive performance of surrogate decisionmakers was significantly lower than that of physicians (AUC of 0.63 for surrogates, 0.82 for residents, 0.80 for intensive care unit fellows and 0.81 for intensive care unit senior physicians). There was no increase in predictive performance related to physicians' experience (i.e., senior physicians did not predict outcomes better than junior physicians). Surrogate decisionmakers worsened their prediction performance when they were asked about probability of death instead of probability of survival, but there was no difference for physicians. Conclusion: Different predictive performance was observed when comparing surrogate decision-makers and physicians, with no effect of experience on health care professionals' prediction. Question framing affected the predictive performance of surrogates but not of physicians.
MeSH term(s)	Critical Illness ; Decision Making ; Hospital Mortality ; Humans ; Intensive Care Units ; Physicians
Language	English
Publishing date	2022-08-10
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	2732162-9
ISSN	1982-4335 ; 1982-4335
ISSN (online)	1982-4335
ISSN	1982-4335
DOI	10.5935/0103-507X.20220019-pt
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Article ; Online: Phenotypes of sickle cell intensive care admissions: an unsupervised machine learning approach in a single-center retrospective cohort.

Padrão, Eduardo Messias Hirano / Bustos, Brian / Mahesh, Ashwin / Fonseca, Guilherme Henrique Hencklain / Taniguchi, Leandro Utino

Annals of hematology

2022 Volume 101, Issue 9, Page(s) 1951–1957

Abstract: Sickle cell disease (SCD) is associated with multiple known complications and increased mortality. This study aims to further understand the profile of intensive care unit (ICU) admissions of SCD patients. In this single-center retrospective cohort ( ... ...

Abstract	Sickle cell disease (SCD) is associated with multiple known complications and increased mortality. This study aims to further understand the profile of intensive care unit (ICU) admissions of SCD patients. In this single-center retrospective cohort (approval number 0926-11), we evaluated SCD-related ICU admissions at our hospital in São Paulo, Brazil. Admissions were clustered using clinical data and organ dysfunction at ICU admission. A hierarchical clustering method was used to distinguish phenotypes. From 140 admissions obtained, 125 were included. The mean age was 30 years, 48% were male, and SS genotype was predominant (71.2%). Non-surgical causes of admissions accounted for 85.6% (n = 107). The mean Sequential Organ Failure Assessment score (SOFA) was 4 (IQR 2-7). Vasopressors were required by 12% and mechanical ventilation by 17.6%. After analysis of the average silhouette width, the optimal number of clusters was 3: cluster 1 (n = 69), cluster 2 (n = 25), cluster 3 (n = 31). Cluster 1 had a mean age of 29 years, 87% of SS genotype, and mean SOFA of 4. Cluster 2 had a mean age of 37 years, 80% of SS genotype, and mean SOFA of 8. Cluster 3 had a mean age of 26 years, 29% of SS genotype, and mean SOFA of 3. The need for mechanical ventilation was 11.6%, 44%, and 9.7%, respectively. Mortality was significantly higher in cluster 2 (44%, p = 0.012). This cohort of critical SCD admissions suggested the presence of three different profiles. This can be informative in the ICU setting to identify SCD patients at higher risk of worse outcomes.
MeSH term(s)	Anemia, Sickle Cell/diagnosis ; Anemia, Sickle Cell/epidemiology ; Anemia, Sickle Cell/genetics ; Brazil/epidemiology ; Critical Care ; Female ; Hospital Mortality ; Humans ; Intensive Care Units ; Male ; Phenotype ; Retrospective Studies ; Unsupervised Machine Learning
Language	English
Publishing date	2022-07-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1064950-5
ISSN	1432-0584 ; 0939-5555 ; 0945-8077
ISSN (online)	1432-0584
ISSN	0939-5555 ; 0945-8077
DOI	10.1007/s00277-022-04918-4
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Article ; Online: Effects of an educational intervention for rational cardiac enzyme requisitions in critically ill patients: a pre-post intervention study.

Tedesco, Natália Sarracceni / Pinheiro, Frederico Augusto Gurgel / Vieira Júnior, José Mauro / Taniguchi, Leandro Utino

International journal for quality in health care : journal of the International Society for Quality in Health Care

2022 Volume 34, Issue 4

Abstract: Background: Although cardiac troponin is recommended as the biomarker of choice to evaluate myocardial injury, inappropriate low-value ordering practice is frequent, particularly routine ordering of creatine kinase-myocardial band (CK-MB) tests where ... ...

Abstract	Background: Although cardiac troponin is recommended as the biomarker of choice to evaluate myocardial injury, inappropriate low-value ordering practice is frequent, particularly routine ordering of creatine kinase-myocardial band (CK-MB) tests where troponin is available. Objective: The aim of this study was to evaluate the impact of an educational intervention for rational request of cardiac biomarkers in the intensive care unit. Method: We conducted a quasi-experimental, pre-post implementation study of an educational program (expository-dialogue presentation and disclosure of a decision algorithm) for rational cardiac biomarker testing in adult critically ill patients. The study was divided into two 12-month periods: pre-intervention (September 2017-August 2018) and post-intervention (October 2018-September 2019). An interrupted time series with a segmented regression model was applied to analyze variation over time in CK-MB and troponin testing. Results: We included 4429 patients: 2181 patients in the pre-intervention period and 2248 patients in the post-intervention period. A reduction in the concomitance of CK-MB and troponin testing was observed (concomitance in 1415 tests in the pre-intervention period vs 348 tests in the post-intervention period). The interrupted time series analysis demonstrated a noticeable immediate reduction in the concomitance of CK-MB with troponin after the intervention (-0.13 tests per patient, P = 0.0016) but not in the secular trend for the concomitance. The proportion of patients with the acute coronary syndrome as a discharge diagnosis was not different between the pre- and post-intervention period. Conclusion: Our pre-post interventional study demonstrated a significant decrease in the concomitance of CK-MB and troponin tests. A rational high-value ordering practice of cardiac biomarkers is possible in critically ill patients and might be suitable for educational interventions.
MeSH term(s)	Adult ; Humans ; Creatine Kinase, MB Form ; Critical Illness ; Troponin ; Acute Coronary Syndrome/diagnosis ; Biomarkers
Chemical Substances	Creatine Kinase, MB Form (EC 2.7.3.2) ; Troponin ; Biomarkers
Language	English
Publishing date	2022-10-25
Publishing country	England
Document type	Journal Article
ZDB-ID	1194150-9
ISSN	1464-3677 ; 1353-4505
ISSN (online)	1464-3677
ISSN	1353-4505
DOI	10.1093/intqhc/mzac088
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Article ; Online: Practices for promoting sleep in intensive care units in Brazil: a national survey.

Ramos, Fernando José da Silva / Taniguchi, Leandro Utino / Azevedo, Luciano Cesar Pontes de

Revista Brasileira de terapia intensiva

2020 Volume 32, Issue 2, Page(s) 268–276

Abstract: Objective: To conduct a national survey of intensive care professionals to identify the practices for promoting sleep in adult intensive care units in Brazil and describe the professionals' perceptions of the importance of sleep for patients.: Methods! ...

Title translation	Práticas de promoção de sono em unidades de terapia intensiva no Brasil: um inquérito nacional.
Abstract	Objective: To conduct a national survey of intensive care professionals to identify the practices for promoting sleep in adult intensive care units in Brazil and describe the professionals' perceptions of the importance of sleep for patients. Methods: An electronic questionnaire was distributed by the clinical research cooperation network of the Associação de Medicina Intensiva Brasileira and by the Brazilian Research in Intensive Care Network to physicians and nurses registered with the association. The questionnaire evaluated the profile of the respondents, the profile of their intensive care units, whether protocols for promoting sleep were present, the pharmacological and nonpharmacological measures typically employed in the unit, and the professionals' perceptions regarding sleep in critically ill patients. Results: A total of 118 questionnaires were evaluated. The Southeast region of the country was the most represented (50 questionnaires, 42.4%). The majority of units had a clinical-surgical profile (93 questionnaires; 78.8%), and 26 had a continuous visitation policy (22.0%). Only 18 intensive care units (15.3%) reported having protocols for promoting sleep. The most cited measure for sleep promotion was reducing light during the night (95 questionnaires; 80.5%), which was more often performed in private intensive care units. Almost all of the responders (99%) believed that poor-quality sleep has a negative impact on patient recovery. Conclusion: The responses to this Brazilian survey revealed that few intensive care units had a program for promoting sleep, although almost all participants recognized the importance of sleep in patient recovery.
MeSH term(s)	Adult ; Brazil ; Critical Care/methods ; Critical Illness ; Health Care Surveys ; Humans ; Intensive Care Units/statistics & numerical data ; Nurses/statistics & numerical data ; Physicians/statistics & numerical data ; Sleep/physiology
Language	Portuguese
Publishing date	2020-07-13
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	2732162-9
ISSN	1982-4335 ; 0103-507X
ISSN (online)	1982-4335
ISSN	0103-507X
DOI	10.5935/0103-507x.20200043
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Article ; Online: Severity scoring systems for pneumonia: current understanding and next steps.

Ranzani, Otavio T / Taniguchi, Leandro Utino / Torres, Antoni

Current opinion in pulmonary medicine

2018 Volume 24, Issue 3, Page(s) 227–236

Abstract: Purpose of review: To describe the current understanding and clinical applicability of severity scoring systems in pneumonia management.: Recent findings: Severity scores in community-acquired pneumonia are strong markers of mortality, but are not ... ...

Abstract	Purpose of review: To describe the current understanding and clinical applicability of severity scoring systems in pneumonia management. Recent findings: Severity scores in community-acquired pneumonia are strong markers of mortality, but are not necessarily clinical decision-aid tools. The use of severity scores to support outpatient care in low-risk patients has moderate-to-strong evidence available in the literature, mainly for the pneumonia severity index, and must be applied together with clinical judgment. It is not clear that severity scores are helpful to guide empiric antibiotic treatment. The inclusion of biomarkers and performance status might improve the predictive performance of the well known severity scores in community-acquired pneumonia. We should improve our methods for score evaluation and move toward the development of decision-aid tools. Summary: The application of the available evidence favors the use of severity scoring systems to improve the delivery of care for pneumonia patients. The incorporation of new methodologies and the formulation of different questions other than mortality prediction might help the further development of severity scoring systems, and enhance their support to the clinical decision-making process for the pneumonia-management cascade.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Clinical Decision-Making ; Community-Acquired Infections/therapy ; Hospitalization ; Humans ; Intensive Care Units ; Pneumonia/therapy ; Severity of Illness Index
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2018-04-17
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	1285505-4
ISSN	1531-6971 ; 1070-5287 ; 1078-1641
ISSN (online)	1531-6971
ISSN	1070-5287 ; 1078-1641
DOI	10.1097/MCP.0000000000000468
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Article ; Online: Association of Frailty, Organ Support, and Long-Term Survival in Critically Ill Patients With COVID-19.

Taniguchi, Leandro Utino / Avelino-Silva, Thiago Junqueira / Dias, Murilo Bacchini / Jacob-Filho, Wilson / Aliberti, Márlon Juliano Romero

Critical care explorations

2022 Volume 4, Issue 6, Page(s) e0712

Abstract: Few studies have explored the effect of frailty on the long-term survival of COVID-19 patients after ICU admission. Furthermore, the Clinical Frailty Scale (CFS) validity in critical care patients remains debated. We investigated the association between ... ...

Abstract	Few studies have explored the effect of frailty on the long-term survival of COVID-19 patients after ICU admission. Furthermore, the Clinical Frailty Scale (CFS) validity in critical care patients remains debated. We investigated the association between frailty and 6-month survival in critically ill COVID-19 patients. We also explored whether ICU resource utilization varied according to frailty status and examined the concurrent validity of the CFS in this setting. Design: Ancillary study of a longitudinal prospective cohort. Setting: University hospital in São Paulo. Patients: Patients with severe COVID-19 admitted to ICU. Interventions: None. Measurements and main results: We assessed baseline frailty using the CFS (1-9; frail ≥ 5) and used validated procedures to compute a Frailty Index (0-1; frail > 0.25). We used Cox models to estimate associations of frailty status with 6-month survival after ICU admission and area under the receiver operating characteristic curves (AUCs) to estimate CFS's accuracy in identifying frailty according to Frailty Index. We included 1,028 patients (mean age, 66 yr; male, 61%). Overall, 224 (22%) patients were frail (CFS ≥ 5), and 608 (59%) died over the 6-month follow-up. Frailty was independently associated with lower 6-month survival and further stratified mortality in patients with similar age and Sequential Organ Failure Assessment scores. We additionally verified that the CFS was highly accurate in identifying frailty as defined by the Frailty Index (AUC, 0.91; 95% CI, 0.89-0.93). Although treatment modalities did not diverge according to frailty status, higher CFS scores were associated with withholding organ support due to refractory organ failure. Conclusions: One in five COVID-19 patients admitted to the ICU was frail. CFS scores greater than or equal to 5 were associated with lower long-term survival and decisions on withholding further escalation of invasive support for multiple organ failure in the ICU. Clinicians should consider frailty alongside sociodemographic and clinical measures to have a fuller picture of COVID-19 prognosis in critical care.
Language	English
Publishing date	2022-05-25
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000712
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