Forecasting Survival in the Medical Intensive Care Unit: A Comparison of Clinical Prognoses With Formal Estimates

1993 ◽  
Vol 32 (04) ◽  
pp. 302-308 ◽  
Author(s):  
J. J. Cottrell ◽  
J. Murakami ◽  
M. E. Mackesy ◽  
B. Fetzer ◽  
A. S. Elstein ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Calibration Curve ◽  
Medical Intensive Care Unit ◽  
Apache Ii ◽  
Physician Training ◽  
Quantitative Index ◽  
Forecasting Accuracy ◽  
Medical Intensive Care ◽  
Consistent Tendency

AbstractPhysicians often need to make prognostic judgments. In the present study, the accuracy was explored of survival estimates for patients in the Medical Intensive Care Unit (MICU). Estimates were made by physicians and nurses several times during each patient’s stay in the MICU and were compared to those of the APACHE II scale, a widely used quantitative index for critically ill patients. ROC curve and calibration curve analyses were performed to assess the accuracy of these estimates. Results revealed that MICU personnel were fairly accurate discriminators of patients who survived vs. who died, although there was a consistent tendency to underestimate survival. In addition, there was some relationship between the level of physician training and forecasting accuracy, but only within the patient’s first 24 hours in the MICU. Finally, the estimates of physicians did not differ significantly from those of the APACHE II scale. Physicians tended to be better calibrated in their predictions, while the APACHE II scale was slightly superior in terms of discrimination.

scholarly journals Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit

2018 ◽  
Vol 46 (3) ◽  
pp. 1254-1262 ◽  
Author(s):  
Surat Tongyoo ◽  
Tanuwong Viarasilpa ◽  
Chairat Permpikul
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Serum Potassium ◽  
Critically Ill Patients ◽  
Medical Intensive Care Unit ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Mortality ◽  
Medical Intensive Care

Objective To compare the outcomes of patients with and without a mean serum potassium (K+) level within the recommended range (3.5–4.5 mEq/L). Methods This prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients’ baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K+ level, and hospital outcomes were recorded. Patients with a mean K+ level of 3.5 to 4.5 mEq/L and with all individual K+ values of 3.0 to 5.0 mEq/L were allocated to the normal K+ group. The remaining patients were allocated to the abnormal K+ group. Results In total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K+ group comprised 74 (46.3%) patients. The abnormal K+ group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal serum K+ level was associated with significantly higher ICU mortality and incidence of ventricular fibrillation. Conclusion Critically ill patients with abnormal K+ levels had a higher incidence of ventricular arrhythmia and ICU mortality than patients with normal K+ levels.

Super Obesity in the Medical Intensive Care Unit

2018 ◽  
Vol 35 (5) ◽  
pp. 478-484
Author(s):  
Santhi Iyer Kumar ◽  
Kathleen Doo ◽  
Julie Sottilo-Brammeier ◽  
Christianne Lane ◽  
Janice M. Liebler
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Apache Ii ◽  
Obese Patients ◽  
Super Obesity ◽  
Super Obese ◽  
Medical Intensive Care ◽  
Reason For Admission

Background: Studies exploring the effect of body mass index (BMI) on outcomes in the intensive care unit (ICU) have yielded mixed results, with few studies assessing patients at the extremes of obesity. We sought to understand the clinical characteristics and outcomes of patients with super obesity (BMI > 50 kg/m2) as compared to morbid obesity (BMI > 40 kg/m2) and obesity (BMI > 30 kg/m2). Methods: A retrospective review of patients admitted to the Los Angeles County + University of Southern California medical intensive care unit (MICU) service between 2008 and 2013 was performed. The first 150 patients with BMI 30 to 40, 40 to 50, and 50+ were separated into groups. Demographic data, comorbid conditions, reason for admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, serum bicarbonate, and arterial carbon dioxide pressure (Pco 2) at admission were collected. Hospital and ICU length of stay (LOS), discharge disposition, mortality, use of mechanical ventilation (invasive and noninvasive), use of radiography, and other clinical outcomes were also recorded. Results: There was no difference in age, sex, and APACHE II score among the 3 groups. A pulmonary etiology was the most common reason for admission in the higher BMI categories ( P < .001). There was no difference in mortality among the groups. Intensive care unit and hospital LOS rose with increasing BMI ( P < .001). Patients admitted for pulmonary etiologies and higher BMIs had an increased ICU and hospital LOS ( P < .001). Super obese patients used significantly more noninvasive mechanical ventilation (NIMV, P < .001). There were no differences in the use of invasive mechanical ventilation across the groups. Conclusion: Super obese patients are most commonly admitted to the MICU with pulmonary diagnoses and have an increased use of noninvasive ventilation. Super obesity was not associated with increased ICU mortality. Clinicians should be prepared to offer NIMV to super obese patients and anticipate a longer LOS in this group.

Risk Factors to Predict Renal Failure and Death in the Medical Intensive Care Unit

1996 ◽  
Vol 11 (2) ◽  
pp. 114-119 ◽  
Author(s):  
Laurie A. Ward ◽  
George N. Coritsidis ◽  
Christos P. Carvounis
Keyword(s):  
Intensive Care Unit ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Failure Group ◽  
Medical Intensive Care ◽  
Normal Albumin

The ability to predict outcomes based on admission criteria has important implications, both prognostically and for assessing interventions on comparable groups. Use of severity of disease scoring systems such as the APACHE II score for predicting mortality has become widespread. There is no comparable formula for acute renal failure. We prospectively evaluated 115 consecutive admissions to the medical intensive care unit to define risk for renal failure from admission data and to assess the impact of admission hypoalbuminemia levels on outcome. Diagnosis, age, serum creatinine and albumin levels, urinary electrolyte concentrations and osmolality, daily serum creatinine levels, and urine output were recorded. Admission APACHE II score was calculated. Admission hypoalbuminemia (57% of patients) was associated with both acute renal failure and death (odds ratios, 16.19 and 8.06, respectively). The Glasgow coma score distinguished between patients in whom acute renal failure developed and in those it did not. Low urine osmolality (<400 mOsm/kg) was the most significant factor in predicting mortality (odds ratio, 9.87). Mortality was lowest in the normal albumin group (2%), intermediate in the low albumin/no renal failure group (12%), and highest in the low albumin/acute renal failure group (53%). The APACHE II score was accurate in 3 of 14 deaths in the hypoalbuminemic population and in the one normal albumin patient who died. We conclude that at admission, hypoalbuminemia, urinary hypo-osmolality, and abnormal creatinine levels are predictive of acute renal failure and death, diagnosis, and mental status impact on the risk for acute renal failure. APACHE II lacks predictive value in hypoalbuminemic patients.

Comparison of Thyroid Hormone and Cortisol Measurements with APACHE II and TISS Scoring Systems as Predictors of Mortality in the Medical Intensive Care Unit

1997 ◽  
Vol 12 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Ridha Arem ◽  
John I. Thornby ◽  
Scott A. Deppe
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cortisol Level ◽  
Physiological Stress ◽  
Medical Intensive Care Unit ◽  
Apache Ii ◽  
Severe Illness ◽  
Predictors Of Mortality ◽  
Medical Intensive Care ◽  
Cortisol Levels

Thyroid and adrenal functions were evaluated in 49 consecutive critically ill, mechanically ventilated patients admitted to the medical intensive care unit (MICU) at Ben Taub General Hospital in Houston, TX. On admission, severity of illness was assessed by Acute Physiological Assessment and Chronic Health Evaluation II (APACHE II) and Therapeutic Intervention Scoring System (TISS) scores. Thyrotropin Stimulating hormone (TSH) measured with a sensitive assay, thyroxine (T4), tri-iodothyronine (T3), T3 resin uptake, and Cortisol levels were measured on the first MICU day at 8 am, and results were assessed based on ability to predict mortality. It was shown that severe hypothyroxinemia (T4 < 3 μg/dL) was associated with a 75% mortality as opposed to a mortality rate of 19% in patients with a T4 level of 3 μg/dL or more ( p < 0.01), and a high 8 am Cortisol level (>30 μg/mL) was associated with a 56% mortality versus 0% in patients with Cortisol values less than 30 μg/dL ( p < 0.005), whereas a high APACHE II (>25) score and a high TISS (>25) score were only associated with a mortality of 47% ( p = 0.06) and 32% (NS), respectively, versus 21 and 20%, respectively, in patients with scores less than 25. Logistical regression analysis revealed that of all the variables, 8 am Cortisol level had the best predictive value of outcome, followed by T4 levels and T3 resin uptake levels. Although high Cortisol and low T4 levels used alone had a sensitivity of 56 and 75% and a specificity of 100 and 80.5%, respectively, combined low T4 and high Cortisol levels had a sensitivity of 100% and a specificity of 81.5% in predicting mortality. Very low T4 levels, due to severe illness, combined with high Cortisol levels (implying high physiological stress), are more sensitive predictors of mortality than APACHE II, TISS, Cortisol levels, or T4 levels alone, or any other combination of predictors.

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