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Celi, Leo Anthony

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Celi

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Leo Anthony

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Celi, Leo Anthony

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2012 - 20193

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Author's Publications: search.filters.isAuthorOfPublication.6a350128-f03a-481c-8d80-c64b78876d13

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    Outcomes of Ventilated Patients With Sepsis Who Undergo Interhospital Transfer: A Nationwide Linked Analysis
    (Ovid Technologies (Wolters Kluwer Health), 2018-01) Rush, Barret; Tyler, Patrick; Stone, David J.; Geisler, Benjamin; Walley, Keith R.; Celi, Leo Anthony
    Objectives The outcomes of critically ill patients who undergo inter-hospital transfer (IHT) are not well understood. Physicians assume that patients who undergo IHT will receive more advanced care that may translate into decreased morbidity or mortality relative to a similar patient who is not transferred. However, there is little empirical evidence to support this assumption. We examined country-level U.S. data from the Nationwide Readmissions Database to examine whether, in mechanically ventilated (MV) patients with sepsis, IHT is associated with a mortality benefit. Design Retrospective data analysis using complex survey design regression methods with propensity score matching. Setting The Nationwide Readmissions Database contains information about hospital admissions from 22 States, accounting for roughly half of U.S. hospitalizations; the database contains linkage numbers so that admissions and transfers for the same patient can be linked across one year of follow-up. Patients From the 2013 NRD Sample, 14,325,172 hospital admissions were analyzed. There were 61,493 patients with sepsis and on MV. Of these, 1630 (2.7%) patients were transferred during their hospitalization. A propensity-matched cohort of 1630 patients who did not undergo IHT was identified. Interventions None. Measurements and Main Results The exposure of interest was inter-hospital transfer to an acute care facility. The primary outcome was hospital mortality; the secondary outcome was hospital length of stay (LOS). The propensity score included age, gender, insurance coverage, do not resuscitate (DNR) status, use of renal replacement therapy, presence of shock and Elixhauser co-morbidities index. After propensity matching, IHT was not associated with a difference in in-hospital mortality (12.3% IHT vs 12.7% non-IHT, p=0.74). However, IHT was associated with a longer total hospital LOS (12.8 days IQR 7.7–21.6 for IHT vs 9.1 days IQR 5.1–17.0 for non-IHT, p<0.01). Conclusions Patients with sepsis requiring MV who underwent IHT did not have improved outcomes compared to a cohort with matched characteristics who were not transferred. The study raises questions about the risk-benefit profile of IHT as an intervention.
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    Prior Statin Use Is Associated with Decreased Mortality and Lower Levels of Liver and Brain Organ Failure Scores in Sepsis - A Matched Observational Study
    (Elsevier BV, 2019-10-14) Tam, Hok Hei; Monian, Brinda; Rincon, Teresa; Celi, Leo Anthony; Geisler, Benjamin
    Background: Statin use is associated with a decreased rate of severe sepsis. The objective of this paper is to quantify the level of organ dysfunction of patients with and without statin use prior to hospitalization. Methods: MIMIC-III was searched for adult sepsis patients. Immunosuppressed patients were excluded. Organ dysfunction was defined as alterations in Sequential Organ Failure Assessment (SOFA) score components or laboratory values. Other endpoints examined include 28-day, 90-day, and in-hospital mortality. All analyses were adjusted for Elixhauser comorbidity index components, age, gender, ethnicity, and year of admission and used doubly robust estimation. In a sensitivity analysis, the effect of statin potency on organ dysfunction was analyzed. Findings: 3,091 statin users and non-users were matched. In the matched cohort, mean age was 72 years, 54% of patients were female, and 31% had diabetes. The odds of mortality at day 28 (0.78), day 90 (0.75), and in the hospital (0.78) were significantly lower for those on statins (p=0.001; p<0.001; and p=0.003, respectively). Central nervous system (CNS, -14% change) and hepatic SOFA (-27% change) component scores were also significantly lower for statin users (p < 0.05). No significant difference was found for other measures of organ failure. Statin potency had statistically significant effects on day-28, day-90, and in-patient mortality, as well as coagulation, hepatic, and CNS components of the SOFA score. Interpretation: Statin use prior to sepsis was associated with dose-dependent lower short-term mortality that was clinically and statistically significant. This mortality benefit might be explained by neuro- and hepato-protective effects.
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    Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients
    (BioMed Central, 2012) Hunziker, Sabina; Celi, Leo Anthony; Lee, Joon; Howell, Michael D
    Introduction: Recently, red cell distribution width (RDW), a measure of erythrocyte size variability, has been shown to be a prognostic marker in critical illness. The aim of this study was to investigate whether adding RDW has the potential to improve the prognostic performance of the simplified acute physiology score (SAPS) to predict short- and long-term mortality in an independent, large, and unselected population of intensive care unit (ICU) patients. Methods: This observational cohort study includes 17,922 ICU patients with available RDW measurements from different types of ICUs. We modeled the association between RDW and mortality by using multivariable logistic regression, adjusting for demographic factors, comorbidities, hematocrit, and severity of illness by using the SAPS. Results: ICU-, in-hospital-, and 1-year mortality rates in the 17,922 included patients were 7.6% (95% CI, 7.2 to 8.0), 11.2% (95% CI, 10.8 to 11.7), and 25.4% (95% CI, 24.8 to 26.1). RDW was significantly associated with in-hospital mortality (OR per 1% increase in RDW (95%CI)) (1.14 (1.08 to 1.19), P < 0.0001), ICU mortality (1.10 (1.06 to 1.15), P < 0.0001), and 1-year mortality (1.20 (95% CI, 1.14 to 1.26); P < 0.001). Adding RDW to SAPS significantly improved the AUC from 0.746 to 0.774 (P < 0.001) for in-hospital mortality and 0.793 to 0.805 (P < 0.001) for ICU mortality. Significant improvements in classification of SAPS were confirmed in reclassification analyses. Subgroups demonstrated robust results for gender, age categories, SAPS categories, anemia, hematocrit categories, and renal failure. Conclusions: RDW is a promising independent short- and long-term prognostic marker in ICU patients and significantly improves risk stratification of SAPS. Further research is needed the better to understand the pathophysiology underlying these effects.