Background/Aim: Norepinephrine, first line adrenergic agent used in critically ill patients with septic shock status, may additionally exacerbate catecholamine toxicity and in certain circumstances may contribute to poorer clinical outcomes that mostly related to sinus tachycardia or tachyarrythmia. Methods: A retrospective study was conducted between Jan 2018 to May 2021. New Onset Prolonged Sinus Tachycardia (NOPST) incidence was recorded if the HR increased by at least 20% from baseline and exceeded 100 bpm and it was correlated with the corresponding Norepinephrine infusion rate. The correlation between NOPST incidence and its corresponding NE infusion rate was statistically investigated by Spearman Correlation Test. The studied critically ill patients divided to either Non-Septic Shock Cohort (Group I) or Septic Shock Cohort (Group II). In addition to One Sample and Independent-T Tests, Chi Square Test was used for the non-parametric data. The ROC analysis was used to investigate the AUROC and the operational Cutoff Norepinephrine rate was picked by investigating the highest youden’s index. Results: The overall NOPST incidence for our 1638 eligible studied critically ill patients was assessed at 65.6% during an average of 14.08±4.06 days and 21.00±5.61 days of the ICU and overall hospital admission days, respectively, in which only ICU stay days was significantly lower in Non-Septic Shock Cohort compared to the Septic Shock Cohort [13.85±3.39 days vs 14.40±4.82 days]. The operating cut-off NE infusion rate to elicit NOPST was investigated at 11.3 mcg per min with sensitivity and specificity of 55.70%, 90.80%, respectively. Conclusion: Septic critically patients on Norepinephrine infusion have significantly higher risk of New Onset Prolonged Sinus Tachycardia (NOSPT) and significantly higher ICU admission days, especially if this infusion rate exceeding 11.5 mcg/min.

Background/Aim: Prolonged pre-intensive care unit (ICU) hospital stay length days was previously shown to be independently associated with poorer outcome. In this study we investigated the impacts of the pre-ICU admission days on major clinical outcomes. Methods: Surgical and medical, to the Medical-Surgical ICU (MSICU) between Jan 2018 and May 2021, were retrospectively reviewed via the Electronic Medical System (Hakeem). All eligible studied critically ill patients were grouped by their hospital length of stay (HLOS) prior to ICU admission: HLOS <6 days (Group I) or HLOS ≥6 days (Group II). Also, the overall 28-day ICU mortality were further subcategorized into early mortality (≤14 days) and late mortality (>14 days). The Comparative variables across the two studied groups were analyzed by One Sample and Independent T-Tests or Chi Square Test to represent the analysis results as Mean±SD and Mean Difference±SEM or Number (Percentage and odd ratio (OD), respectively. The area under the ROC curves (AUROCs) of the pre-ICU HLOS were expressed as AUC (95% CI; Range). The optimal Cutoff operating point on each ROC curve was picked by investigating the highest youden’s index. Results: The mean age of the whole study cohort was 51.88±16.22 years, and the Pre-ICU LOS<6 days Cohort were significantly older than the Pre-ICU LOS≥6 days Cohort (52.87±15.48 years versus 51.14±16.72 years, respectively, p-value = 0.033). Insignificantly, males were distributed in the study in approximately 2.55: 1 ratio compared to female (1177 (71.9%) versus 461 (28.1%), respectively, An overall 28-day ICU mortality was detected in 1318 of all eligible studied critically ill patients with an overall incidence of 80.46% during an average of 14.08±4.06 days and   21.00±5.61 days of the ICU and overall hospital admission days, respectively. Our tested prognosticators had significantly AUROC with Area±SEM (95% CI; Range) of 0.694±0.015, (95% CI; 0.664-0.723) and 0.587±0.016 (95% CI; 0.556-0.619), respectively. Conclusion: ICU admission from a general care floor, medically ICU admitted patients and surgically admitted ICU patients, after ≥6 days is associated with poorer clinical outcome as compared to earlier pre-ICU admission days.