scholarly journals Maternal admissions to Intensive Care Units in France: trends in rates, causes and severity

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Y Barry ◽  
C Deneux-Tharaux ◽  
M Saucedo ◽  
V Goulet ◽  
I Guseva-Canu ◽  
...  
Keyword(s):  
Intensive Care ◽  
Temporal Trends ◽  
Simplified Acute Physiology Score ◽  
Incidence Rates ◽  
Icu Admission ◽  
Admission Rates ◽  
Saps Ii ◽  
Saps Ii Score ◽  
Territorial Disparities ◽  
Discharge Database

Abstract Introduction Maternal intensive care unit admission (ICU) is an indicator of severe maternal morbidity. This study aimed to estimate rates of maternal ICU admission during or following pregnancy in France, and to describe the characteristics of women admitted, the severity of their condition, associated diagnoses, regional disparities, and temporal trends between 2010 and 2014. Methods Women hospitalised in France in ICU during pregnancy or up to 42 days after pregnancy between 2010 and 2014 were identified using the national hospital discharge database (PMSI-MCO). The Simplified Acute Physiology Score (SAPS II) was used to estimate the severity. Trends in incidence rates were quantified using percentages of average annual variation based on a Poisson regression model. Results In total, 16,011 women were admitted to ICU, representing an overall rate of 3.97 ‰ deliveries. The average annual decrease in this rate between 2010 and 2014 was 1.7% (IC95%:-2, 00%; -1, 45%; p < 0.0001) on average per year. The SAPS II score increased significantly from 18.4 in 2010 to 21.5 in 2014. Obstetrical hemorrhage (39.8%) and hypertensive complications during pregnancy (24.8%) were the most common reasons for admission. Within mainland France, we found notable disparities in maternal ICU admission rates between regions, from lowest in Pays-de-la-Loire region (2.69‰) to highest in Ile-de-France (5.05‰). Conclusions The rate of maternal ICU admission decreased from 2010 to 2014 in France, with a concomitant increase in case severity. Additional studies are needed to understand the territorial disparities identified in our study. Key messages The decreasing incidence of maternal ICU admission could be due to organisational changes with increased admission to intermediate care units. These changes have to be understood to accurately use maternal CU admission for maternal health surveillance.

A simplified acute physiology score in the prediction of acute organophosphate poisoning outcome in an intensive care unit

2007 ◽  
Vol 26 (8) ◽  
pp. 623-627 ◽  
Author(s):  
S. Shadnia ◽  
D. Darabi ◽  
A. Pajoumand ◽  
A. Salimi ◽  
M. Abdollahi
Keyword(s):  
Intensive Care ◽  
Simplified Acute Physiology Score ◽  
Acute Physiology Score ◽  
Organophosphate Poisoning ◽  
Poison Center ◽  
Survival Group ◽  
Icu Admission ◽  
Saps Ii ◽  
Saps Ii Score ◽  
The Impact

Organophosphate poisoning (OPP) occurs frequently and accounts for a large number of intoxication cases treated in intensive care units (ICU). Poisoning by these agents is a serious public health problem. Among pesticides, OPs are the main cause of poisoning and death in Loghman-Hakim Poison Center of Tehran, Iran. The aim of this study was to determine the impact of the Simplified Acute Physiology Score (SAPS II) in the prediction of mortality in patients with acute OPP requiring admission to the ICU of Loghman-Hakim Hospital Poison Center over a period of 12 months. This study was a prospective, case-control of records of patients with acute OPP admitted to the ICU between January 2006 and December 2006. The Demographic data were collected and SAPS II score was recorded. During the study period, 24 subjects were admitted to the ICU with acute OPP. All 24 patients (15 male) required endotracheal intubation and mechanical ventilation in addition to gastric decontamination and standard therapy with atropine and oximes and adequate hydration. Of these, 24 patients, eight (five male) died. SAPS II score was significantly higher in the non-survival group than the survival group. Mortality following acute OPP remains high despite adequate intensive care and specific therapy with atropine and oximes. One-third of the subjects needing intensive care die within the hospitalization period. SAPS II scores calculated within the first 24 hours were recognized as good prognostic indicator among patients with acute OPP that required ICU admission. It is concluded that SAPS II score above 11 within the first 24 hours is a predictor of poor outcome in patients with acute OPP requiring ICU admission. Human & Experimental Toxicology (2007) 26, 623—627

Prognostic Factors for Neutropenic Patients Admitted to Intensive Care.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3900-3900
Author(s):  
Madalena Silva ◽  
Luisa Checa ◽  
Fatima Costa ◽  
Rui Moreno ◽  
Eduardo G. Silva ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Underlying Disease ◽  
Simplified Acute Physiology Score ◽  
Prognostic Impact ◽  
Saps Ii ◽  
Severity Scores ◽  
Saps Ii Score ◽  
Organ Failures ◽  
Neutropenic Patients

Abstract The admission of neutropenic patients (pts) to intensive care units (ICU) is controversial, especially when mechanical ventilation is required. Knowledge of the relative prognostic impact of factors related to the underlying disease and to the severity of acute organ failures might help avoiding futile admissions. We retrospectively assessed predictors of 30-day mortality in neutropenic (<1000/ul) pts referred from a single Hematology unit to the 2 ICUs of the institution over a 10-year period. Of 66 consecutive pts, median age 48 (15–73), 82% had acute leukemia (AL) and 21% were in complete remission (CR). On ICU admission 62% of the pts had a neutrophil count ≤500/ul; microbiologically documented infection was found in 42%. The main reason for ICU referral was severe sepsis or septic shock in 62% of the cases and respiratory failure in 38%. Seventy per cent of the pts were already on vasopressor agents. At ICU entry the median Simplified Acute Physiology Score (SAPS) II was 63 and 26% of pts had ≥ 2 acute organ system failures (OSF). Coma was present in 23%. Mechanical ventilation was eventually needed in 89% and dialysis in 9% of the pts. Mortality at 30 days was 73%. By univariate logistic regression analysis mortality was not significantly related to age, to status of underlying disease (CR vs no CR/not yet known) to duration of neutropenia nor to depth of neutropenia at entry (≤ 500 vs >500/ul). Pts who died were more likely to have non-M3 AL subtype vs M3 (p=0.037), to have ≥ 2 acute OSF vs < 2 (p=0.012) and a higher SAPS II score (p< 0.001). In multivariate analysis only the latter 2 variables remained significant. In conclusion, our data show that 27% of neutropenic pts admitted to ICUs are alive at 30 days; that selection for admission should not be based on the characteristics of the underlying malignancy; and that the 30-day mortality is highly predictable by initial acute illness severity scores.

scholarly journals Early Prediction of Seven-Day Mortality in Intensive Care Unit Using a Machine Learning Model: Results from the SPIN-UTI Project

2021 ◽  
Vol 10 (5) ◽  
pp. 992
Author(s):  
Martina Barchitta ◽  
Andrea Maugeri ◽  
Giuliana Favara ◽  
Paolo Marco Riela ◽  
Giovanni Gallo ◽  
...  
Keyword(s):  
Machine Learning ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Learning Algorithm ◽  
Area Under The Curve ◽  
Support Vector ◽  
Icu Admission ◽  
Risk Of Death ◽  
Saps Ii ◽  
Svm Algorithm

Patients in intensive care units (ICUs) were at higher risk of worsen prognosis and mortality. Here, we aimed to evaluate the ability of the Simplified Acute Physiology Score (SAPS II) to predict the risk of 7-day mortality, and to test a machine learning algorithm which combines the SAPS II with additional patients’ characteristics at ICU admission. We used data from the “Italian Nosocomial Infections Surveillance in Intensive Care Units” network. Support Vector Machines (SVM) algorithm was used to classify 3782 patients according to sex, patient’s origin, type of ICU admission, non-surgical treatment for acute coronary disease, surgical intervention, SAPS II, presence of invasive devices, trauma, impaired immunity, antibiotic therapy and onset of HAI. The accuracy of SAPS II for predicting patients who died from those who did not was 69.3%, with an Area Under the Curve (AUC) of 0.678. Using the SVM algorithm, instead, we achieved an accuracy of 83.5% and AUC of 0.896. Notably, SAPS II was the variable that weighted more on the model and its removal resulted in an AUC of 0.653 and an accuracy of 68.4%. Overall, these findings suggest the present SVM model as a useful tool to early predict patients at higher risk of death at ICU admission.

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 Outcome of Patients With Necrotizing Vasculitis Admitted to the Intensive Care Unit (ICU) for Sepsis: Results of a Single-Centre Retrospective Analysis

2020 ◽  
pp. 088506662095376
Author(s):  
Marco Krasselt ◽  
Christoph Baerwald ◽  
Sirak Petros ◽  
Olga Seifert
Keyword(s):  
Intensive Care Unit ◽  
Logistic Regression ◽  
Intensive Care ◽  
Tertiary Hospital ◽  
Simplified Acute Physiology Score ◽  
Apache Ii ◽  
Necrotizing Vasculitis ◽  
Multivariate Logistic Regression ◽  
Sepsis Mortality ◽  
Saps Ii

Introduction/Background: Vasculitis patients have a high risk for infections that may require intensive care unit (ICU) treatment in case of resulting sepsis. Since data on sepsis mortality in this patient group is limited, the present study investigated the clinical characteristics and outcomes of vasculitis patients admitted to the ICU for sepsis. Methods: The medical records of all necrotizing vasculitis patients admitted to the ICU of a tertiary hospital for sepsis in a 13-year period have been reviewed. Mortality was calculated and multivariate logistic regression was used to determine independent risk factors for sepsis mortality. Moreover, the predictive power of common ICU scores was further evaluated. Results: The study included 34 patients with necrotizing vasculitis (mean age 69 ± 9.9 years, 35.3% females). 47.1% (n = 16) were treated with immunosuppressives (mostly cyclophosphamide, n = 35.3%) and 76.5% (n = 26) received glucocorticoids. Rituximab was used in 4 patients (11.8%).The in-hospital mortality of septic vasculitis patients was 41.2%. The Sequential Organ Failure Assessment (SOFA) score (p = 0.003) was independently associated with mortality in multivariate logistic regression. Acute Physiology And Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II) and SOFA scores were good predictors of sepsis mortality in the investigated vasculitis patients (APACHE II AUC 0.73, p = 0.02; SAPS II AUC 0.81, p < 0.01; SOFA AUC 0.898, p < 0.0001). Conclusions: Sepsis mortality was high in vasculitis patients. SOFA was independently associated with mortality in a logistic regression model. SOFA and other well-established ICU scores were good mortality predictors.

scholarly journals Performance of Sequential Organ Failure Assessment and Simplified Acute Physiology Score II for Post-Cardiac Surgery Patients in Intensive Care Unit

2021 ◽  
Vol 8 ◽  
Author(s):  
Fei Xu ◽  
Weina Li ◽  
Cheng Zhang ◽  
Rong Cao
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Scoring System ◽  
Simplified Acute Physiology Score ◽  
Saps Ii ◽  
Icu Stay ◽  
Cutoff Values ◽  
Adjusted Model

Background: The aim of this study is to assess the performance of Sequential Organ Failure Assessment (SOFA) score and Simplified Acute Physiology Score (SAPS II) on outcomes of patients with cardiac surgery and identify the cutoff values to provide a reference for early intervention.Methods: All data were extracted from MIMIC-III (Medical Information Mart for Intensive Care-III) database. Cutoff values were calculated by the receiver-operating characteristic curve and Youden indexes. Patients were grouped, respectively, according to the cutoff values of SOFA and SAPS II. A non-adjusted model and adjusted model were established to evaluate the prediction of risk. Comparison of clinical efficacy between two scoring systems was made by decision curve analysis (DCA). The primary outcomes of this study were in-hospital mortality, 28-day mortality, 90-day mortality, and 1-year mortality after cardiac surgery. The secondary outcomes included length of hospital stay and intensive care unit (ICU) stay and the incidence of acute kidney injury (AKI) within 7 days after ICU admission.Results: A total of 6,122 patients were collected and divided into the H-SOFA group (SOFA ≥ 7) and L-SOFA group (SOFA &lt; 7) or H-SAPS II group (SAPS II ≥ 43) and L-SAPS II group (SAPS II &lt; 43). In-hospital mortality, 28-day mortality, 90-day mortality, and 1-year mortality were higher, the length of hospital and ICU stay were longer in the H-SOFA group than in the L-SOFA group (p &lt; 0.05), while the incidence of AKI was not significantly different. In-hospital mortality, 28-day mortality, 90-day mortality, 1-year mortality, and the incidence of AKI were all significantly higher in the H-SAPS II group than in the L-SAPS II group (p &lt; 0.05). Hospital stay and ICU stay were longer in the H-SAPS II group than in the L-SAPS II group (p &lt; 0.05). According to DCA, the SAPS II scoring system had more net benefits on assessing the long-term mortality compared with the SOFA scoring system.Conclusion: Exceeding the cutoff values of SOFA and SAPS II scores could lead to increased mortality and extended length of ICU and hospital stay. The SAPS II scoring system had a better discriminative performance of 90-day mortality and 1-year mortality in post-cardiac surgery patients than the SOFA scoring system. Emphasizing the critical value of the scoring system is of significance for timely treatment.

scholarly journals Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e10326
Author(s):  
Stanislas Kandelman ◽  
Jérémy Allary ◽  
Raphael Porcher ◽  
Cássia Righy ◽  
Clarissa Francisca Valdez ◽  
...  
Keyword(s):  
Intensive Care ◽  
Deep Sedation ◽  
Simplified Acute Physiology Score ◽  
Sedation Scale ◽  
Neurological Assessment ◽  
Multicenter Cohort Study ◽  
Cough Reflex ◽  
Saps Ii ◽  
Brain Injured ◽  
Injured Patients

Background Deep sedation may hamper the detection of neurological deterioration in brain-injured patients. Impaired brainstem reflexes within the first 24 h of deep sedation are associated with increased mortality in non-brain-injured patients. Our objective was to confirm this association in brain-injured patients. Methods This was an observational prospective multicenter cohort study involving four neuro-intensive care units. We included acute brain-injured patients requiring deep sedation, defined by a Richmond Assessment Sedation Scale (RASS) < −3. Neurological assessment was performed at day 1 and included pupillary diameter, pupillary light, corneal and cough reflexes, and grimace and motor response to noxious stimuli. Pre-sedation Glasgow Coma Scale (GCS) and Simplified Acute Physiology Score (SAPS-II) were collected, as well as the cause of death in the Intensive Care Unit (ICU). Results A total of 137 brain-injured patients were recruited, including 70 (51%) traumatic brain-injured patients, 40 (29%) vascular (subarachnoid hemorrhage or intracerebral hemorrhage). Thirty patients (22%) died in the ICU. At day 1, the corneal (OR 2.69, p = 0.034) and cough reflexes (OR 5.12, p = 0.0003) were more frequently abolished in patients that died in the ICU. In a multivariate analysis, abolished cough reflex was associated with ICU mortality after adjustment to pre-sedation GCS, SAPS-II, RASS (OR: 5.19, 95% CI [1.92–14.1], p = 0.001) or dose of sedatives (OR: 8.89, 95% CI [2.64–30.0], p = 0.0004). Conclusion Early (day 1) cough reflex abolition is an independent predictor of mortality in deeply sedated brain-injured patients. Abolished cough reflex likely reflects a brainstem dysfunction that might result from the combination of primary and secondary neuro-inflammatory cerebral insults revealed and/or worsened by sedation.

Prognosis of Very Elderly Patients After Intensive Care

2021 ◽  
Author(s):  
Philippe Michel ◽  
Fouad FADEL ◽  
Gaëtan Plantefève ◽  
Stephan Ehrmann ◽  
bruno Gelée
Keyword(s):  
Intensive Care ◽  
Elderly Patients ◽  
Telephone Interview ◽  
Epidemiological Data ◽  
Acute Pulmonary Oedema ◽  
Age Group ◽  
Very Elderly ◽  
Exclusion Criteria ◽  
Saps Ii ◽  
Saps Ii Score

Abstract Background: Very elderly patients (aged over 85 years) are increasingly treated in intensive care units (ICU) despite the reluctance of doctors to admit these patients considered fragile. Only a few studies in this age group have described the relevance of treatment of these patients in the intensive care unit. Methods: he inclusion criterion for this study was patients aged 85 years or over on admission. The exclusion criteria were high dependence before admission or an inability to answer the telephone. Epidemiological data, antecedents, lifestyle, autonomy (ADL score of six items) were recorded on admission to the ICU and by telephone interview at six months. Results: Eight French ICU included 239 patients aged over 85 years. The most common diagnoses were non-cradiogenic lung disease (36%), severe sepsis / septic shock (29%) and acute pulmonary oedema (28%). 23% of patients were dependent on admission. 71% of patients were still living when discharged from the ICU and 52% were still living at 6 months. Among the non-dependent patients before hospitalisation, 17% became dependent. The only prognostic criteria found were the SAPS II score on admission and the place of residence before admission (nursing home or ”with family” had a poor prognosis). Conclusions: Although the prognosis of these very elderly patients was good after hospitalisation in the ICU, it should be noted that the population was highly selected with few comorbidities or dependence. No triage criteria could be proposed. ClinicalTrials.gov Identifier: NCT02849756

Acute Myeloid Leukemia and Survival on the Intensive Care Unit (ICU) - Biology- and Treatment-Related Determinants of Outcome - An Analysis of the AML-CG

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2166-2166
Author(s):  
Bernhard Heilmeier ◽  
Johannes Thudium ◽  
Matthias Kochanek ◽  
Christoph Schmid ◽  
Joachim Stemmler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Univariate Analysis ◽  
Primary Diagnosis ◽  
Induction Phase ◽  
Icu Admission ◽  
Saps Ii ◽  
Icu Outcome

Abstract Abstract 2166 Background: An established factor for predicting the mortality of patients admitted to an ICU is the Severe Acute Physiology Score (SAPS) II. However, for patients with acute myeloid leukemia (AML) it is uncertain whether factors beyond SAPS II do influence the ICU outcome. Therefore we examined additional factors including age and factors related to AML biology and its treatment in the so far largest cohort of patients with AML worldwide regarding their ICU outcome. Methods: Retrospective analysis of 256 patients with 366 admissions to medical ICU between 2004 and 2009 in 3 large German hematologic centers. Patient age and gender, reason for ICU admission, duration of intensive care, SAPSII, need for invasive mechanical ventilation (IMV), renal replacement therapy and/or vasopressors, laboratory values at ICU admission for creatinine, bilirubin and C-reactive protein, AML karyotype, presence of FLT3-ITD and/or NPM1-mutation, FAB classification, last AML treatment, AML status and allogeneic transplant status were evaluated as potential risk factors. Correlations were analyzed using the Mann-Whitney U test. Univariate analysis was performed using the log rank test for the time until death on ICU occurred. Significant risk factors were studied in multivariate analysis (Cox regression). Results: At the time of analysis (08/2010) the median age of patients was 55.3 (range 19.7–84.9) years, and 47.5% were female. 46% of ICU admissions were due to infectious complications. A respiratory problem was present in 60% of the ICU transfers. IMV, vasopressors and renal replacement therapy were necessary in 51.3%, 42.6% and 22.7%, respectively, of the ICU courses. ICU survival was 64.8%. AML status was primary diagnosis/induction phase in 53.3%, postremission phase in 15.8% and relapse/refractory in 27.6% of ICU courses. 66.4% of admissions to ICU had conservative treatment (no transplant), 15.8% underwent allogeneic hematopoietic stem cell transplantation (allo SCT) in the same hospital stay (peritransplant status) and 14.5% had had allo SCT in a former hospital stay (posttransplant status). AML karyotype was favourable in 7.1%, intermediate in 47.8% and unfavourable in 20.2%. SAPS II was available in 208 ICU transfers. Duration of intensive care was 8.1 (mean)/3.0 (median) days with a range from 0.5–76 days. In univariate analysis risk factors predicting diminished ICU survival were high SAPS II (p=0.008), sepsis as reason for ICU admission (p=0.007), need for IMV (p<0.001), use of vasopressors (p<0.001), renal replacement therapy (p=0.002), intermediate or unfavourable AML karyotype (p=0.027), FAB classification other than AML M3 (p=0.012), postremission or relapse/refractory status of AML (p=0.029) and posttransplant status of AML (p=0.002). ICU mortality was lower in primary diagnosis/induction phase and higher in posttransplant phase of AML than predicted by the median SAPS II of these cohorts. In multivariate analysis the only significant predictor of inferior ICU survival was the extent of vasopressor treatment (hazard ratio (hr) 1.83, 95% CI 1.09–3.08; p=0.022), whereas high SAPS II was of borderline significance (hr 1.02, 95% CI 1.00– 1.03; p=0.064). Conclusions: In contrast to the broad majority of ICU patients, SAPS II is not an optimal predictor of ICU survival in patients with AML. Disease status was of high relevance with an AML status of primary diagnosis/induction phase indicating a better and posttransplant (but not peritransplant) status a worse ICU survival than predicted by SAPS II. The strongest predictor for ICU mortality was the extent of vasopressor use. In contrast age up to the 8th decade had no impact on ICU survival. These results may help to better define ICU admission and treatment policies for patients with AML. Disclosures: No relevant conflicts of interest to declare.

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