scholarly journals Fr402 MELD-NA SCORE VERSUS SOFA SCORE AND APACHE II SCORE AS EARLY PREDICTORS OF MORTALITY IN COVID-19 PATIENTS WITH LIVER INVOLVEMENT

2021 ◽  
Vol 160 (6) ◽  
pp. S-312-S-313
Author(s):  
Sandra R. Gomez ◽  
Eric Lam ◽  
Luis Gonzalez Mosquera ◽  
Joshua Fogel ◽  
Paul Mustacchia
Keyword(s):  
Sofa Score ◽  
Apache Ii ◽  
Liver Involvement ◽  
Apache Ii Score ◽  
Predictors Of Mortality ◽  
Early Predictors

scholarly journals Serum Soluble Triggering Receptor Expressed on Myeloid Cells-1 and Procalcitonin Can Reflect Sepsis Severity and Predict Prognosis: A Prospective Cohort Study

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Zhenyu Li ◽  
Hongxia Wang ◽  
Jian Liu ◽  
Bing Chen ◽  
Guangping Li
Keyword(s):  
Sofa Score ◽  
Prognostic Significance ◽  
Elevated Serum ◽  
Myeloid Cells ◽  
Serum Levels ◽  
Clinical Severity ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Survival Group ◽  
Severity Scores

Objective. To investigate the prognostic significance of serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), procalcitonin (PCT), N-terminal probrain natriuretic peptide (NT-pro-BNP), C-reactive protein (CRP), cytokines, and clinical severity scores in patients with sepsis.Methods. A total of 102 patients with sepsis were divided into survival group (n=60) and nonsurvival group (n=42) based on 28-day mortality. Serum levels of biomarkers and cytokines were measured on days 1, 3, and 5 after admission to an ICU, meanwhile the acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores were calculated.Results. Serum sTREM-1, PCT, and IL-6 levels of patients in the nonsurvival group were significantly higher than those in the survival group on day 1 (P<0.01). The area under a ROC curve for the prediction of 28 day mortality was 0.792 for PCT, 0.856 for sTREM-1, 0.953 for SOFA score, and 0.923 for APACHE II score. Multivariate logistic analysis showed that serum baseline sTREM-1 PCT levels and SOFA score were the independent predictors of 28-day mortality. Serum PCT, sTREM-1, and IL-6 levels showed a decrease trend over time in the survival group (P<0.05). Serum NT-pro-BNP levels showed the predictive utility from days 3 and 5 (P<0.05).Conclusion. In summary, elevated serum sTREM-1 and PCT levels provide superior prognostic accuracy to other biomarkers. Combination of serum sTREM-1 and PCT levels and SOFA score can offer the best powerful prognostic utility for sepsis mortality.

scholarly journals Risk factors for mortality in critically ill patients with COVID-19: a multicenter retrospective case-control study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jinghua Gao ◽  
Li Zhong ◽  
Ming Wu ◽  
Jingjing Ji ◽  
Zheying Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Organ Failure ◽  
Critically Ill ◽  
Sofa Score ◽  
Lymphocyte Count ◽  
Cox Regression ◽  
Survival Curve ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Hospital Death

Abstract Background Coronavirus disease 2019 (COVID-19) has spread around the world, until now, the number of positive and death cases is still increasing. Therefore, it remains important to identify risk factors for death in critically patients. Methods We collected demographic and clinical data on all severe inpatients with COVID-19. We used univariable and multivariable Cox regression methods to determine the independent risk factors related to likelihood of 28-day and 60-day survival, performing survival curve analysis. Results Of 325 patients enrolled in the study, Multi-factor Cox analysis showed increasing odds of in-hospital death associated with basic illness (hazard ratio [HR] 6.455, 95% Confidence Interval [CI] 1.658–25.139, P = 0.007), lymphopenia (HR 0.373, 95% CI 0.148–0.944, P = 0.037), higher Sequential Organ Failure Assessment (SOFA) score on admission (HR 1.171, 95% CI 1.013–1.354, P = 0.033) and being critically ill (HR 0.191, 95% CI 0.053–0.687, P = 0.011). Increasing 28-day and 60-day mortality, declining survival time and more serious inflammation and organ failure were associated with lymphocyte count < 0.8 × 109/L, SOFA score > 3, Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 7, PaO2/FiO2 < 200 mmHg, IL-6 > 120 pg/ml, and CRP > 52 mg/L. Conclusions Being critically ill and lymphocyte count, SOFA score, APACHE II score, PaO2/FiO2, IL-6, and CRP on admission were associated with poor prognosis in COVID-19 patients.

scholarly journals The Characteristics of Mortality Predictor Scoring for Sepsis Patients in Haji Adam Malik Hospital

2021 ◽  
Vol 8 (10) ◽  
pp. 339-344
Author(s):  
Abdul Halim Harahap ◽  
Franciscus Ginting ◽  
Lenni Evalena Sihotang
Keyword(s):  
Sofa Score ◽  
Scoring System ◽  
Scoring Systems ◽  
Developed Countries ◽  
Apache Ii ◽  
Apache Ii Score ◽  
P Value ◽  
Cross Sectional ◽  
Cross Sectional Design ◽  
Score Apache

Introduction: Sepsis is a leading cause of death in the Intensive Care Unit (ICU) in developed countries and its incidence is increasing. Many scoring systems are used to assess the severity of disease in patients admitted to the ICU. SOFA score to assess the degree of organ dysfunction in septic patients. The Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system is most often used for patients admitted to the ICU. CCI scoring system to assess the effect of comorbid disease in critically ill patients on mortality. The study aimed to describe the characteristics of the use of scoring to predict patients’ mortality admitted to Haji Adam Malik Hospital. Methods: This is an observational study with a cross-sectional design. A total of 299 study subjects met the inclusion criteria and exclusion criteria, three types of scoring, namely SOFA score, APACHE II score, and CCI score were used to assess the prognosis of septic patients. Data analysis was performed using SPSS. P-value <0.05 was considered statistically significant. Results: A total of 252 people (84.3%) of sepsis patients died. The mean age of the septic patients who died was 54.25 years. The SOFA score ranged from 0-24, the median SOFA score in deceased sepsis patients was 5.0. The APACHE II score ranged from 0-71, the median APACHE II score in deceased sepsis patients was 23.0. The CCI score ranged from 0-37, the median CCI score in deceased sepsis patients was 5.0. Conclusion: Higher scores are associated with an increased probability of death in septic patients. Keywords: Sepsis; mortality predictor; SOFA score; APACHE II score, CCI score.

scholarly journals Clinical Characteristics of Carbapenem-Resistant Klebsiella Pneumoniaee Infections In A Tertiary Hospital In China

2021 ◽  
Author(s):  
Zhiwen Cui ◽  
Lirui Wang ◽  
Wei Chang ◽  
Minghui Li ◽  
Yuexia Li ◽  
...  
Keyword(s):  
Survival Time ◽  
Sofa Score ◽  
Clinical Characteristics ◽  
Bloodstream Infections ◽  
Polymyxin B ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Drainage Fluid ◽  
Carbapenem Resistant ◽  
Antimicrobial Regimen

Abstract Background：The infections due to carbapenem-resistant Klebsiella pneumoniae (CR-KP) have become an important problem. The aim of the study is to evaluate the clinical characteristics of CR-KP.Methods: A retrospective cohort study has been made on all patients presenting with CR-KP infections. 615 patients with CR-KP humor infections diagnosed were identified. 135 patients who did not meet the requirements were excluded. Clinical characteristics, antimicrobial regimens, and outcomes of patients have been analyzed.Results: The CR-KP infections overall mortality was 37.3%, and bloodstream infections mortality was 66.2%. Survival analysis revealed that there were statistically significant differences between bloodstream infection and pulmonary and drainage fluid infection. Logistics regression analysis showed that hemopathy, age (>60 years), solid tumors, diabetes, septic shock, acute kidney injury and stroke were independent predictors associated with the 30-day mortality. Multivariate linear regression was performed in APACHE II score, SOFA score, lymphocyte absolute value (LYM) and survival time. Survival time was negatively correlated with APACHE II score and SOFA score, while positively correlated with LYM. Finally, we investigated different antimicrobial regimens for CR-KP infections. Chi-square test showed that antimicrobial regimen combined carbapenems, tigecycline with polymyxin B was superior the one combined carbapenems with polymyxin B. Ceftazidime avibactam-based antimicrobial regimens also had no advantage over other therapeutic regimens.Conclusions: Our study confirmed there is a high mortality rate in CR-KP infections, especially in the bloodstream infections. The outcome is greatly influenced by the patients’ clinical conditions. Antimicrobial regimen combined carbapenems, tigecycline with polymyxin B might be a better choice.

scholarly journals TACI και σήψη σε βαρέως πάσχοντες ασθενείς στη ΜΕΘ

2014 ◽  
Author(s):  
Μαρία Κομπότη
Keyword(s):  
Sofa Score ◽  
Hazard Ratio ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Toll Like Receptor ◽  
Wild Type ◽  
Odds Ratios ◽  
Toll Like Receptor 4 ◽  
Pcr Rflp

Σκοπός: ο προσδιορισμός των γενετικών πολυμορφισμών των μορίων TACI, BAFF και TLR4 και η διερεύνηση πιθανής συσχέτισής τους με την εμφάνιση σήψης και τη θνητότητα σε ασθενείς που εισάγονται στη ΜΕΘ. Ασθενείς-Μέθοδος: Προοπτική μελέτη παρακολούθησης όλων των ασθενών που εισήχθησαν στη Μονάδα Εντατικής Θεραπείας μέχρι την έκβαση (έξοδος, θάνατος). Για τη φυσική ανοσία μελετήθηκαν δύο πολυμορφισμοί του toll-like receptor 4 (ΤLR4-D299G και TLR4-T399I) και ένας πολυμορφισμός του C2 που προκαλεί ανεπάρκεια συμπληρώματος (C2del28bp). Για την επίκτητη ανοσία μελετήθηκαν δύο πολυμορφισμοί του BAFF-R (BAFF-R-H159Y και BAFF-R-P21R) και ένας του TACI (TACI-C104R). Η ανίχνευση των πολυμορφισμών έγινε με αλυσιδωτή αντίδραση πολυμεράσης και ανάλυση με ενδονουκλεάσες περιορισμού (PCR-RFLP). Αποτελέσματα: Στη μελέτη συμπεριελήφθησαν 215 ασθενείς (148 άνδρες και 67 γυναίκες). Η ηλικία (μέσος ± SD) ήταν 54,1±19,7 έτη, APACHE II score εισαγωγής στη ΜΕΘ 22,0±6,0 και SOFA score εισαγωγής στη ΜΕΘ 9,7±3,5. Σήψη στη ΜΕΘ βρέθηκε σε 108 ασθενείς (50,2%) και η θνητότητα στη ΜΕΘ ήταν 20,5% [95% διάστημα αξιοπιστίας 15,0–25,9]. Οι SNPs του TLR4 βρέθηκαν σε συζευγμένη κατάσταση. Οι φορείς κάποιου TLR4 SNP και οι φορείς του BAFFR-P21R συσχετίστηκαν ανεξάρτητα με χαμηλότερη πιθανότητα σήψης στη ΜΕΘ συγκριτικά με τους wild-type ομοζυγώτες [διορθωμένα odds ratios 0,32, 95%CI 0,12–0,86, p=0,024 για τον TLR4-T399I, 0,34, 95%CI 0,13–0,94, p=0,037 για τον TLR4-T399I and 0,44, 95%CI 0,20–0,97, p=0,044 για τον BAFFR-P21R]. Από την ανάλυση υποομάδων, φάνηκε ότι η συσχέτιση αυτή αφορούσε στους παθολογικούς ασθενείς και οριακά στους τραυματίες, ενώ στους χειρουργικούς ασθενείς δεν παρατηρήθηκε συσχέτιση. Η φορεία του TACI-C104R SNP είχε καλή προβλεπτική αξία μετά από διόρθωση ως προς συγχυτικούς παράγοντες [hazard ratio 5,01 (1,14–22,03, p=0,033). Ο BAFFR-H159Y SNP δεν συσχετίστηκε με την εμφάνιση σήψης και τη θνητότητα, ενώ ο πολυμορφισμός C2del28bp δεν ανευρέθηκε στο δείγμα της μελέτης.Συμπεράσματα: Η μελέτη μας έδειξε ότι σε βαρέως πάσχοντες ασθενείς ΜΕΘ, οι πολυμορφισμοί TLR4-D299G (rs4986790), TLR4-T399I (rs4986791) και TNFRSF13C/BAFFR-P21R (rs77874543) ασκούν προστατευτική επίδραση αναφορικά με την εμφάνιση σήψης, ενώ ο πολυμορφισμός TNFRSF13B/TACI-C104R (rs34557412) συσχετίζεται σημαντικά με αύξηση της θνητότητας στη ΜΕΘ. Ο πολυμορφισμός TNFRSF13C/BAFFR-H159Y (rs61756766) δεν συσχετίστηκε με την εμφάνιση σήψης ή τη θνητότητα στη ΜΕΘ. Διαπιστώθηκε ανισορροπία σύνδεσης για τους πολυμορφισμούς TLR4-D299G (rs4986790) και TLR4-T399I (rs4986791) και για τους πολυμορφισμούς TNFRSF13C/BAFFR-P21R (rs77874543) και TNFRSF13C/BAFFR-H159Y (rs61756766). Ο πολυμορφισμός C2-c.841_849+19del28 (rs9332736) δεν ανιχνεύτηκε στο δείγμα των ασθενών της μελέτης.

scholarly journals The Results of the Russian Clinical Trial of Mesenchymal Stromal Cells (MSCs) in Severe Neutropenic Patients (pts) with Septic Shock (SS) (RUMCESS trial)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2220-2220 ◽  
Author(s):  
Gennadii M. Galstian ◽  
Elena N. Parovichnikova ◽  
Polina M. Makarova ◽  
Larisa A. Kuzmina ◽  
Vera V. Troitskaya ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Organ Dysfunction ◽  
Sofa Score ◽  
Conflicts Of Interest ◽  
Survival Rates ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Complication Rates ◽  
Term Survival ◽  
Risk Of Death

Abstract Background: Recent evidence suggests that MSCs might improve survival during sepsis in animal models. However, no study has investigated the effects of MSC therapy on the survival of pts with sepsis and SS, especially severe-neutropenic pts. Aim: The aim of this study was to investigate the efficacy of the administration of MSCs for the treatment of SS in neutropenic pts. Patients and Methods: This prospective, single-center, randomized Russian clinical trial of MSCs in severe neutropenic pts with SS (RUMCESS) (NCT 01849237) was approved by the local ethics committee and was begun in December 2012. Neutropenic pts (WBC < 0.5x109/l) with SS were enrolled on to the study. The pts were randomly assigned (1:1) to receive either conventional therapy (CT) of SS (CT group), or CT plus donor MSCs at a dose of 106/kg intravenously within the first 10 hours after SS onset (CT+MSCs group). Written informed consent was obtained for all pts. All pts were admitted and treated in the ICU of the National Research Center for Hematology (Moscow). The Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sepsis-related Organ Failure Assessment (SOFA) score were employed to determine the severity of illness. Pts were followed up for 28 days after enrolment in the study, and 28-day all-cause mortality was assessed. Pts characteristics and complication rates were compared using Fisher's exact test. The Kaplan-Meier method with the log-rank test, and Cox proportional hazard regression model were used to determine the statistical significance of the relationship between overall survival (OS) and the treatment regimen. Statistical analyses were performed using SAS 9.1. Results: Of the 27 neutropenic pts with SS, 13 received CT and 14 received CT+MSCs. There were no statistically significant differences in the demographic variables between groups . The CT group included 7 males, 6 females, aged 33-81 yrs, median 55 yrs. The CT+MSCs group included 6 males, 8 females, aged 30-75 yrs, median 48 yrs. Hematological disorders were also similar in the two groups: AML (4), NHL (4), HL (1), MM (3), MDS (1) in the CT group, and AML (5), NHL (7), MM (1) in the CT+MSCs group. In all pts, except for one with MDS, neutropenia developed after chemotherapy. In 8/13 pts in the CT group and 9/14 pts in the CT+MSCs group blood cultures were found positive, mostly gram-negative. Baseline APACHE II scores (34.2 [95% CI 28.3-43.1] and 32.2 [95% CI 26.2-37.5] in the CT- and CT+MSC-groups, respectively), and SOFA scores (17.9 [95% CI 13.5-22.2] and 15.1 [95% CI 11.0-19.2] respectively), were similar in the two groups. 28-day survival rates were 15% (2 out of 13 pts) in the CT group and 57% (8 out of 14 pts) in the CT+MSCs group (P=0.04) (Figure 1). The significant increase in 28 days OS of the pts in CT+MCSs group was associated with SOFA score decrease, which was started in three days after onset of SS. Despite higher 28-day survival rates only 3 pts treated with CT+MSCs remained alive after 3 months, and 5 of 8 pts from the CT+MSCs-group who survived 28 days died later because of sepsis-related organ dysfunction. Conclusions: Administration of MSCs in the first hours of SS might improve short-term survival in neutropenic pts, but does not prevent death from sepsis-related organ dysfunction in the long term. Perhaps repeated administration of MSC is required. Figure 1. Comparison of OS rates between the two groups of pts in the ICU. There was a statistically significant increase of the 28-day OS rates (42% vs. 15%; P=0.04) and a statistically significant decrease of the risk of death (HR 0.35; 95% CI 0.13 - 0.91; P=0.04) in the CT+MCSs group vs. the CT group. Figure 1. Comparison of OS rates between the two groups of pts in the ICU. There was a statistically significant increase of the 28-day OS rates (42% vs. 15%; P=0.04) and a statistically significant decrease of the risk of death (HR 0.35; 95% CI 0.13 - 0.91; P=0.04) in the CT+MCSs group vs. the CT group. Disclosures No relevant conflicts of interest to declare.

scholarly journals Clinical Profile and Outcome of Patients with Severe Acute Pancreatitis

2020 ◽  
Vol 9 (3) ◽  
pp. 8-11
Author(s):  
Rishabh Sehgal ◽  
Inder Pal Singh ◽  
Jyotisterna Mittal
Keyword(s):  
Acute Pancreatitis ◽  
Alcohol Consumption ◽  
Severe Acute Pancreatitis ◽  
Sofa Score ◽  
Clinical Profile ◽  
Etiological Factor ◽  
Clinical Severity ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Marshall Score

Background: Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas leading to pancreatic autodigestion. The present study was conducted to study the clinical profile and outcome of patients with severe acute pancreatitis. Subjects & Methods: The study was conducted on 40 patients of acute pancreatitis. Clinical profile including history, examination findings, etiology of pancreatitis, clinical severity (according to Modified Marshall Score, BISAP score, APACHE II, HAPS score, SOFA score) was recorded. Results: Severe Acute Pancreatitis (SAP) among patients. Majority of the patients i.e. 22 (55%) had alcohol consumption as etiological factor causing SAP followed by biliary 10 (25%) & idiopathic 5 (12.5%). Hypertriglyceridemia and drug-induced (herbal medication) pancreatitis was present in 1 (2.5%) patient each. Out of all 1 (2.5%), patients had a history of both alcohol consumption and the presence of gallstone as an etiological factor. 22 patients (55%) out of 40 patients only conservative management was used while 18(45%) patients underwent USG guided percutaneous drainage was done. Out of these 18 patients, 3(7.5%) patients required Laparoscopic Necrosectomy & 2(5%) patients required open necrosectomy in addition to ultrasound-guided PCD. Patients who improved had a mean BISAP SCORE of 2.15   0.54, Modified Marshall score of 3.65    1.44, APACHE II score of 9.77  4.45, SOFA score 5.54  2.49, RANSON’s score 3.85   1.80 and HAP score of 0.65   0.63. Conclusion: Most common   etiology of severe acute pancreatitis is alcohol followed by biliary etiology. Out of severity scores (BISAP, APACHE-II, SOFA, HAPS), only BISAP score ≥3 is predictive of poor outcome in patients with severe acute pancreatitis.

scholarly journals Evaluation of predictors of mortality in patients of ruptured liver abscess: a prospective study

2021 ◽  
Vol 8 (12) ◽  
pp. 3639
Author(s):  
Syed A. Faridi ◽  
Syed H. Harris ◽  
Yasir Alvi
Keyword(s):  
Prognostic Factors ◽  
Prospective Study ◽  
Liver Abscess ◽  
Laboratory Data ◽  
Left Lobe ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Delayed Presentation ◽  
Predictors Of Mortality ◽  
A Prospective Study

Background: Ruptured liver abscess is a rare condition which is associated with high mortality. Ruptured liver abscess should be assessed carefully especially in patients with poor prognostic factors, which highlight the need for early diagnosis to further improve our results of management. The aim of the present study was to evaluate the predictors of mortality in patients of ruptured liver abscess.Methods: This was a prospective study, performed at Jawaharlal Nehru medical college, AMU, Aligarh between October 2015 to October 2017. For each case-patient, we reviewed demographic data, underlying medical conditions, clinical features, laboratory data, imaging and microbial findings and treatment. The prognostic factors independently related to mortality were then identified using univariate and multivariate analysis considering significance at p<0.05.Results: The overall in-hospital mortality was 27% (11 out of 40). On multivariate regression analysis, the factors that independently predicted mortality were shock at presentation, time of presentation (>48 hours), left lobe abscess and APACHE II score on admission more than 15.Conclusions: The independent predictors of mortality in ruptured liver abscess are shock at presentation, delayed presentation, higher APACHE II score on admission and left lobe abscess.

scholarly journals A retrospective study of sepsis-associated encephalopathy: epidemiology, clinical features and adverse outcomes

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jiayi Chen ◽  
Xiaobei Shi ◽  
Mengyuan Diao ◽  
Guangyong Jin ◽  
Ying Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Clinical Features ◽  
Sofa Score ◽  
Adverse Outcomes ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Gastrointestinal Infections ◽  
Independent Risk Factors ◽  
Poor Outcomes

Abstract Background Sepsis-associated encephalopathy (SAE) is a common complication of sepsis that may result in worse outcomes. This study was designed to determine the epidemiology, clinical features, and risk factors of SAE. Methods This was a retrospective study of all patients with sepsis who were admitted to the Critical Care Medicine Department of Hangzhou First People’s Hospital Affiliated with Zhejiang University School of Medicine from January 2015 to December 2019. Results A total of 291 sepsis patients were screened, and 127 (43.6%) were diagnosed with SAE. There were significant differences in median age, proportion of underlying diseases such as hypertension, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, gastrointestinal infections, detection rate of Enterococcus, and 28-day mortality between the SAE and non-SAE groups. Both the SOFA score and APACHE II score were independent risk factors for SAE in patients with sepsis. All 127 SAE patients were divided into survival and non-survival groups. The age, SOFA score, and APACHE II score were independently associated with 28-day mortality in SAE patients. Conclusion In the present retrospective study, nearly half of patients with sepsis developed SAE, which was closely related to poor outcomes. Both the SOFA score and APACHE II score were independent risk factors for predicting the occurrence and adverse outcome of SAE.

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