Acute generalized peritonitis in African children: assessment of severity of illness using modified APACHE II score

• Background Ventilator-associated pneumonia is a significant cause of morbidity and mortality and may be influenced by oral health. • Objective To describe the relationship between ventilator-associated pneumonia and oral health status, changes in oral health status during the first 7 days after intubation, and microbial colonization of the oropharynx and trachea. • Methods A total of 66 patients were enrolled within 24 hours of intubation and were followed up for up to 7 days. Data on oral health measures and the Clinical Pulmonary Infection Score (CPIS) were collected at baseline, day 4 (n = 37), and day 7 (n = 21). A regression model was used to predict risk of pneumonia at day 4. • ResultsDental plaque and oral organisms increased over time. Correlations were significant for baseline and day 4 dental plaque (P < .001), baseline salivary lactoferrin and day 4 plaque (P = .01), and lower salivary volume and higher day 4 CPIS (P = .02). Potential pathogens were identified in oral cultures for 6 patients before or at the same time as the appearance of the organisms in tracheal aspirates. Correlations were significant with day 4 CPIS for score on the Acute Physiology and Chronic Health Evaluation (APACHE) II (P = .007), day 4 salivary volume (P = .02), interaction of APACHE II score and day 1 CPIS (P<.001), and interaction of day 1 CPIS and plaque (P=.01). • Conclusions Higher dental plaque scores confer greater risk for ventilator-associated pneumonia, particularly for patients with greater severity of illness. Salivary volume and lactoferrin may affect the risk.

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Assessment of Outcome over a 10-year Period of Patients Admitted to a Multidisciplinary Adult Intensive Care Unit with Haematological and Solid Tumours

Anaesthesia and Intensive Care ◽

10.1177/0310057x0503300105 ◽

2005 ◽

Vol 33 (1) ◽

pp. 26-35 ◽

Cited By ~ 20

Author(s):

J. L. Moran ◽

P. J. Solomon ◽

P. J. Williams

Keyword(s):

Mechanical Ventilation ◽

Cox Model ◽

Severity Of Illness ◽

Cohort Effect ◽

Solid Tumours ◽

Apache Ii ◽

Apache Ii Score ◽

Adult Intensive Care Unit ◽

Icu Admission ◽

Over Time

The risk factors for time to mortality, censored at 30 days, of patients admitted to an adult teaching hospital ICU with haematological and solid malignancies were assessed in a retrospective cohort study. Patients, demographics and daily ICU patient data, from admission to day 8, were identified from a prospective computerized database and casenote review in consecutive admissions to ICU with haematological and solid tumours over a 10-year period (1989–99). The cohort, 108 ICU admissions in 89 patients was of mean age (±SD) 55±14 years; 43% were female. Patient diagnoses were leukaemia (35%), lymphoma (38%) and solid tumours (27%). Median time from hospital to ICU admission was five days (range 0–67). On ICU admission, 50% had septic shock and first day APACHE II score was 28±9. Forty-six per cent of patients were ventilated. ICU and 30-day mortality were 39% and 54% respectively. Multivariate Cox model predictors (P<0.05), using only ICU admission day data were: Charlson comorbidity index (CCI), time to ICU admission (days) and mechanical ventilation. For daily data (admission through day 8), predictors were: cohort effect (2nd vs 1st five-year period); CCI; time to ICU admission (days); APACHE II score and mechanical ventilation. Outcomes were considered appropriate for severity of illness and demonstrated improvement over time. Ventilation was an independent outcome determinant. Controlling for other factors, mortality has improved over time (1st vs 2nd five year period). Analysis restricted to admission data alone may be insensitive to particular covariate effects.

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Controlling for Severity of Illness in Assessment of the Association Between Antimicrobial-Resistant Infection and Mortality: Impact of Calculation of Acute Physiology and Chronic Health Evaluation (APACHE) II Scores at Different Time Points

Infection Control and Hospital Epidemiology ◽

10.1086/518751 ◽

2007 ◽

Vol 28 (7) ◽

pp. 832-836 ◽

Cited By ~ 11

Author(s):

Keith W. Hamilton ◽

Warren B. Bilker ◽

Ebbing Lautenbach

Keyword(s):

Severity Of Illness ◽

Chronic Health Evaluation ◽

Apache Ii ◽

Fluoroquinolone Resistance ◽

Apache Ii Score ◽

Health Evaluation ◽

Time Points ◽

Resistant Infection ◽

Multivariable Models ◽

Culture Specimen

Background.In studies of the association between antibiotic-resistant infection and mortality, the importance of controlling for the underlying severity of illness is well recognized. However, it is unclear when the severity of illness should be assessed. Controlling for severity of illness on the day the culture specimen is obtained may underestimate the true association between resistance and mortality.Objective.TO assess the impact of calculating the Acute Physiology and Chronic Health Evaluation (APACHE) II score at different time points on the association between antimicrobial resistance and mortality.Methods.We used an existing data set from a study that investigated the association between fluoroquinolone resistance and mortality. The APACHE II score was calculated at 3 time points: the day the culture specimen was obtained, 1 day before the culture specimen was obtained, and 2 days before the culture specimen was obtained. Separate multivariable models were constructed using the 3 different APACHE II scores. These models were compared qualitatively.Results.Of 91 total subjects, 51 were infected with a fluoroquinolone-resistant strain and 40 with a fluoroquinolone-susceptible strain. The median APACHE II score for all subjects was 13 (95% confidence interval [CI], 11-15) when calculated on the day the culture specimen was obtained, 12 (95% CI, 11-13) when calculated 1 day before, and 11 (95% CI, 10-13) when calculated 2 days before the culture specimen was obtained. Of 91 subjects, 12 (13.2%) died. The 3 multivariable models (each with the APACHE II score calculated on a different day) were not substantively different; the adjusted odds ratio for the association between fluoroquinolone-resistant infection and mortality varied only from 1.38 to 1.65 in the 3 models.Conclusions.APACHE II scores calculated at different time points relative to obtainment of the culture specimen did not differ substantively. Furthermore, when the adjusted association between fluoroquinolone resistance and mortality was assessed, there were no substantive differences across multivariable models that incorporated APACHE II scores calculated at different time points.

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Why the surgical patients are so critical in their intensive care unit arrival?

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502013001300010 ◽

2013 ◽

Vol 28 (suppl 1) ◽

pp. 48-53 ◽

Cited By ~ 3

Author(s):

Anibal Basile-Filho ◽

Mayra Gonçalves Menegueti ◽

Maria Auxiliadora-Martins ◽

Edson Antonio Nicolini

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Negative Impact ◽

Survival Rates ◽

Severity Of Illness ◽

Apache Ii ◽

Apache Ii Score ◽

Death Risk ◽

Icu Transfer ◽

The Impact

PURPOSE: To assess the ability of the Acute Physiology and Chronic Health Evaluation II (APACHE II) to stratify the severity of illness and the impact of delay transfer to an Intensive Care Unit (ICU) on the mortality of surgical critically ill patients. METHODS: Five hundred and twenty-nine patients (60.3% males and 39.7% females; mean age of 52.8 ± 18.5 years) admitted to the ICU were retrospectively studied. The patients were divided into survivors (n=365) and nonsurvivors (n=164). APACHE II and death risk were analysed by generation of receiver operating characteristic (ROC) curves. The interval time between referral and ICU arrival was also registered. The level of significance was 0.05. RESULTS: The mean APACHE II and death risk was 19.9 ± 9.6 and 37.7 ± 28.9%, respectively. The area under the ROC curve for APACHE II and death risk was 0.825 (CI = 0.765-0.875) and 0.803 (CI = 0.741-0.856). The overall mortality (31%) increased progressively with the delay time to ICU transfer, as also evidencied by the APACHE II score and death risk. CONCLUSION: This investigation shows that the longer patients wait for ICU transfer the higher is their criticallity upon ICU arrival, with an obvious negative impact on survival rates.

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Acute generalized peritonitis in adult African patients: Assessment of severity using APACHE II score

Annals of the College of Surgeons Hong Kong ◽

10.1046/j.1442-2034.2003.00151.x ◽

2003 ◽

Vol 7 (1) ◽

pp. 23-28 ◽

Cited By ~ 2

Author(s):

Abdul Rashid K. Adesunkanmi ◽

Tajudeen A. Badmus ◽

E. Augustine Agbakwuru ◽

Akinwumi B. Ogunronbi

Keyword(s):

Apache Ii ◽

Apache Ii Score ◽

Generalized Peritonitis ◽

African Patients

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A multicenter comparison of dialysis membranes in the treatment of acute renal failure requiring dialysis.

Journal of the American Society of Nephrology ◽

10.1681/asn.v92257 ◽

1998 ◽

Vol 9 (2) ◽

pp. 257-266

Author(s):

J Himmelfarb ◽

N Tolkoff Rubin ◽

P Chandran ◽

R A Parker ◽

R L Wingard ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Complement Activation ◽

Severity Of Illness ◽

Apache Ii ◽

Apache Ii Score ◽

Dialysis Membrane ◽

Significant Difference ◽

Initiation Of Dialysis ◽

Discharge From Hospital

The mortality of patients with acute renal failure (ARF) remains high, and in several large studies approaches 60%. This mortality is particularly high in patients with ARF who require dialysis and has not changed substantially over several years, despite the introduction of major advances in monitoring and treatment. Increasing prevalence of comorbidities has been suggested as the major factor in this persistently high mortality. This study investigates the potential role of the dialysis membrane on patient outcome in a prospective multicenter study of 153 patients with ARF requiring dialysis. The membrane assignment was made in alternating order and was limited to membranes with low complement activation (Biocompatible [BCM]) and cellulosic, high complement activation (Bioincompatible [BICM]). Both types of membranes were low-flux membranes. Patients were dialyzed with the assigned membrane until recovery, discharge from hospital, or death. The severity of illness of each patient was assessed using the APACHE II score at the time of initiation of dialysis. A logistic regression analysis was used to adjust for the APACHE II score. The results of the study showed a statistically significant difference in survival (57% in patients on BCM, 46% in patients on BICM; P = 0.03) and in recovery of renal function (64% in patients on BICM and 43% in patients on BICM; P = 0.001). These differences were particularly marked in the patients who were nonoliguric (>400 ml/d of urine output) at initiation of the study. In the subset of patients who were nonoliguric at the start of dialysis, a larger fraction (70%) became oliguric after initiating dialysis on a BICM membrane, in contrast to 44% who were initiated on a BCM membrane (P = 0.03). It is concluded that the biocompatibility of the dialysis membrane plays a role in the outcome of patients with ARF, particularly those who are nonoliguric at the time of initiation of dialysis.

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Clinical Correlation Analysis of Complications in Elderly Patients with Sequelae of Stroke with Different Barthel Index in Tianjin Emergency Department

BioMed Research International ◽

10.1155/2021/6625440 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Xingzhen Zheng ◽

Haidong Wang ◽

Xiaolin Bian

Keyword(s):

Emergency Department ◽

Elderly Patients ◽

Barthel Index ◽

Upper Gastrointestinal Bleeding ◽

Severity Of Illness ◽

Decubitus Ulcer ◽

Apache Ii ◽

Apache Ii Score ◽

Stroke Patients ◽

Upper Gastrointestinal

Objective. The Barthel index (BI) is the most commonly used measure of poststroke disability. The purpose of this article is to explore the different complications and severity of the sequelae of elderly stroke patients with different BI in the emergency department, so as to provide a theoretical basis for strengthening the treatment of elderly patients with stroke sequelae. Methods. A retrospective study was adopted, and 1896 patients were divided into two groups according to the BI: 823 patients in the bedridden group ( BI ≤ 40 points ) and 1073 patients in the nonbedridden group ( BI > 40 points ). The type and number of complications and APACHE II score were compared between the two groups. Results. Compared with the two groups, pneumonia, renal insufficiency, respiratory failure, and decubitus ulcer in the bedridden group had a higher incidence, but the incidence of upper gastrointestinal bleeding and fractures in the nonbedridden group was significantly higher ( P < 0.05 ). The APACHE II score of the patients in the bedridden group was higher than that of the nonbedridden group, and they were critical ( P < 0.001 ). And the number of complications was higher than that in the nonbedridden group. Moreover, the BI was negatively correlated with the APACHE-II score and the number of complications, and the APACHE II score was positively correlated with the number of complications ( P < 0.001 ). Conclusion. Different complications and severity of illness occur in elderly patients with sequelae of stroke after different BI in the emergency department.

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Application of APACHE II Score in assessing the severity and outcome in peritonitis due to hollow viscus perforation

International Surgery Journal ◽

10.18203/2349-2902.isj20190828 ◽

2019 ◽

Vol 6 (3) ◽

pp. 940

Author(s):

M. Venkat Reddy ◽

T. Amarsimha Reddy ◽

Satyadev . ◽

B. RaghuRam Teja ◽

P. ShanmugaRaju

Keyword(s):

Apache Ii ◽

Individual Risk ◽

Apache Ii Score ◽

Hollow Viscus ◽

Prospective Survey ◽

Generalized Peritonitis ◽

Risk Of Mortality ◽

Threatening Condition ◽

Life Threatening ◽

Hollow Viscus Perforation

Background: Acute generalized peritonitis from Gastrointestinal hollow viscus perforation is a potentially life threatening condition. The aim of the study was to assess the application of APACHE II score in assessing the severity and outcome in peritonitis due to hollow viscus perforation and to correlate morbidity and mortality patterns using the modified APACHE II Score and its significance on the outcome.Methods: A prospective survey of 50 patients with acute generalized peritonitis due to hollow viscus perforation was carried out in general surgical wards, CAIMS, Karimnagar. APACHE-II scores were assigned to all patients in order to calculate their individual risk of mortality before undergoing emergency surgery.Results: Total 50 patients were admitted during the study period. Age and sex distribution shows that perforation was common >60 years in our study. Higher modified APACHE II scores statistically influenced mortality in all the patients irrespective of aetiology with p<0.001 which is statistically significant.Conclusions: Modified APACHE II scoring predicts mortality which was significant irrespective of the aetiology.

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