Resuscitation after cardiac surgery in Australia: a survey of practice and the implementation of a training course

Abstract

Objective: To characterise the out-of-hours cover of Cardiac-Surgical Intensive Care Units in Australia, the experience of covering physicians in the training, and management of, cardiac arrest after cardiac surgery, and to describe a novel educational course.

Design: Nighttime phone survey with doctors on public cardiac intensive care units across Australia. Members of nursing, intensive care, and cardiac surgery staff, devised a dedicated half-day course to address the principles of managing a cardiac arrest post-cardiac surgery.

Setting: Tertiary teaching hospital in Sydney, New South Wales, Australia.

Patients and Participants: No patient data used. Qualitative and quantitative feedback from doctors covering intensive care units, and participants, on a pilot course designed to formally train medical and nursing personnel in the management of cardiac arrest after cardiac surgery.

Interventions: Design and implementation of a new training course.

Measurements and Results: We demonstrated wide variation in the availability of training opportunities in Cardiac-surgical Unit-Advanced Life Support, with few units having cardiothoracic surgical doctors on site at night, and the majority of units being covered by a registrar grade, intensive care trainee, out-of-hours. Our pilot course was feasible, well received, and demonstrated improvements in candidates’ confidence in managing cardiac arrests, and their ability to perform, or assist with, emergency re-sternotomy.

Conclusions: The experience of doctors covering cardiac intensive care units varies greatly. There is a lack of dedicated guidelines covering the management of cardiac arrest in the post-cardiac surgical population, with wide variability in whether institutions offer training for this emergency, and how frequently these opportunities are available. There is also a lack of trained medical staff on-site, out-of-hours, able to perform emergency re-sternotomy.


Authors:

Colistin resistance in organisms causing ventilator-associated pneumonia - Are we going into pre-antibiotic era?

Abstract

Introduction: Ventilator-associated pneumonia (VAP) is one of the most common infections in mechanically ventilated patients. VAP is usually caused by multidrug resistant bacteria. The beta-lactam antibiotics, which were once considered the backbone of antibiotic therapy is under strain due to a variety of bacterial antibiotic resistance. Recent evidence suggests that colistin is the only cannon left in the medical armory to treat bacterial infections, mainly those acquired in the hospital that no other drug can treat. But excessive use of colistin has recently led to resistance to these group of drugs. Initially, resistance to colistin was due to mutations but recently detected plasmid-mediated colistin resistance, which is transferrable, heralds the breach of the last group of antibiotics, polymixins. Colistin resistance is on the rise, especially in South East Asia countries. So strict infection control policies are required to control the spread of this infection.

Objective: This study was conducted to see the burden of colistin resistant organisms causing VAP in ICU of Himalayan Institute of Medical Sciences, Dehradun, India.

Design: A prospective observational study.

Setting: Study was conducted in a 40-bed semi-closed ICU of a tertiary care super specialized hospital between August 2016 to April 2017.

Patients and participants: Out of 2304 patients admitted to ICU 420 had a suspicion of VAP. A total of 476 lower respiratory tract samples were collected from 400 patients with clinical evidence of lower respiratory tract infections in form of endotracheal (ET) aspirate, tracheal tube (TT) aspirate, and bronchoalveolar lavage (BAL) specimens.

Intervention: Organism identification and the susceptibility testing were done by using an automated system VITEK 2.

Result: Out of 476 sample received, only 186 samples organisms were isolated, which showed Acinetobacter baumanii was the most common organism. It was found that 19 organisms had resistance to colistin. Klebsiella pneumoniae (25.7%) was the most common organism, which was resistant to colistin, followed by Pseudomonas aeruginosa (16%) and Acinetobacter baumanii (2.4%).

Conclusion: The emergence of colistin resistant strains is a very serious problem as there are only few treatment options. As colistin use is a risk factor for colistin resistance, colistin should not be used alone, combination therapy should be preferred.


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Vitamin D deficiency and outcome of patients with sepsis in pediatric intensive care unit: a prospective observational study

Abstract

Background: Vitamin D is important in immunomodulation, regulation of inflammation and cytokines, cell proliferation, cell differentiation, apoptosis, angiogenesis, muscle strength, and muscle contraction. Patients with sepsis have high mortality rate and high deficiency in vitamin D. (1) Vitamin D is increasingly recognized as an important mediator of immune function and may have a preventive role in the pathogenesis of sepsis. (2) Vitamin D also influence cardiovascular function. (3) We aimed to find the correlation of vitamin D level with severity of sepsis in patients admitted to pediatric intensive care unit (PICU).

Setting: Participants and laboratory were collected from patients with sepsis who admitted to the PICU at Dr. Sardjito General Hospital, Yogyakarta.

Patients and Participants: Participants pediatric sepsis patients admitted to the PICU from September 2015 to April 2016. Blood samples for 25-hydroxyvitamin D [25(OH)D] concentration were collected at the first 24 hours admission in PICU using ELISA method. Other data recorded include pediatric logistic organ dysfunction (PELOD) score at admission, PICU length of stay and mortality.

Measurement and results: A total of 297 patients were admitted to the PICU during the 8-month study period. Fourty-two patients had diagnosis of sepsis, severe sepsis or septic shock on PICU admission. Of all these studied patients, 25(OH)D deficiency was identified in 23 (54.8%) patients, insufficiency in 9 (21.4%) patients, and normal levels in 10 (23.8%) patients. PICU mortality was higher in patients with 25(OH)D deficiency, ie 7 (30.44%) patients, but it did not show any statistical significance compared to the group of patients with 25(OH)D insufficiency or normal level of 25(OH)D group of patients (p=0.78). The group with normal level of 25(OH)D had the highest PELOD score but on the other hand they have the lowest mortality rate.

Conclusions: There is a high prevalence of vitamin D deficiency in pediatric sepsis patients admitted to PICU, but not correlated with PELOD score on admission. PICU lenght of stay also not associated with mortality in PICU.


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Electrocardiography Holter monitoring abnormalities in acute intracerebral hemorrhages

Abstract

Objective: To avoid the misinterpretation of electrocardiogram (ECG) abnormalities in acute intracerebral hemorrhage (ICH), it is important to recognize ECG abnormalities in such patients. Previous studies have reported ECG disorders in ICH patients based on a single ECG tracing. In this study, we used ECG Holter monitoring to determine ECG abnormalities in acute ICH patients.

Methods: This was a prospective analysis of acute (up to 24 hours following admission) non-traumatic ICH patients who were admitted to our hospital between January 2014 and April 2015. Initially, an ECG and cerebral computed tomography (CT) scan were obtained within the first day of admission. The patients then underwent ECG Holter monitoring for 24 hours. Finally, the ECG abnormalities and their association with the CT scan findings were analyzed.

Results: This study included 108 patients with acute non-traumatic ICH. The most frequent ECG abnormalities shown by Holter monitoring were ectopic beats (85.2%), followed by sinus tachycardia (63.2%). Only the presence of midline shift on the CT scan had a significant correlation with ectopic beats (OR: 1.3, CI: 1.05-1.7).

Conclusion: ECG Holter monitoring in 108 acute ICH patients demonstrated a correlation between the presence of midline shift on the cranial CT scan and ectopic beats in the ECG Holter monitoring.


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Initial caloric administration as a risk factor for mortality in critically ill children

Abstract

Background: The mortality rate of critically ill children with multiple organ dysfunction syndrome (MODS) in Indonesia is approximately 51.85%. Various studies suggested malnutrition as a risk factor for mortality; therefore, nutrition therapy in the form of initial caloric administration became imperative.

Objective: To determine the relationship between initial caloric administration (initial route, initial time and the fulfilment of caloric requirement) and mortality of critically ill children.

Design: Case-control study.

Setting: The Pediatric Intensive Care Unit (PICU) of Dr. Sardjito General Hospital Yogyakarta in 2015.

Patients and participants: Children aged 1 month to 18 years old hospitalized in the PICU for at least 4 days in 2015. Subjects were divided into case group (non-surviving patients) and control group (surviving patients).

Measurements and results: We used McNemar test and stepwise conditional logistic regression for data analysis. From 102 subjects (51 in each group), the proportion of malnourished children in the case group was higher than in the control group (58.8% and 29.4%, respectively). Parenteral route and lack of caloric achievement within the 3rd to 6th day of hospitalization significantly increased the risk of mortality (p<0.05) with ORs of 13 (95%CI 1.95 to 552.47), 3.8 (95%CI 1.37 to 13.02), 4.25 (95%CI 1.39 to 17.26), 4.00 (95%CI 1.08 to 22.09), and 10.0 (95%CI 1.42 to 433.98), respectively. Caloric initiation after the first 48 hours of hospitalization did not significantly affect the mortality rate (p>0.05). Confounding variables that affected mortality include the severity of disease, use of ventilator, hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and malnutrition (p<0.05). Multivariate analysis revealed that parenteral route and malnutrition significantly influenced mortality with ORs of 36.05 (95%CI 3.22 to 404.13) and 9.04 (95%CI 2.09 to 39.19), respectively.

Conclusion: There is a relationship between route of initial caloric administration and mortality of critically ill children, where parenteral nutrition significantly influenced mortality in critically ill children.


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Difference in serum procalcitonin levels between decompensated liver cirrhosis patients with and without bacterial infection

Abstract

Background: Decompensated liver cirrhosis may increase procalcitonin (PCT) levels in patients without bacterial infection. Previous studies have not provided conclusive results about the difference in serum PCT levels caused by specific liver decompensation and bacterial infection.

Objective: To examine the role of PCT in assisting the diagnosis of bacterial infection in decompensated liver cirrhosis patients.

Methods: A cross-sectional study on decompensated liver cirrhosis patients who were outpatients and admitted to Cipto Mangunkusumo Hospital, Jakarta, was conducted between December 2015 until May 2016. Procalcitonin levels were examined and bacterial infection was identified using standard criteria for each type of infection suspected. Analysis was performed to determine the difference in PCT levels between patients with and without bacterial infection, and to obtain the cutoff point of PCT for bacterial infection diagnosis using the receiver operating characteristic (ROC) curve.

Results: There were 38 patients with decompensated liver cirrhosis, 16 (42.1%) with bacterial infection, and 22 (57.9%) without bacterial infection. Patients with bacterial infection (3.607±0.643 ng/ml) had significantly higher PCT levels than those without bacterial infection (0.738±1.185 ng/ml). The level of PCT for bacterial infection in decompensated liver cirrhosis had an area under the ROC curve of 0.933 (CI 0.853-1.014). The cutoff point of PCT for bacterial infection diagnosis in decompensated liver cirrhosis patients was 2.79 ng/ml, with a sensitivity of 87.5% and specificity of 86.4%.

Conclusion: The PCT levels of decompensated liver cirrhosis patients with bacterial infection were higher than those of patients without bacterial infection. The cutoff point of PCT for bacterial infection diagnosis in decompensated liver cirrhosis patients was 2.79 ng/ml.


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Comparative analysis of clinical pharmacy interventions in a pediatric intensive care unit

Abstract

Objective: The objectives of this study were 1) to describe and characterize interventions performed by a clinical pharmacist and 2) provide a comparative analysis of length of stay, mortality, and drug charges in control and intervention groups.

Design: This was a retrospective analysis of clinical pharmacy interventions performed in a Pediatric Intensive Care Unit (PICU) over two years. The clinical pharmacy faculty member was a dual-residency trained specialist in pediatric critical care, and was on-site in the PICU for approximately 0.5 full time equivalents.

Setting and patients: The interventions occurred in an 18-bed medical-surgical PICU in a tertiary care children's hospital. All patients admitted to the PICU during the study period were included.

Interventions: The intervention group was comprised of patients admitted to the PICU during the study period for which the clinical pharmacist suggested changes in medication therapy. All other PICU patients were included in the control group. Interventions suggested were varied, including drug dosing adjustments, antibiotic recommendations, sedation recommendations, and discontinuation of drug therapy.

Measurements and main results: On average, there were 4.4 interventions per patient (0.35 interventions per patient-day). Dosing recommendations, pharmacokinetic recommendations, and discontinuation of medications were the most common types of interventions performed. Antibiotics and sedation/analgesia were the most common drug classes for intervention. There were statistically significant differences in the length of stay and mortality of groups, with both higher in the intervention group. Notably, the intervention group also had higher Pediatric Risk of Mortality (PRISM) scores and drug charges, signifying increased severity of illness compared to the control group. Estimated annual cost savings in the intervention group was $ 86,000.

Conclusions: Antibiotics and sedation/analgesia dosing were the most common areas for pharmacy interventions. Patients with higher PRISM scores had increased interventions. Cost savings were considerable even with a part time pharmacist.


Authors:

The effect of mild hypothermia therapy in the level of MMP-9 protein and the Marshall CT score in high risk traumatic brain injury

Abstract

The effect of mild hypothermia therapy (34°-36°C) and alterations of matrix metalloproteinase-9 (MMP-9) were examined in 20 patients with high risk traumatic brain injury (TBI). The neurologic status was assessed using the Full Outline of UnResponsiveness (FOUR) score and the outcome using the Marshall CT score. The objective of this study was to determine serum MMP-9 level and the Marshall CT score. This research used a prospective randomized controlled study and was conducted in RD Kandou Hospital Manado. Patients with high risk TBI (the FOUR score ≤7) were randomized into two groups, with and without mild hypothermia therapy, and were investigated within 24 and 72 hours. The MMP-9 protein levels were estimated using enzyme-linked immunosorbent assay (ELISA). Different levels of these variables were compared in the two groups. The results showed that the level of MMP-9 protein significantly decreased (p<0.05) in the hypothermia group; however, there was no significant improvement of the Marshall CT score (p>0.05) within 24-72 hours. The study concluded that mild hypothermia therapy had a significant influence on the alteration of biomarkers rather than the alteration of anatomical imaging in high risk TBI patients.


Authors:

Decision making of tracheostomy and extubation outcomes in mechanically ventilated patients evaluated by logistic regression and decision tree analyses

Abstract

Background: Most studies determining the predictors of extubation outcomes in patients with mechanical ventilation have not included high-risk populations who avoid extubation and undergo tracheostomy.

Objective: To evaluate predictors of extubation intolerance by analyzing patients regardless of whether extubation was attempted or not.

Design: Retrospective cohort study.

Settings: Mixed intensive care unit (ICU) of Kumamoto University Hospital.

Patients and participants: Medical data of 288 consecutive mechanically ventilated adults were collected. Initial outcomes of endotracheal tube treatment were classified as 1) successful extubation, 2) extubation failure, and 3) tracheostomy without attempting extubation. Clinical variables responsible for those outcomes were determined by logistic regression and decision tree analyses. We defined combined outcome of extubation failure and tracheostomy as extubation intolerance in the present study.

Results: Of 288 patients, 17 failed extubation and 37 opted for tracheostomy without extubation. Logistic regression analysis revealed that the significant predictors of extubation failure were weak cough strength, poor consciousness, and excessive airway secretion. The propensity score of extubation failure calculated by logistic regression analysis in the tracheostomy group was as high as that of extubation failure group. A decision tree to predict the outcomes was described by branching with consciousness, style of ICU admission, and volume of airway secretion.

Conclusions: The principle predictors of extubation intolerance were related to instability of airway patency, and the decision making of tracheostomy was shown to be appropriate. These statistical methods could reduce the selection bias of study subjects.


Authors:

Incidence of CAUTI in a new integrated ICU/HD in Singapore over 1 year

Abstract

Hospital-acquired infection worldwide has been associated with significant mortality and morbidity and unfortunately catheter-associated urinary tract infection (CAUTI) is known to be one of the commonest hospital-acquired infections.

A retrospective study was done to determine the incidence of CAUTI in the Intensive Care Unit/High Dependency (ICU/HD) in Ng Teng Fong General Hospital (NTFGH) since it was opened from 1 July 2015 to 31 July 2016. NTFGH Intensive Care Unit is an integrated ICU/HD unit that manages a combination of surgical, medical, trauma and cardiac patients. The inclusion criteria were patients catheterized and with urinary tract infections diagnosed in ICU/HD and also diagnosed with UTI within 48 hours of discharge from ICU/HD. The data was retrieved from hospital electronic database. The types of organisms and their resistant pattern to antibiotics were analysed.

A total of 3159 patients were admitted to the ICU/HD during this period. One hundred eighteen patients were diagnosed with urinary tract infections in general and out of this group 69 patients were noted to have CAUTI based on CDC criteria. The commonest organisms related to CAUTI were Escherichia coli and Klebsiella pneumoniae. These two organisms showed a similar pattern of establishing resistance to all the first line antibiotics used and they were ampicillin, amoxicillin-clavulanic acid and cephalosporins. Though the usage of quinolones, sulfamethoxazole-trimethoprim and gentamicin were low, these organisms have also established resistance to these 3 antibiotics. Enterococcus fecalis was the next commonest organism and was often associated with the presentation of diarrhea. Other organisms including Pseudomonas, Proteus, Enterobacter, Morganella, Citrobacter, Burkholderia and Staphylococcus were sporadically reported.

The common risk factors for developing CAUTI noted were surgical elderly male patients with diabetes and a history of obstructive UTI.

A committee involving a team from ICU has been set to review the current indwelling urinary catheter bundle and rectify the problems and implement new measures to reduce the incidence of CAUTI.


Authors:

A randomized pilot study of parenteral glutamine supplementation in severe sepsis

Abstract

Purpose: Glutamine depletion can occur in critically ill patients and parenteral glutamine supplementation can have beneficial effects on critically ill patients by preserving gut barrier and improving immune function. We wanted to examine the effect of glutamine supplementation in a cohort of severe sepsis patients admitted to a hospital in South East Asia.

Design: A single center, randomized, doubleblinded, placebo-controlled, pilot study. The primary outcome was 28-day mortality. Secondary outcomes were ICU length of stay (LOS), hospital LOS, duration of mechanical ventilation and occurrence of new infections. Disease severity on admission was assessed by Sequential Organ Failure Assessment (SOFA) score.

Setting: Medical intensive care unit (MICU) of Changi General Hospital, which is a 1000-bedded teaching hospital in Singapore.

Patients and participants: Patients admitted to the MICU for severe sepsis with ≥2-organ dysfunction.

Interventions: In the intervention arm, intravenous glutamine was given for 5 days at a dose of 0.5 g/kg body weight/day. The placebo was normal saline.

Measurements and results: Thirty-nine patients were randomized to receive glutamine (n=19) or placebo (n=20). The glutamine group exhibited milder disease severity than placebo (median SOFA score 8 vs 11, p=0.038). There was no overall difference in 28-day mortality between the glutamine and placebo (42% vs 15%, p=0.06). When adjusted for disease severity, the glutamine arm had 5.6 times higher death rates (95% CI 1.1-30.2, p=0.044). The glutamine group had lower incidence of new infections (0% vs 30%, p=0.02). There was no difference in ICU LOS, hospital LOS and the duration of mechanical ventilation.

Conclusions: Parenteral glutamine may increase mortality risk in ICU patients with severe sepsis while reducing the risk of new infections.


Authors:

A comparison of NSS vs balanced salt solution as a fluid resuscitation and impact of fluid balance on clinical outcomes in pediatric septic shock

Abstract

Septic shock is a common condition affecting children worldwide. Initial resuscitation with crystalloid fluid is the first step in treatment of septic shock. However, there is increasing concern about side effects of using normal saline. Our objective was to compare the effectiveness of balanced salt solution vs 0.9% normal saline solution (NSS) on decreasing morbidity and mortality in pediatric septic shock. This was a prospective observational study enrolled septic children aged 1-15 years treated at the Department of Pediatrics, King Chulalongkorn Memorial Hospital. They were given fluids resuscitation according to Surviving Sepsis Campaign (SSC) guidelines. Thirty-five sepsis children were enrolled, 20 received normal saline as first line fluid resuscitation and 15 received balanced salt solution (Ringer lactate solution [RLS]) as first line fluid resuscitation. Baseline characteristic of both groups were similar. RLS group received significantly less fluid resuscitation at 24 and 48 hours compared to NSS group (134.3±42.9 vs 171.3±49.5; p=0.02, 236.9±75.7 vs 313.1±115.3; p=0.03). Moreover, RLS group had significantly less metabolic acidosis and better base excess at 6 hours and 24 hours compared to NSS group (2.5±4.1 vs -3.7±4.1; p<0.001, 3.4±3.2 vs -1.2±3.9; p=0.03). There was no statistically significant difference in mortality between two groups (15% [n=3] NSS, 6.7% [n=1] RLS).

Conclusion: Using balanced salt solution for resuscitation decreased metabolic acidosis and tended to decrease fluid intake and fluid accumulation.


Authors:

Blood plasma plasmalogens and fatty acids in multiple organ dysfunction syndrome

Abstract

Introduction: Changes in fatty acid composition as well as in a level of blood plasma plasmalogens in cases of various pathological conditions are evidences of lipid metabolism disorders and can indicate their reasons and degree. The objective of this study was to analyze fatty acids and plasmalogens of blood plasma in patients with multiple organ dysfunction syndrome (MODS).

Methods: Fatty acid ethyl esters and diethyl acetals of fatty aldehydes obtained during sample preparation were analyzed by capillary gasliquid chromatography.

Results: Marked changes in the plasma fatty acid composition and plasmalogen levels in pa tients with MODS were detected.

Conclusions: Based on the detected significant reduction in the plasmalogen levels of blood plasma, a conclusion was made about possible presence of peroxisome dysfunctions in patients with MODS. Peroxisome dysfunction may be one of the reasons of violation of detoxification processes, fatty acids oxidation disorder, prolongation and intensification of the inflammatory process, neurological disorders, and decreased blood antioxidant capacity. The assumption was made about an important role of fatty acids in disturbance of systemic hemodynamics, assessment of a degree of lipid metabolism disorders and activity of сatabolic response.


Authors:

The effect of selective COX-2 inhibitor on blood glutamate in moderate traumatic brain injury

Abstract

Head injury is the leading cause of death and disability in adolescence, children and the elderly. Post-traumatic brain damage is determined by combination of primary and secondary head injuries. Neuroinflammation is one mechanism of secondary brain injury. Selective cyclooxygenase (sCOX-2) inhibitors are drugs commonly used in treatment of postoperative pain but also possess an anti-inflammatory effect. The aim of this study is to determine the role of sCOX-2 inhibitors to inhibit the inflammatory processes in patients with head injury by measuring the glutamate levels.

This is a double blind randomized controlled study involving patients with moderate head injuries who underwent surgery at Dr. Hasan Sadikin Hospital Bandung since December 2013 until December 2015. After obtaining study approval from the Research Ethics Committees of School of Medicine Padjadjaran University/Dr. Hasan Sadikin Hospital, samples were clustered randomly into 5 groups: the control group, the COX2-group I (given sCOX-2 inhibitor once/day), the COX2-group II (given sCOX-2 inhibitor twice/day), the COX2-group III (given sCOX-2 inhibitor thrice/day), and the COX2-group IV (given sCOX-2 inhibitor four times/day), and each group consisted of 6 patients. All patients received standard therapy as recommended by Brain Trauma Foundation Guidelines 2007 as well as performed monitoring of blood pressure, pulse rate, respiratory rate, oxygen saturation, temperature and blood sugar during pre and postoperative stages. The data were analyzed using paired samples t-test and one-way Anova, which p<0.05 is considered as statistically significant.

Results showed that there was a significant reduction in glutamate level in COX2-group II with the p-value of 0.035. The study concluded that sCOX-2 inhibitor has a brain protective effect by lowering the levels of glutamate as neuroinflammatory biomarkers in patients with head injury.


Authors:

Albumin level as a predictor of shock and recurrent shock in children with dengue hemorrhagic fever

Abstract

Background: The severity of dengue hemorrhagic fever (DHF) can be seen from bleeding and plasma leakage manifestations. Albumin level is one of the markers of plasma leakage in dengue infection. Whether albumin can be used as a predictor of shock in DHF patients or of recurrent shock in dengue shock syndrome (DSS) patients still need to be further evaluated.

Objective: To determine serum albumin level as a predictor of shock in DHF and of recurrent shock in DSS.

Design: A cohort prospective study.

Setting: Department of Child Health, Prof. Dr. RD Kandou Hospital, Manado, Indonesia.

Patients and participants: Sixty-seven DHF patients and 58 DSS patients aged 1- to 14-yearold were enrolled in our study. Sampling was done with consecutive sampling method. The inclusion criteria were patients diagnosed with DHF/DSS based on World Health Organization (WHO) criteria (2011). The exclusion criteria were patients who received corticosteroids, blood transfusion, albumin infusion and patients with severe malnutrition. The dependent variables were shock and recurrent shock. The independent variable was serum albumin level. The relation between serum albumin level and shock or recurrent shock were analyzed using logistic regression test, power 0.80, α 0.05 and was significant if p<0.05. We used receiver operating characteristic (ROC) curve to determine prognostic factors. Data was analyzed using software SPSS v 21.0.

Results: There was significant correlation between albumin level and shock in DHF patients (p=0.0001, area under the curve (AUC) 0.865, cut-off 3.05, odds ratio (OR) 17.4, sensitivity 79%, specificity 81%), but there was no correlation between albumin level and recurrent shock in DSS patients.

Conclusions: Serum albumin level can be used as a predictor of shock in DHF patients but it cannot be used as predictor of recurrent shock in DSS patients.


Authors: