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Oscarsson Tibblin, Anna
Alternative names
Publications (10 of 19) Show all publications
de Geer, L., Oscarsson Tibblin, A., Fredrikson, M. & Walther, S. M. (2019). No association with cardiac death after sepsis: A nationwide observational cohort study. Acta Anaesthesiologica Scandinavica, 63(3), 344-351
Open this publication in new window or tab >>No association with cardiac death after sepsis: A nationwide observational cohort study
2019 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 63, no 3, p. 344-351Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cardiac dysfunction is a well-known complication of sepsis, but its long-term consequences and implications for patients remain unclear. The aim of this study was to investigate cardiac outcome in sepsis by assessing causes of death up to 2 years after treatment in an Intensive Care Unit (ICU) in a nationwide register-based cohort collected from the Swedish Intensive Care Registry.

METHODS: A cohort of 13 669 sepsis and septic shock ICU patients from 2008 to 2014 was collected together with a non-septic control group, matched regarding age, sex and severity of illness (n = 6582), and all without preceding severe cardiac disease. For a large proportion of the severe sepsis and septic shock patients (n = 7087), no matches were found. Information on causes of death up to 2 years after ICU admission was sought in the Swedish National Board of Health and Welfare's Cause of Death Registry.

RESULTS: Intensive Care Unit mortality was nearly identical in a matched comparison of sepsis patients to controls (24% in both groups) but higher in more severely ill sepsis patients for whom no matches were found (33% vs 24%, P < 0.001). There was no association of sepsis to cardiac deaths in the first month (OR 1.03, 95%CI 0.87 to 1.20, P = 0.76) nor up to 2 years after ICU admission (OR 1.01, 95%CI 0.82 to 1.25, P = 0.94) in an adjusted between-group comparison.

CONCLUSIONS: There was no association with an increased risk of death related to cardiac disease in patients with severe sepsis or septic shock when compared to other ICU patients with similar severity of illness.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-154455 (URN)10.1111/aas.13280 (DOI)000458335800009 ()30318583 (PubMedID)2-s2.0-85054923116 (Scopus ID)
Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-03-04Bibliographically approved
De Geer, L., Oscarsson, A., Fredrikson, M. & Walther, S. (2015). Cardiac mortality after septic shock.. In: : . Paper presented at SFAI-veckan 2015, 21 september, 2015 – 23 september, 2015 Stockholm Waterfront Congress Center, Stockholm.
Open this publication in new window or tab >>Cardiac mortality after septic shock.
2015 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-125582 (URN)
Conference
SFAI-veckan 2015, 21 september, 2015 – 23 september, 2015 Stockholm Waterfront Congress Center, Stockholm
Available from: 2016-02-26 Created: 2016-02-26 Last updated: 2016-03-10
De Geer, L., Oscarsson, A., Fredrikson, M. & Walther, S. M. (2015). Cardiac mortality after severe sepsis and septic shock: A nationwide observational cohort study.
Open this publication in new window or tab >>Cardiac mortality after severe sepsis and septic shock: A nationwide observational cohort study
2015 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: Cardiac dysfunction is a well-known complication of sepsis, but its long-term consequences remain unclear. The aim of this study was to investigate cardiac outcome after sepsis by assessing causes of death in a nationwide register-based cohort.

Methods: A cohort of 9,520 severe sepsis and septic shock intensive care (ICU) patients without preceding severe cardiac failure and discharged alive from the ICU was collected from the Swedish Intensive Care Registry (SIR) from 2008 to 2013, together with a nonseptic control group (n = 4,577). Patients were matched according to age, sex and severity of illness. Information on cause of death after ICU discharge was sought in the Swedish National Board of Health and Welfare’s Cause of Death Registry.

Results: After ICU discharge, 3,954 (42%) of severe sepsis or septic shock patients died. In 654 (16%) of these, cardiac failure was registered as the cause of death. The follow-up time was 17,693 person-years (median 583 days/person; maximum 5.7 years) and the median (IQR) time from ICU discharge to cardiac failure-related death 81 (17 - 379) days. With increasing severity of illness (quartiles of SAPS3), the hazard rate for cardiac failure-related death increased (hazard ratio (HR) 1.58 (95% CI 1.19 - 2.09, p <0.001) in the highest quartile compared to the lowest). In a matched comparison between severe sepsis or septic shock patients and controls, survival was similar, and the hazard rate for cardiac failurerelated death did not differ between groups (HR 0.97, 95% CI 0.88 – 1.10, p = 0.62).

Conclusions: The risk of death with cardiac failure as the cause of death after severe sepsis or septic shock increases with severity of illness on admission. Patients with severe sepsis or septic shock are not, however, at an increased risk of death with cardiac failure as the cause of death when compared to other ICU patients with similar severity of illness.

Keywords
Shock, septic; Heart failure; Intensive care; Outcome
National Category
Nursing Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-122757 (URN)
Available from: 2015-11-20 Created: 2015-11-20 Last updated: 2015-11-20Bibliographically approved
de Geer, L., Oscarsson, A. & Gustafsson, M. (2015). Lung ultrasound in quantifying lung water in septic shock patients. Paper presented at 35th International Symposium on Intensive Care and Emergency Medicine, 17-20 March 2015, Brussels, Belgium. Critical Care, 19(1), 140
Open this publication in new window or tab >>Lung ultrasound in quantifying lung water in septic shock patients
2015 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 19, no 1, p. 140-Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Quantification of lung ultrasound (LUS) artifacts (B-lines) is used to assess pulmonary congestion in emergency medicine and cardiology [1,2]. We investigated B-lines in relation to extravascular lung-water index (EVLWI) from invasive transpulmonary thermodilution in septic shock patients. Our aim was to evaluate the role of LUS in an intensive care setting.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-117727 (URN)10.1186/cc14220 (DOI)
Conference
35th International Symposium on Intensive Care and Emergency Medicine, 17-20 March 2015, Brussels, Belgium
Available from: 2015-05-07 Created: 2015-05-07 Last updated: 2017-12-04Bibliographically approved
Potgieter, D., Simmers, D., Ryan, L., Biccard, B. M., Lurati-Buse, G. A., Cardinale, D. M., . . . Rodseth, R. N. (2015). N-terminal pro-B-type Natriuretic Peptides Prognostic Utility Is Overestimated in Meta-analyses Using Study-specific Optimal Diagnostic Thresholds. Anesthesiology, 123(2), 264-271
Open this publication in new window or tab >>N-terminal pro-B-type Natriuretic Peptides Prognostic Utility Is Overestimated in Meta-analyses Using Study-specific Optimal Diagnostic Thresholds
Show others...
2015 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 123, no 2, p. 264-271Article in journal (Refereed) Published
Abstract [en]

Background:N-terminal fragment B-type natriuretic peptide (NT-proBNP) prognostic utility is commonly determined post hoc by identifying a single optimal discrimination threshold tailored to the individual study population. The authors aimed to determine how using these study-specific post hoc thresholds impacts meta-analysis results. Methods: The authors conducted a systematic review of studies reporting the ability of preoperative NT-proBNP measurements to predict the composite outcome of all-cause mortality and nonfatal myocardial infarction at 30 days after noncardiac surgery. Individual patient-level data NT-proBNP thresholds were determined using two different methodologies. First, a single combined NT-proBNP threshold was determined for the entire cohort of patients, and a meta-analysis conducted using this single threshold. Second, study-specific thresholds were determined for each individual study, with meta-analysis being conducted using these study-specific thresholds. Results: The authors obtained individual patient data from 14 studies (n = 2,196). Using a single NT-proBNP cohort threshold, the odds ratio (OR) associated with an increased NT-proBNP measurement was 3.43 (95% CI, 2.08 to 5.64). Using individual study-specific thresholds, the OR associated with an increased NT-proBNP measurement was 6.45 (95% CI, 3.98 to 10.46). In smaller studies (less than100 patients) a single cohort threshold was associated with an OR of 5.4 (95% CI, 2.27 to 12.84) as compared with an OR of 14.38 (95% CI, 6.08 to 34.01) for study-specific thresholds. Conclusions:Post hoc identification of study-specific prognostic biomarker thresholds artificially maximizes biomarker predictive power, resulting in an amplification or overestimation during meta-analysis of these results. This effect is accentuated in small studies.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS and WILKINS, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-122778 (URN)10.1097/ALN.0000000000000728 (DOI)000363537300006 ()26200179 (PubMedID)
Note

Funding Agencies|CLS Behring Biotherapies for Life (Vienna, Austria); Astra Zeneca (Vienna, Austria); Boehringer Ingelheim (Ingelheim, Germany); CLS Behring Biotherapies for Life; Novo Nordisk Pharma GmbH (Vienna, Austria)

Available from: 2015-11-23 Created: 2015-11-23 Last updated: 2017-12-01
Kareliusson, F., de Geer, L. & Oscarsson Tibblin, A. (2015). Risk prediction of ICU readmission in a mixed surgical and medical population. Journal of Intensive Care, 3(30)
Open this publication in new window or tab >>Risk prediction of ICU readmission in a mixed surgical and medical population
2015 (English)In: Journal of Intensive Care, ISSN 2052-0492, Vol. 3, no 30Article in journal (Refereed) Published
Abstract [en]

Background

Readmission to intensive care units (ICU) is accompanied with longer ICU stay as well as higher ICU, in-hospital and 30-day mortality. Different scoring systems have been used in order to predict and reduce readmission rates.

Methods

The purpose of this study was to evaluate the Stability and Workload Index for Transfer (SWIFT) score as a predictor of readmission. Further, we wanted to study steps and measures taken at the ward prior to readmission.

Results

This was a retrospective study conducted at the mixed surgical and medical ICU at Linköping University Hospital. One thousand sixty-seven patients >18 years were admitted to the ICU during 2 years and were included in the study. During the study period, 27 patients were readmitted to the ICU. Readmitted patients had a higher SWIFT score than the non-readmitted (16.1 ± 6.8 vs. 13.0 ± 7.5, p = 0.03) at discharge. The total ICU length of stay was longer (7.5 ± 7.5 vs. 2.9 ± 5.1, p = 0.004), and the 30-day mortality was higher (26 vs. 7 %, p < 0.001) for readmitted patients. Fifty-six percent of readmitted patients were assessed by the critical care outreach service (CCOS) at the ward prior to ICU readmission. A SWIFT score of 15 or more was associated with a significantly higher readmission rate (p = 0.03) as well as 30-day mortality (p < 0.001) compared to a score of ≤14.

Conclusions

A SWIFT score of 15 or more is associated with higher readmission rate and 30-day mortality. The SWIFT score could therefore be used for risk prediction for readmission and mortality at ICU discharge.

Place, publisher, year, edition, pages
BioMed Central, 2015
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-121541 (URN)10.1186/s40560-015-0096-1 (DOI)26157581 (PubMedID)
Available from: 2015-09-23 Created: 2015-09-23 Last updated: 2016-04-25Bibliographically approved
de Geer, L., Engvall, J. & Oscarsson Tibblin, A. (2015). Strain echocardiography in septic shock - a comparison with systolic and diastolic function parameters, cardiac biomarkers and outcome. Critical Care, 19(1), Article ID 122.
Open this publication in new window or tab >>Strain echocardiography in septic shock - a comparison with systolic and diastolic function parameters, cardiac biomarkers and outcome
2015 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 19, no 1, article id 122Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Myocardial dysfunction is a well-known complication in septic shock but its characteristics and frequency remains elusive. Here, we evaluate global longitudinal peak strain (GLPS) of the left ventricle as a diagnostic and prognostic tool in septic shock.

METHODS: Fifty adult patients with septic shock admitted to a general intensive care unit were included. Transthoracic echocardiography was performed on the first day, and repeated during and after ICU stay. Laboratory and clinical data and data on outcome were collected daily from admission and up to 7 days, shorter in cases of death or ICU discharge. The correlation of GLPS to left ventricular systolic and diastolic function parameters, cardiac biomarkers and clinical data were compared using Spearman's correlation test and linear regression analysis, and the ability of GLPS to predict outcome was evaluated using a logistic regression model.

RESULTS: On the day of admission, there was a strong correlation and co-linearity of GLPS to left ventricular ejection fraction (LVEF), mitral annular motion velocity (é) and to amino-terminal pro-brain natriuretic peptide (NT-proBNP) (Spearman's ρ -0.70, -0.53 and 0.54, and R(2) 0.49, 0.20 and 0.24, respectively). In LVEF and NT-proBNP there was a significant improvement during the study period (analysis of variance (ANOVA) with repeated measures, p = 0.05 and p < 0.001, respectively), but not in GLPS, which remained unchanged over time (p = 0.10). GLPS did not correlate to the improvement in clinical characteristics over time, did not differ significantly between survivors and non-survivors (-17.4 (-20.5-(-13.7)) vs. -14.7 (-19.0 - (-10.6)), p = 0.11), and could not predict mortality.

CONCLUSIONS: GLPS is frequently reduced in septic shock patients, alone or in combination with reduced LVEF and/or é. It correlates with LVEF, é and NT-proBNP, and remains affected over time. GLPS may provide further understanding on the character of myocardial dysfunction in septic shock.

Place, publisher, year, edition, pages
BioMed Central, 2015
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-115750 (URN)10.1186/s13054-015-0857-1 (DOI)000352053300001 ()25777932 (PubMedID)
Available from: 2015-03-18 Created: 2015-03-18 Last updated: 2017-12-04
de Geer, L., Oscarsson, A. & Engvall, J. (2015). Variability in echocardiographic measurements of left ventricular function in septic shock patients. Cardiovascular Ultrasound, 13(1), 19
Open this publication in new window or tab >>Variability in echocardiographic measurements of left ventricular function in septic shock patients
2015 (English)In: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 13, no 1, p. 19-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Echocardiography is increasingly used for haemodynamic evaluation and titration of therapy in intensive care, warranting reliable and reproducible measurements. The aim of this study was to evaluate the observer dependence of echocardiographic findings of left ventricular (LV) diastolic and systolic dysfunction in patients with septic shock.

METHODS: Echocardiograms performed in 47 adult patients admitted with septic shock to a general intensive care unit (ICU) were independently evaluated by one cardiologist and one intensivist for the following signs: decreased diastolic tissue velocity of the base of the LV septum (e), increased early mitral inflow (E) to e ratio (E/e), decreased LV ejection fraction (EF) and decreased LV global longitudinal peak strain (GLPS). Diastolic dysfunction was defined as e <8.0cm/s and/or E/e [greater than or equal to]15 and systolic dysfunction as EF <50% and/or GLPS>15%. Ten randomly selected examinations were re-analysed two months later. Pearson’s r was used to test the correlation and Bland-Altman plots to assess the agreement between observers. Kappa statistics were used to test the consistency between readers and intraclass correlation coefficients (ICC) for inter- and intraobserver variability.

RESULTS: In 44 patients (94%), image quality was sufficient for echocardiographic measurements. The agreement between observers was moderate (k=0.60 for e, k=0.50 for E/e and k=0.60 for EF) to good (k=0.71 for GLPS). Pearson’s r was 0.76 for e, 0.85 for E/e, 0.78 for EF and 0.84 for GLPS (p<0.001 for all four). The ICC between observers for e was very good (0.85; 95% confidence interval (CI) 0.73-0.92), good for E/e (0.70; 95% CI 0.45 - 0.84), very good for EF (0.87; 95% CI 0.77 - 0.93), excellent for GLPS (0.91; 95% CI 0.74 - 0.95), and very good for all measures repeated by one of the observers. On Bland-Altman analysis, the mean differences and 95% limits of agreement for e, E/e, EF and GLPS were 0.01 (0.04 - 0.07), 2.0 (14.2 - 18.1), 0.86 (16 - 14.3) and 0.04 (5.04 - 5.12), respectively.

CONCLUSIONS: Moderate observer-related differences in assessing LV dysfunction were seen. GLPS is the least user dependent and most reproducible echocardiographic measurement of LV function in septic shock.

Place, publisher, year, edition, pages
BioMed Central, 2015
National Category
Nursing Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-117725 (URN)10.1186/s12947-015-0015-6 (DOI)000352845000001 ()25880324 (PubMedID)
Available from: 2015-05-07 Created: 2015-05-07 Last updated: 2017-12-04Bibliographically approved
De Geer, L., Fredrikson, M. & Oscarsson Tibblin, A. (2012). Amino-terminal pro-brain natriuretic peptide as a predictor of outcome in patients admitted to intensive care. A prospective observational study. European Journal of Anaesthesiology, 29(6), 275-279
Open this publication in new window or tab >>Amino-terminal pro-brain natriuretic peptide as a predictor of outcome in patients admitted to intensive care. A prospective observational study
2012 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 29, no 6, p. 275-279Article in journal (Refereed) Published
Abstract [en]

Context: Amino-terminal pro-brain-type natriuretic peptide is known to predict outcome in patients with heart failure, but its role in an intensive care setting is not yet fully established. Objective: To assess the incidence of elevated amino-terminal pro-brain natriuretic peptide (NT-pro-BNP) on admission to intensive care and its relation to death in the ICU and within 30 days. Design: Prospective, observational cohort study. Setting: A mixed noncardiothoracic tertiary ICU in Sweden. Patients and main outcome measures NT-pro-BNP was collected from 481 consecutive patients on admission to intensive care, in addition to data on patient characteristics and outcome. A receiver-operating characteristic curve was used to identify a discriminatory level of significance, a stepwise logistic regression analysis to correct for other clinical factors and a Kaplan-Meier analysis to assess survival. The correlation between Simplified Acute Physiology Score (SAPS) 3, Sequential Organ Failure Assessment score (SOFA) and NT-pro-BNP was analysed using Spearmans correlation test. Quartiles of NT-pro-BNP elevation were compared for baseline data and outcome using a logistic regression model. Results: An NT-pro-BNP more than 1380 ng l(-1) on admission was an independent predictor of death in the ICU and within 30 days [odds ratio (OR) 2.6; 95% confidence interval (CI), 1.5 to 4.4] and was present in 44% of patients. Thirty-three percent of patients with NT-pro-BNP more than 1380 ng l(-1), and 14.6% of patients below that threshold died within 30 days (log rank P 0.005). NT-pro-BNP correlated moderately with SAPS 3 and with SOFA on admission (Spearmans rho 0.5552 and 0.5129, respectively). In quartiles of NT-pro-BNP elevation on admission, severity of illness and mortality increased significantly (30-day mortality 36.1%; OR 3.9; 95% CI, 2.0 to 7.3 in the quartile with the highest values, vs. 12.8% in the lowest quartile). Conclusion: We conclude that NT-pro-BNP is commonly elevated on admission to intensive care, that it increases with severity of illness and that it is an independent predictor of mortality.

Place, publisher, year, edition, pages
Lippincott, Williams and Wilkins / Wiley-Blackwell, 2012
Keywords
brain natriuretic peptide, intensive care, survival rate
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-78569 (URN)10.1097/EJA.0b013e32835470a8 (DOI)000304436100005 ()
Available from: 2012-06-15 Created: 2012-06-15 Last updated: 2017-12-07Bibliographically approved
Reini, K., Fredrikson, M. & Oscarsson Tibblin, A. (2012). The prognostic value of the Modified Early Warning Score in critically ill patients: a prospective, observational study. European Journal of Anaesthesiology, 29(3), 152-157
Open this publication in new window or tab >>The prognostic value of the Modified Early Warning Score in critically ill patients: a prospective, observational study
2012 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 29, no 3, p. 152-157Article in journal (Refereed) Published
Abstract [en]

Context The Modified Early Warning Score is a validated assessment tool for detecting risk of deterioration in patients at risk on medical and surgical wards. less thanbrgreater than less thanbrgreater thanObjective To assess the prognostic ability of the Modified Early Warning Score in predicting outcome after critical care. less thanbrgreater than less thanbrgreater thanDesign A prospective observational study. less thanbrgreater than less thanbrgreater thanSetting A tertiary care general ICU. less thanbrgreater than less thanbrgreater thanPatients Five hundred and eighteen patients aged at least 16 years admitted to the ICU at Linkoping University Hospital were included. less thanbrgreater than less thanbrgreater thanIntervention The Modified Early Warning Score was documented on arrival at the ICU and every hour for as long as the patient was breathing spontaneously, until discharge from the ICU. less thanbrgreater than less thanbrgreater thanMain outcome measures The primary endpoint was mortality in the ICU. Secondary endpoints were 30-day mortality, length of stay and readmission to the ICU. less thanbrgreater than less thanbrgreater thanResults Patients with a Modified Early Warning Score of at least six had significantly higher mortality in the ICU than those with a Modified Early Warning Score andlt;6 (24 vs. 3.4%, Pandlt; 0.001). A Modified Early Warning Score of at least six was an independent predictor of mortality in the ICU [odds ratio (OR) 5.5, 95% confidence interval (CI) 2.4-20.6]. The prognostic ability of the Modified Early Warning Score on admission to the ICU [area under the curve (AUC) 0.80, 95% CI 0.72-0.88] approached those of the Simplified Acute Physiology Score III (AUC 0.89, 95% CI 0.83-0.94) and the Sequential Organ Failure Assessment score on admission (AUC 0.91, 95% CI 0.86-0.97). A Modified Early Warning Score of at least six on admission was also an independent predictor of 30-day mortality (OR 4.3, 95% CI 2.3-8.1) and length of stay in the ICU (OR 2.3, 95% CI 1.4-3.8). In contrast, the Modified Early Warning Score on discharge from the ICU did not predict the need for readmission. less thanbrgreater than less thanbrgreater thanConclusion This study shows that the Modified Early Warning Score is a useful predictor of mortality in the ICU, 30-day mortality and length of stay in the ICU.

Place, publisher, year, edition, pages
Lippincott, Williams and Wilkins / Wiley-Blackwell, 2012
Keywords
clinical assessment, death, intensive care, mortality, risk management
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-75717 (URN)10.1097/EJA.0b013e32835032d8 (DOI)000300412000007 ()
Available from: 2012-03-09 Created: 2012-03-09 Last updated: 2017-12-07
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