Publications by authors named "Stephanie Judge"

2 Publications

  • Page 1 of 1

Association Between Urine Output and Mortality in Critically Ill Patients: A Machine Learning Approach.

Crit Care Med 2021 Sep 22. Epub 2021 Sep 22.

School of Medicine, Griffith University, Southport, QLD, Australia. Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia. Centre for Transformative Innovation, Faculty of Business and Law, Swinburne University of Technology, Hawthorn, VIC, Australia. Department of Data Science and AI, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Melbourne, VIC, Australia. Department of Cardiology, Alfred Hospital, Melbourne, VIC, Australia. Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia. Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.

Objectives: Current definitions of acute kidney injury use a urine output threshold of less than 0.5 mL/kg/hr, which have not been validated in the modern era. We aimed to determine the prognostic importance of urine output within the first 24 hours of admission to the ICU and to evaluate for variance between different admission diagnoses.

Design: Retrospective cohort study.

Setting: One-hundred eighty-three ICUs throughout Australia and New Zealand from 2006 to 2016.

Patients: Patients greater than or equal to 16 years old who were admitted with curative intent who did not regularly receive dialysis. ICU readmissions during the same hospital admission and patients transferred from an external ICU were excluded.

Measurements And Main Results: One hundred and sixty-one thousand nine hundred forty patients were included with a mean urine output of 1.05 mL/kg/hr and an overall in-hospital mortality of 7.8%. A urine output less than 0.47 mL/kg/hr was associated with increased unadjusted in-hospital mortality, which varied with admission diagnosis. A machine learning model (extreme gradient boosting) was trained to predict in-hospital mortality and examine interactions between urine output and survival. Low urine output was most strongly associated with mortality in postoperative cardiovascular patients, nonoperative gastrointestinal admissions, nonoperative renal/genitourinary admissions, and patients with sepsis.

Conclusions: Consistent with current definitions of acute kidney injury, a urine output threshold of less than 0.5 mL/kg/hr is modestly predictive of mortality in patients admitted to the ICU. The relative importance of urine output for predicting survival varies with admission diagnosis.
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September 2021

Optimism and Pain Interference in Aging Women.

Ann Behav Med 2020 02;54(3):202-212

Department of Psychology, University of Kentucky, Lexington, KY, USA.

Background: Pain interferes with people's daily lives and often limits the extent to which they can pursue goals and engage in activities that promote well-being. However, people vary in how much interference they experience at a given level of pain.

Purpose: The present study tested how optimism affects and is affected by pain interference and goal-directed activity among older women.

Methods: Every 3 months for 2 years, community-dwelling middle- and older-age women (N = 199) completed online daily diaries at home for a 7 day period, in which they reported their daily pain, pain interference, and goal-directed activity. Optimism was measured at the start and end of the study. Multilevel models tested the between- and within-person relationships among pain, optimism, and pain interference or goal-directed activity. Linear regression predicted change in optimism over 2 years from pain interference and goal-directed activity.

Results: Pain best predicted pain interference and optimism best predicted goal-directed activity. There were subtle interactions between optimism and pain-predicting interference and goal-directed activity. Accumulated goal-directed activity and pain interference across the study predicted longitudinal changes in optimism, with higher activity and lower pain interference predicting increased optimism over 2 years.

Conclusions: Optimism may play a protective role in disruptions caused by pain on a day-to-day basis, leading to increased goal-directed activity and possibly decreased pain interference. In turn, less interference and more goal-directed activity feed forward into increased optimism, resulting in a virtuous cycle that enhances optimism and well-being among older women.
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February 2020