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Objective: This study investigated the risk factors of ketamine associated‐lower urinary tract symptoms (LUTS), such as duration of use, dosage of ketamine, co‐occurring substance use of other psychoactive drugs, comorbidities, and depression. Methods: This study was a cross‐sectional survey. LUTS was assessed with the O'Leary symptom and problem index (OSPI) scores. We included the comorbidities of interstitial cystitis/painful bladder syndrome (IC/PBS) as comorbid factors. Depression was evaluated based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5). Duration of use, dosage of ketamine and the OSPI scores were subjected to log transformation because of the skewed distribution. Result: Among 143 participating ketamine users, 25 (17.5%) had LUTS. Duration of ketamine use was significantly positively correlated with OSPI scores (adjusted β [95% CI], 0.21 [0.06–0.35] in log‐log model), which equaled a 10% increase in months of ketamine‐use increased OSPI scores by 2.02 %. Female and depression were significantly associated OSPI scores (adjusted β [95% CI], 0.20 [0.03–0.37], 0.49 [0.29–0.70], respectively in the log‐linear model), with OSPI scores being 1.22 times higher in female, and 1.63 times higher in ketamine users with depression. Dosage of use was not significantly associated with OSPI scores (adjusted β [95% CI], 0.04 [−0.12 to 0.20], P = 0.64 in log‐log model), likewise with comorbid diseases (adjusted β [95% CI], 0.07 [−0.08 to 0.21], P = 0.36 in log‐linear model). Conclusion: Depression and longer duration of exposure to ketamine are significantly associated with the development of LUTS among ketamine users. Early evaluation and intervention of depression should be considered in patients of ketamine‐associated LUTS. [ABSTRACT FROM AUTHOR]

Background: Fluid balance is a fundamental management of patients with sepsis, and this study aimed to investigate the impact of cumulative fluid balance on critically ill patients with influenza admitted to an intensive care unit (ICU). Methods: This multicenter retrospective cohort study was conducted by the Taiwan Severe Influenza Research Consortium (TSIRC) which includes eight medical centers. Patients with virology-proven influenza infection admitted to ICUs between October 2015 and March 2016 were included for analysis. Results: A total of 296 patients were enrolled (mean age: 61.4±15.6 years; 62.8% men), and 92.2% (273/296) of them required mechanical ventilation. In the survivors, the daily fluid balance was positive from day 1 to day 3, and then gradually became negative from day 4 to day 7, whereas daily fluid balance was continuously positive in the non-survivors. Using the cumulative fluid balance from day 1–4 as a cut-off point, we found that a negative cumulative day 1–4 fluid balance was associated with a lower 30-day mortality rate (log-rank test, P = 0.003). To evaluate the impact of shock on this association, we divided the patients into shock and non-shock groups. The positive correlation between negative day 1–4 fluid balance and mortality was significant in the non-shock group (log-rank test, P = 0.008), but not in the shock group (log-rank test, P = 0.396). In a multivariate Cox proportional hazard regression model adjusted for age, sex, cerebrovascular disease, and PaO2/FiO2, day 1–4 fluid balance was independently associated with a higher 30-day mortality rate (aHR 1.088, 95% CI: 1.007–1.174). Conclusions: A negative day 1–4 cumulative fluid balance was associated with a lower mortality rate in critically ill patients with influenza. Our findings indicate the critical role of conservative fluid strategy in the management of patients with complicated influenza. [ABSTRACT FROM AUTHOR]

Background: Influenza virus infection leads to acute pulmonary injury and acute respiratory distress syndrome (ARDS). The Radiographic Assessment of Lung Edema (RALE) score has been proposed as a reliable tool for the evaluation of the opacity of chest X-rays (CXRs). This study aimed to examine the RALE scores and outcomes in patients with influenza-associated ARDS. Methods: Patients who were newly diagnosed with influenza-associated ARDS from December 2015 to March 2016 were enrolled. Two independent reviewers scored the CXRs obtained on the day of ICU admission and on days 2 and 7 after intensive care unit (ICU) admission. Results: During the study, 47 patients had influenza-associated ARDS. Five died within 7 days of ICU admission. Of the remaining 42, non-survivors (N = 12) had higher Sequential Organ Failure Assessment scores (SOFA) at ICU admission and higher day 7 RALE scores than survivors (N = 30). The day 7 RALE score independently related to late in-hospital mortality (aOR = 1.121, 95% CI: 1.014–1.240, p = 0.025). Conclusions: The RALE score for the evaluation of opacity on CXRs is a highly reproducible tool. Moreover, RALE score on day 7 was an independent predictor of late in-hospital mortality in patients with influenza-associated ARDS. [ABSTRACT FROM AUTHOR]