scholarly journals The association between four scoring systems and 30-day mortality among intensive care patients with sepsis: a cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tianyang Hu ◽  
Huajie Lv ◽  
Youfan Jiang
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Scoring Systems ◽  
Roc Curves ◽  
The Elderly ◽  
Net Benefit ◽  
Intensive Care Patients ◽  
Saps Ii ◽  
Saps Ii Score ◽  
Net Benefits

AbstractSeveral commonly used scoring systems (SOFA, SAPS II, LODS, and SIRS) are currently lacking large sample data to confirm the predictive value of 30-day mortality from sepsis, and their clinical net benefits of predicting mortality are still inconclusive. The baseline data, LODS score, SAPS II score, SIRS score, SOFA score, and 30-day prognosis of patients who met the diagnostic criteria of sepsis were retrieved from the Medical Information Mart for Intensive Care III (MIMIC-III) intensive care unit (ICU) database. Receiver operating characteristic (ROC) curves and comparisons between the areas under the ROC curves (AUC) were conducted. Decision curve analysis (DCA) was performed to determine the net benefits between the four scoring systems and 30-day mortality of sepsis. For all cases in the cohort study, the AUC of LODS, SAPS II, SIRS, SOFA were 0.733, 0.787, 0.597, and 0.688, respectively. The differences between the scoring systems were statistically significant (all P-values < 0.0001), and stratified analyses (the elderly and non-elderly) also showed the superiority of SAPS II among the four systems. According to the DCA, the net benefit ranges in descending order were SAPS II, LODS, SOFA, and SIRS. For stratified analyses of the elderly or non-elderly groups, the results also showed that SAPS II had the most net benefit. Among the four commonly used scoring systems, the SAPS II score has the highest predictive value for 30-day mortality from sepsis, which is better than LODS, SIRS, and SOFA. The results of the DCA curves show that using the SAPS II score to predict the 30-day mortality of intensive care patients with sepsis to guide clinical applications may obtain the highest net benefit.

scholarly journals Effectiveness of LODS, OASIS, and SAPS II to predict in-hospital mortality for intensive care patients with ST elevation myocardial infarction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Liang Wang ◽  
Zhengwei Zhang ◽  
Tianyang Hu
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Clinical Benefit ◽  
Predictive Value ◽  
Scoring Systems ◽  
Study Cohort ◽  
Intensive Care Patients ◽  
Saps Ii ◽  
Saps Ii Score

AbstractThe relationship between three scoring systems (LODS, OASIS, and SAPS II) and in-hospital mortality of intensive care patients with ST segment elevation myocardial infarction (STEMI) is currently inconclusive. The baseline data, LODS score, OASIS score, SAPS II score, and in-hospital prognosis of intensive care patients with STEMI were retrieved from the Medical Information Mart for Intensive Care IV database. Propensity score matching analysis was performed to reduce bias. Receiver operating characteristic curves (ROC) were drawn for the three scoring systems, and comparisons between the areas under the ROC curves (AUC) were conducted. Decision curve analysis (DCA) was performed to determine the net benefits of the three scoring systems. LODS and SAPS II were independent risk factors for in-hospital mortality. For the study cohort, the AUCs of LODS, OASIS, SAPS II were 0.867, 0.827, and 0.894; after PSM, the AUCs of LODS, OASIS, SAPS II were 0.877, 0.821, and 0.881. A stratified analysis of the patients who underwent percutaneous coronary intervention/coronary artery bypass grafting (PCI/CABG) or not was conducted. In the PCI/CABG group, the AUCs of LODS, OASIS, SAPS II were 0.853, 0.825, and 0.867, while in the non-PCI/CABG group, the AUCs of LODS, OASIS, SAPS II were 0.857, 0.804, and 0.897. The results of the Z test suggest that the predictive value of LODS and SAPS II was not statistically different, but both were higher than OASIS. According to the DCA, the net clinical benefit of LODS was the greatest. LODS and SAPS II have excellent predictive value, and in most cases, both were higher than OASIS. With a more concise composition and greater clinical benefit, LODS may be a better predictor of in-hospital mortality for intensive care patients with STEMI.

scholarly journals The Pros and Cons of the Prediction Game: The Never-ending Debate of Mortality in the Intensive Care Unit

2019 ◽  
Vol 16 (18) ◽  
pp. 3394 ◽  
Author(s):  
Piotr A. Fuchs ◽  
Iwona J. Czech ◽  
Łukasz J. Krzych
Keyword(s):  
Intensive Care ◽  
Scoring Systems ◽  
Roc Curves ◽  
Simplified Acute Physiology Score ◽  
Apache Ii ◽  
Icu Mortality ◽  
Saps Ii ◽  
Icu Discharge ◽  
Pros And Cons ◽  
Long Term Prognosis

Background: The Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scales are scoring systems used in intensive care units (ICUs) worldwide. We aimed to investigate their usefulness in predicting short- and long-term prognosis in the local ICU. Methods: This single-center observational study covered 905 patients admitted from 1 January 2015 to 31 December 2017 to a tertiary mixed ICU. SAPS II, APACHE II, and SOFA scores were calculated based on the worst values from the first 24 h post-admission. Patients were divided into surgical (SP) and nonsurgical (NSP) subjects. Unadjusted ICU and post-ICU discharge mortality rates were considered the outcomes. Results: Baseline SAPS II, APACHE II, and SOFA scores were 41.1 ± 20.34, 14.07 ± 8.73, and 6.33 ± 4.12 points, respectively. All scores were significantly lower among SP compared to NSP (p < 0.05). ICU mortality reached 35.4% and was significantly lower for SP (25.3%) than NSP (57.9%) (p < 0.001). The areas under the receiver-operating characteristic (ROC) curves were 0.826, 0.836, and 0.788 for SAPS II, APACHE II, and SOFA scales, respectively, for predicting ICU prognosis, and 0.708, 0.709, and 0.661 for SAPS II, APACHE II, and SOFA, respectively, for post-ICU prognosis. Conclusions: Although APACHE II and SAPS II are good predictors of ICU mortality, they failed to predict survival after discharge. Surgical patients had a better prognosis than medical ICU patients.

scholarly journals Chronic heart failure in intensive care unit: can we accurately predict the risk?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Maltes ◽  
S Maltes ◽  
B.M.L Rocha ◽  
G.J.L Cunha ◽  
P Lopes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care ◽  
Kidney Injury ◽  
Scoring Systems ◽  
Roc Curves ◽  
Simplified Acute Physiology Score ◽  
Apache Ii ◽  
Risk Scores ◽  
Risk Of Death ◽  
Saps Ii

Abstract Background Severity of disease scoring systems, namely the Simplified Acute Physiology Score (SAPS) and Acute Physiology and Chronic Health Evaluation (APACHE), are widely used to predict mortality in Intensive Care Units (ICU). Yet, neither score includes chronic HF in their model. We aimed to evaluate whether these scores perform well in risk prediction of death of patients previously diagnosed with heart failure (HF). Methodology This is a single-center retrospective cohort of patients admitted to an ICU in 2019. Those whose admission lasted &lt;24 hours were excluded from analysis. The SAPS II and APACHE II scores were calculated using data from the first 24 hours of ICU admission, imputing the worst variable obtained within this timeframe. HF was defined according to the ESC recommendations. In order to assess the performance of the scores, Receiver Operating Characteristic (ROC) Curves were used to predict the risk of death in ICU in HF compared to the non-HF population. Results A total of 267 patients were hospitalized in ICU for a period over 24 hours in 2019 (mean age 67±16 years; 58.8% males; 21.7% with chronic HF; 33.7% admitted for sepsis). Compared to patients without HF, those with chronic HF were older (74±13 vs. 65±16 years; p&lt;0.001) and had higher risk scores (mean SAPS II: 43.2±21.7 vs. 56.5±20.7; p&lt;0.001; mean APACHE II: 19.8±10.0 vs. 25.1±10.0; p&lt;0.001). Moreover, these patients were at higher risk of meaningful events during hospitalization (e.g. acute kidney injury: 38.0 vs. 66.1%; p&lt;0.001; shock at any time: 52.4 vs. 67.8%; p=0.036). Furthermore, patients with HF had a trend towards higher mortality rates in ICU (17.3 vs. 28.8%; p=0.051) and a significantly higher death in overall hospitalization (30.8 vs. 45.8%; p=0.032). ROC curves performed well in predicting the risk of ICU death regardless of HF (SAPS II – AUC 0.78 vs. 0.81; p=0.36; APACHE II – AUC 0.75 vs. 0.78; p=0.37). Conclusion Approximately 1 in every 4 patients admitted to the ICU had chronic HF. Traditional risk scoring systems (SAPS II and APACHE II) performed well regardless of HF. While these results are reassuring as far as risk stratification accuracy is concerned, HF patients remained at a higher risk for worse outcomes. Therefore, prognostic tools with a therapeutic clinical applicability are urgently needed to improve the outcome of this population. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Sepsis Diagnostics: Intensive Care Scoring Systems Superior to MicroRNA Biomarker Testing

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 701
Author(s):  
Fabian Link ◽  
Knut Krohn ◽  
Anna-Maria Burgdorff ◽  
Annett Christel ◽  
Julia Schumann
Keyword(s):  
Intensive Care ◽  
Scoring Systems ◽  
Digital Pcr ◽  
Absolute Quantification ◽  
Medical Problem ◽  
Control Group ◽  
Multiple Parameters ◽  
Sepsis Diagnosis ◽  
Intensive Care Patients ◽  
Healthy Control

Sepsis represents a serious medical problem accounting for numerous deaths of critically ill patients in intensive care units (ICUs). An early, sensitive, and specific diagnosis is considered a key element for improving the outcome of sepsis patients. In addition to classical laboratory markers, ICU scoring systems and serum miRNAs are discussed as potential sepsis biomarkers. In the present prospective observational study, the suitability of miRNAs in sepsis diagnosis was tested based on proper validated and normalized data (i.e., absolute quantification by means of Droplet Digital PCR (ddPCR)) in direct comparison to classical sepsis markers and ICU scores within the same patient cohort. Therefore, blood samples of septic intensive care patients (n = 12) taken at day of admission at ICU were compared to non-septic intensive care patients (n = 12) and a healthy control group (n = 12). Our analysis indicates that all tested biomarkers have only a moderate informative power and do not allow an unequivocal differentiation between septic and non-septic ICU patients. In conclusion, there is no standalone laboratory parameter that enables a reliable diagnosis of sepsis. miRNAs are not superior to classical parameters in this respect. It seems recommendable to measure multiple parameters and scores and to interpret them with regard to the clinical presentation.

scholarly journals Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study

2013 ◽  
pp. 184-188 ◽  
Author(s):  
Alvaro Sanabria ◽  
Ximena Gomez ◽  
Valentin Vega ◽  
Luis Carlos Dominguez ◽  
Camilo Osorio
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Critically Ill ◽  
Medical Condition ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Adult Patients ◽  
Saps Ii Score

Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

scholarly journals Risk factors for delirium in intensive care patients: a prospective cohort study

Critical Care ◽  
2009 ◽  
Vol 13 (3) ◽  
pp. R77 ◽  
Author(s):  
Bart Van Rompaey ◽  
Monique M Elseviers ◽  
Marieke J Schuurmans ◽  
Lillie M Shortridge-Baggett ◽  
Steven Truijen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Intensive Care ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Intensive Care Patients
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