Accuracy and reliability of APACHE II scoring in two intensive care units

Objetivo: determinar la relación entre la demanda de carga laboral de enfermería y la gravedad del paciente en unidades de cuidados intensivos de adultos en la ciudad de Cartagena, en el mes de julio de 2008. Método: investigación de corte longitudinal. Muestra de 42 pacientes, se obtuvieron registros TISS-28 y registros Apache II. Se realizó el cálculo de media aritmética, desviación estándar y proporciones, así como el cálculo del coeficiente de correlación de Pearson. Resultados: participaron 42 pacientes; la media para la edad fue 58,2 años (IC 95% 52,1-64,4). El 51,3% fueron mujeres. Se obtuvieron 42 calificaciones del Apache II al ingreso de los pacientes a la UCI con un promedio de 28,9, de los cuales el 66,7% (28) tienen un mal pronóstico, y 188 calificaciones de TISS-28, con un promedio de 28,7 (IC 95% 25,7-31,7). El promedio de TISS de egreso fue de 25,7 (IC 95% 22,4-28,9) por paciente. El 61,9% de los pacientes perteneció a la clase III. La razón enfermera/paciente clase IV fue de 0,57 inferior a 1:1(1). Se encontró una asociación entre el Apache II y TISS-28 de 0,55 (0,501-0,75) y un coeficiente de determinación de 0,38 (p<0,05). Conclusiones: existe una moderada correlación entre el TISS-28 y el Apache II dejando ver sobrecarga de trabajo de enfermería en las UCI, lo que repercute en la atención directa al paciente crítico.

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Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units

10.21203/rs.3.rs-16162/v3 ◽

2020 ◽

Author(s):

Toshifumi Fujiwara ◽

Kentaro Tokuda ◽

Kenta Momii ◽

Kyohei Shiomoto ◽

Hidetoshi Tsushima ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Intensive Care ◽

Prognostic Factors ◽

Intensive Care Units ◽

Fatal Outcome ◽

Laboratory Data ◽

International Normalized Ratio ◽

Apache Ii ◽

Apache Ii Score ◽

Icu Admission

Abstract Background: Patients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs). Methods: This was a retrospective observational study. This study included 67 patients (20 males, 47 females) with RA who were admitted at the ICU of our institution for ≥48 h between January 2008 and December 2017. We analyzed the 30-day mortality of these patients and the investigated prognostic factors in RA patients admitted to our ICU.Results: Upon admission, the median age was 70 (range, 33–96) years, and RA duration was 10 (range, 0–61) years. The 5-year survival after ICU admission was 47%, and 30-day, 90-day, and 1-year mortality rates were 22%, 27%, and 37%, respectively. The major reasons for ICU admission were cardiovascular complications (24%) and infection (40%) and the most common ICU treatments were mechanical ventilation (69%), renal replacement (25%), and vasopressor (78%). In the 30-day mortality group, infection led to a fatal outcome in most cases (67%), and nonsurvival was associated with a significantly higher glucocorticoid dose, updated Charlson’s comorbidity index (CCI), and acute physiology and chronic health evaluation (APACHE) II score. Laboratory data obtained at ICU admission showed that lower platelet number and total protein and higher creatinine and prothrombin time international normalized ratio (PT-INR) indicated significantly poorer prognosis. The multivariate Cox proportional hazard model revealed that nonuse of csDMARDs, high updated CCI, increased APACHE II score, and prolonged PT-INR were associated with a higher risk of mortality after ICU admission.Conclusion: Our study demonstrated that the nonuse of csDMARDs, high updated CCI, elevated APACHE II score, and coagulation abnormalities predicted poorer prognosis in RA patients admitted to the ICU.

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Factors associated with nursing workload in three intensive care units

Revista da Escola de Enfermagem da USP ◽

10.1590/1980-220x-reeusp-2020-0272 ◽

2021 ◽

Vol 55 ◽

Author(s):

Diana Isabel Cáceres Rivera ◽

Claudia Consuelo Torres ◽

Luis Alberto López Romero

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Diagnostic Category ◽

Multiple Linear Regression Model ◽

Apache Ii ◽

Nursing Workload ◽

Bivariate Analysis ◽

Apache Ii Score ◽

Cross Sectional ◽

Factors Associated

ABSTRACT Objective: To determine the nursing workload in intensive care units (ICUs) and the factors associated with the Nursing Activities Score (NAS). Method: An analytical cross-sectional study was carried out in three ICUs in Bucaramanga, Colombia, between February 2018 and February 2020. The nursing workload was estimated based on the NAS. A descriptive and bivariate analysis stratified by ICU was performed using a robust multiple linear regression model, and the factors associated with the nursing workload (p < 0.05) were estimated. Results: In this study, 362 records were included. The median NAS was 68.1 points (Q1:47.2–Q3:116.7). APACHE II (β = 3.13, CI: 95% 2.28; 3.98), days of stay in ICU ≥3 (β = 16.78, CI: 95% 6.15; 27.41), surgery provenance service (β = 22.31, CI: 95% 9.76; 34.86), and traumatology and emergencies diagnostic category (β = 33.72, CI 95%: 9.90; 57.53) were associated with high NAS scores. Conclusion: The nursing staff spend approximately 70% of their time on a single patient, and administrative work takes up most of their time. Hospital stays of longer than 3 days, high APACHE II score, coming from the surgery department, and having a diagnosis of trauma and emergency were associated with a high workload.

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Apache II Cannot be Used to Compare Performance between Intensive Care Units

Clinical Science ◽

10.1042/cs082025pa ◽

1992 ◽

Vol 82 (s26) ◽

pp. 25P-25P

Author(s):

BW Millar ◽

OF Boyd ◽

S Henderson ◽

RM Grounds ◽

ED Bennett

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Apache Ii

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Long-term Survival in the Intensive Care Unit After Erythrocyte Blood Transfusion

American Journal of Critical Care ◽

10.4037/ajcc2009193 ◽

2009 ◽

Vol 18 (2) ◽

pp. 124-131 ◽

Cited By ~ 19

Author(s):

Milo Engoren ◽

Cynthia Arslanian-Engoren

Keyword(s):

Intensive Care ◽

Blood Transfusion ◽

Confidence Interval ◽

Intensive Care Units ◽

Case Control ◽

Apache Ii ◽

Term Survival ◽

Long Term Survival ◽

Risk Of Death

Background Erythrocyte blood transfusions are commonly used in intensive care units, yet little is known about their effects on long-term survival. Objective To determine the effect of erythrocyte blood transfusion in intensive care units on long-term survival. Methods Retrospective analysis of a prospectively collected database of 2213 patients admitted January 27, 2001, to April 30, 2002, to the cardiac, burn, neurological-neurosurgical, and combined medical-surgical intensive care units in a tertiary care, university-affiliated, urban medical center. Further analysis was done on a case-control subgroup (n = 556) formed by matching scores on the Acute Physiology and Chronic Health Evaluation (APACHE) II and propensity scores. Results Although transfusion was univariably associated with increased risk of death at all 3 times (0–30, 31–180, and >180 days after admission to the unit), multivariable adjustment with Cox modeling showed that transfusion had no association with mortality for the first 2 intervals (0–30 and 31–180 days), but was associated with a 25% lower risk of death (hazard ratio, 0.75; 95% confidence interval, 0.57–0.99; P = .04) in patients who survived at least 180 days after admission to the unit. In the case-control patients, after correction for APACHE II risk of death and propensity to receive a transfusion, transfusion had no association with mortality for the first 2 intervals, but was associated with 29% lowered risk of death (hazard ratio, 0.71; 95% confidence interval, 0.50–0.99; P=.046). Conclusion Blood transfusion was associated with a decreased risk of late (>180 days) death in intensive care patients.

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Association of Serum PCSK9 Levels with Antibiotic Resistance and Severity of Disease in Patients with Bacterial Infections Admitted to Intensive Care Units

Journal of Clinical Medicine ◽

10.3390/jcm8101742 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1742 ◽

Cited By ~ 2

Author(s):

Tannaz Jamialahmadi ◽

Yunes Panahi ◽

Mohamamd Amin Safarpour ◽

Shiva Ganjali ◽

Mahdi Chahabi ◽

...

Keyword(s):

Antibiotic Resistance ◽

Intensive Care ◽

Intensive Care Units ◽

Bacterial Infections ◽

Density Lipoprotein ◽

Apache Ii ◽

Lipoprotein Cholesterol ◽

Serum Glutamic Oxaloacetic Transaminase ◽

Resistance To Antibiotics ◽

Severity Of Disease

Background: The results of several studies have suggested that infections and sepsis, either bacterial or viral, might be associated with elevated plasma proprotein convertase subtilisin/kexin type 9 (PCSK9) levels. Since there are no data on PCSK9 levels and antibiotic resistance or the severity of disease in patients with bacterial infections in intensive care units, the aim of this study was to investigate whether any such associations exist. Methods: 100 patients (46 males, mean age 67.12 ± 1.34 years) with bacterial infections who were staying in an intensive care unit (ICU) longer than 48 h but less than 7 days and who were not receiving corticosteroids were analyzed. Their serum levels of albumin, C-reactive protein, glucose, lactate, blood urea nitrogen, prothrombin (international normalized ratio), total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, PCSK9, and procalcitonin were measured. The severity of the patients’ condition was assessed by using the Glasgow Coma Scale (GCS), the Sequential Organ Failure Assessment (SOFA), and the Acute Physiology and Chronic Health Evaluation II (APACHE II) scales. Results: Using a hierarchical regression modeling approach, no significant association was found between PCSK9 levels and either the severity of disease (APACHE II, SOFA, and GCS) indices or resistance to antibiotics. Conclusion: The results suggest that there is no association between PCSK9 levels and resistance to antibiotics or the condition of patients hospitalized in intensive care units.

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Intensive Care Society's APACHE II study in Britain and Ireland--II: Outcome comparisons of intensive care units after adjustment for case mix by the American APACHE II method.

BMJ ◽

10.1136/bmj.307.6910.977 ◽

1993 ◽

Vol 307 (6910) ◽

pp. 977-981 ◽

Cited By ~ 194

Author(s):

K M Rowan ◽

J H Kerr ◽

E Major ◽

K McPherson ◽

A Short ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Apache Ii ◽

Case Mix

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Association of Vitamin D Status of Septic Patients in Intensive Care Units With Altered Procalcitonin Levels and Mortality

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2013-4330 ◽

2015 ◽

Vol 100 (2) ◽

pp. 516-523 ◽

Cited By ~ 12

Author(s):

Zhaoyan Chen ◽

Zuojie Luo ◽

Xiaoqin Zhao ◽

Qiang Chen ◽

Jieyu Hu ◽

...

Keyword(s):

Vitamin D ◽

Intensive Care ◽

Intensive Care Units ◽

Mortality Rates ◽

Apache Ii ◽

Apache Ii Score ◽

Intact Pth ◽

Serum 25Ohd ◽

Icu Admission ◽

Fluid Load

Abstract Objective: The purpose of this study was to determine whether vitamin D levels correlate with procalcitonin (PCT) levels and mortality in septic patients. Methods: The following data were collected from 236 patients upon admission to intensive care units (ICUs): demographics; Acute Physiology and Chronic Health Evaluation (APACHE) II score; Sequential Organ Failure Assessment (SOFA) score; 25-hydroxyvitamin D (25OHD), PCT, intact PTH, albumin, creatinine, and ionized calcium (iCa) levels; 25OHD sampling seasonality; fluid load (colloid and crystalloid before 25OHD sampling); mechanical ventilation duration; and length of stay (LOS) in the ICU. The primary endpoint was all-cause mortality 28 days after ICU admission. Results: Patients with 25OHD deficiency had significantly higher APACHE II and SOFA scores, positive blood culture rates, PCT levels, intact PTH levels, and 28-day mortality rates. These patients also had lower iCa levels, longer LOS in the ICU, and longer ventilator durations than patients with 25OHD insufficiency or sufficiency. Age, sex, 25OHD sampling seasonality, serum albumin and creatinine levels, and fluid load did not vary among the 3 groups. Serum 25OHD levels at admission were significantly negatively correlated with PCT levels. PTH responders had significantly higher 28-day mortality rates than did PTH nonresponders. Cox regression showed that a 25OHD level of <20 ng/mL was an independent risk factor for 28-day mortality. Conclusions: Lower serum 25OHD levels at ICU admission were associated with 28-day mortality in septic patients. Serum 25OHD levels were inversely correlated with PCT levels. Hypovitaminosis D was associated with higher mortality rates in PTH responders than in nonresponders.

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