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Your search keyword '"Harada, Megan Y."' showing total 27 results
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27 results on '"Harada, Megan Y."'

2. Predictors of Mortality in the Critically Ill Cirrhotic Patient: Is the Model for End-Stage Liver Disease Enough?

Author

Annamalai, Alagappan, Harada, Megan Y, Chen, Melissa, Tran, Tram, Ko, Ara, Ley, Eric J, Nuno, Miriam, Klein, Andrew, Nissen, Nicholas, and Noureddin, Mazen

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Kidney Disease, Clinical Research, Liver Disease, Chronic Liver Disease and Cirrhosis, Transplantation, Digestive Diseases, Patient Safety, 4.2 Evaluation of markers and technologies, Detection, screening and diagnosis, Good Health and Well Being, Aged, Critical Care, Critical Illness, End Stage Liver Disease, Female, Hospitalization, Humans, Liver Cirrhosis, Liver Function Tests, Male, Middle Aged, Predictive Value of Tests, Retrospective Studies, Risk Factors, Severity of Illness Index, Surgery, Clinical sciences
Abstract

BackgroundCritically ill cirrhotics require liver transplantation urgently, but are at high risk for perioperative mortality. The Model for End-stage Liver Disease (MELD) score, recently updated to incorporate serum sodium, estimates survival probability in patients with cirrhosis, but needs additional evaluation in the critically ill. The purpose of this study was to evaluate the predictive power of ICU admission MELD scores and identify clinical risk factors associated with increased mortality.Study designThis was a retrospective review of cirrhotic patients admitted to the ICU between January 2011 and December 2014. Patients who were discharged or underwent transplantation (survivors) were compared with those who died (nonsurvivors). Demographic characteristics, admission MELD scores, and clinical risk factors were recorded. Multivariate regression was used to identify independent predictors of mortality, and measures of model performance were assessed to determine predictive accuracy.ResultsOf 276 patients who met inclusion criteria, 153 were considered survivors and 123 were nonsurvivors. Survivor and nonsurvivor cohorts had similar demographic characteristics. Nonsurvivors had increased MELD, gastrointestinal bleeding, infection, mechanical ventilation, encephalopathy, vasopressors, dialysis, renal replacement therapy, requirement of blood products, and ICU length of stay. The MELD demonstrated low predictive power (c-statistic 0.73). Multivariate analysis identified MELD score (adjusted odds ratio [AOR] = 1.05), mechanical ventilation (AOR = 4.55), vasopressors (AOR = 3.87), and continuous renal replacement therapy (AOR = 2.43) as independent predictors of mortality, with stronger predictive accuracy (c-statistic 0.87).ConclusionsThe MELD demonstrated relatively poor predictive accuracy in critically ill patients with cirrhosis and might not be the best indicator for prognosis in the ICU population. Prognostic accuracy is significantly improved when variables indicating organ support (mechanical ventilation, vasopressors, and continuous renal replacement therapy) are included in the model.

Published
2017

9. The Effect of Early Positive Cultures on Mortality in Ventilated Trauma Patients

Author

Barmparas, Galinos, Harada, Megan Y., Ko, Ara, Dhillon, Navpreet K., Smith, Eric J. T., Li, Tong, Mohseni, Shahin, Ley, Eric J., Barmparas, Galinos, Harada, Megan Y., Ko, Ara, Dhillon, Navpreet K., Smith, Eric J. T., Li, Tong, Mohseni, Shahin, and Ley, Eric J.

Abstract

Background: The purpose was to examine the incidence of positive cultures in a highly susceptible subset of trauma patients admitted to the surgical intensive care unit (SICU) for mechanical ventilation and to examine the impact of their timing on outcomes. Patients and Methods: A retrospective review was conducted of blunt trauma patients admitted to the SICU for mechanical ventilation at a level I trauma center over a five-year period. All urine, blood, and sputum cultures were abstracted. Patients with at least one positive culture were compared with those with negative or no cultures. The primary outcome was mortality. A Cox regression model with a time-dependent variable was utilized to calculate the adjusted hazard ratio (AHR). Results: The median age of 635 patients meeting inclusion criteria was 46 and 74.2% were male. A total of 298 patients (46.9%) had at least one positive culture, with 28.9% occurring within two days of admission. Patients with positive cultures were more likely to be severely injured with an injury severity score (ISS) 16 (68.5% vs. 45.1%, p<0.001). Overall mortality was 22%. Patients who had their first positive culture within two and three days from admission had a significantly higher AHR for mortality (AHR: 14.46, p<0.001 and AHR: 10.59, p=0.028, respectively) compared to patients with a positive culture at day six or later. Conclusions: Early positive cultures are common among trauma patients requiring mechanical ventilation and are associated with higher mortality. Early identification with damage control cultures obtained on admission to aid with early targeted treatment might be justified.

Published
2018
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18. Pain Assessment and Control in the Injured Elderly

Author

Ko, Ara, primary, Harada, Megan Y., additional, Smith, Eric J.T., additional, Scheipe, Michael, additional, Alban, Rodrigo F., additional, Melo, Nicolas, additional, Margulies, Daniel R., additional, and Ley, Eric J., additional

Published
2016
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