Prognostic Value of Lactate / Albumin Ratio combined with APACHE II, SAPS II and SOFA Score for Predicting Mortality in Critically Ill Patients with Septic Shock

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Walid H Nofal ◽  
Sahar K Abo Alela ◽  
Moustafa M Aldeeb ◽  
Gamal M Elewa
Keyword(s):  
Septic Shock ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Predictive Value ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Albumin Ratio ◽  
Saps Ii ◽  
Saps Ii Score

Abstract Background Despite all worldwide efforts towards sepsis, more than 5.3 million patients die annually. Till now, there is no parameter or score to detect mortality in septic patients precisely. Objectives The aim of this study was to evaluate the prognostic performance of the lactate/albumin (L/A) ratio when combined with APACHE II score, SOFA score and SAPS II for predicting 28-day mortality in critically ill patients with septic shock. Patients and Methods After approval of the Medical Ethics Committee of Ain Shams Faculty of Medicine, an informed consent was taken from the patient or next of kin to include his/her data in this study. All patients who were admitted to the intensive care units (ICUs) with septic shock from 1st of September, 2019 to 30th of March, 2020 were assessed for enrollment in this study. Results In this prospective observational study, 100 adult patients of both sexes with septic shock were enrolled. They were categorized into two groups according to the primary endpoint (outcome) “28-days mortality”. Sixty-one patients (61%) died (non-survivors’ group) and thirtynine patients (39%) survived (survivors group). The most significant factors which affecting the mortality were LAR, SOFA score on admission, APACHE II, and SAPS II score. Prediction performance of the four variables for estimating 28 days mortality. When combined LAR + SOFA, LAR + APACHE, LAR + SAPS II, Overall score the ROC (AUROC, 0.867,0.847,0.849,,0.899 respectively) was the highest, compared to the other single models and lower cutoff (>0.48, >0.53, >0.42, >0.47 respectively)in comparison to single scores. Moreover, the overall score (including the 4 parameters together) gave the best predictive value for 28 day mortality Conclusion Lactate/Albumin ratio combined with APACHI II, SOFA and SAPS scores gave the best predictive value for 28 day mortality in septic shock patients, when compared with each separate score Recommendations combined LAR + SOFA, LAR + APACHE, LAR + SAPS II, Overall score recommended to use to predictho spital mortality, Further research on large sample sizeto study the risk stratification and implementing new scores using the lactate/albumin ratio (LAR) is needed. Simple, available and cheap markers should be used in developing new prediction scores.

scholarly journals Combining Sequential Organ Failure Assessment (SOFA) Score with Acute Physiology and Chronic Health Evaluation (APACHE) II Score to Predict Hospital Mortality of Critically Ill Patients

2007 ◽  
Vol 35 (4) ◽  
pp. 515-521 ◽  
Author(s):  
K. M. Ho
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Characteristic Curve ◽  
Apache Ii ◽  
Brier Score ◽  
Apache Ii Score ◽  
Failure Assessment ◽  
Predict Hospital Mortality

The ability to accurately adjust for the severity of illness in outcome studies of critically ill patients is essential. Previous studies have showed that Sequential Organ Failure Assessment (SOFA) score and Acute Physiology and Chronic Health Evaluation (APACHE) II score can predict hospital mortality of critically ill patients. The effects of combining these two scores to predict hospital mortality of critically ill patients has not been evaluated. This cohort study evaluated the performance of combining the APACHE II score with SOFA score in predicting hospital mortality of critically ill patients. A total of 1,311 consecutive adult patients admitted to a tertiary 22-bed multidisciplinary intensive care unit (ICU) in Western Australia were considered. The APACHE II, Admission SOFA, Delta SOFA and maximum SOFA score were all related to hospital survival in the univariate analyses. Combining Max SOFA (area under receiver operating characteristic curve 0.875 vs. 0.858, P=0.014; Nagelkerke R2: 0.411 vs. 0.371; Brier Score: 0.086 vs. 0.090) or Delta SOFA score (area under receiver operating characteristic curve 0.874 vs. 0.858, P=0.003; Nagelkerke R2: 0.412 vs. 0.371; Brier Score: 0.086 vs. 0.090) with the APACHE II score improved the discrimination and overall performance of the predictions when compared with using the APACHE II score alone, especially in the emergency ICU admissions. Combining Max SOFA or Delta SOFA score with the APACHE II score may improve the accuracy of risk adjustment in outcome studies of critically ill patients.

scholarly journals The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients

2018 ◽  
Vol 7 (10) ◽  
pp. 333 ◽  
Author(s):  
Ji Park ◽  
Kyung Chung ◽  
Joo Song ◽  
Song Kim ◽  
Eun Kim ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Univariate Analysis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Proportional Hazard ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
Cox Proportional Hazard

The C-reactive protein (CRP)/albumin ratio has recently emerged as a marker for poor prognosis or mortality across various patient groups. This study aimed to identify the association between CRP/albumin ratio and 28-day mortality and predict the accuracy of CRP/albumin ratio for 28-day mortality in medical intensive care unit (ICU) patients. This was a retrospective cohort study of 875 patients. We evaluated the prognostic value of CRP/albumin ratio to predict mortality at 28 days after ICU admission, using Cox proportional hazard model and Kaplan-Meier survival analysis. The 28-day mortality was 28.0%. In the univariate analysis, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score (p < 0.001), CRP level (p = 0.045), albumin level (p < 0.001), and CRP/albumin ratio (p = 0.032) were related to 28-day mortality. The area under the receiver operating characteristic (ROC) curve (the area under the ROC curves (AUC)) of CRP/albumin ratio was higher than that of CRP for mortality (0.594 vs. 0.567, p < 0.001). The cut-off point for CRP/albumin ratio for mortality was 34.3. On Cox proportional-hazard regression analysis, APACHE II score (hazards ratio (HR) = 1.05, 95% confidence interval (CI) = 1.04–1.07, p < 0.001) and CRP/albumin ratio (HR = 1.68, 95% CI = 1.27–2.21, p < 0.001 for high CRP/albumin ratio) were independent predictors of 28-day mortality. Higher CRP/albumin ratio was associated with increased mortality in critically ill patients.

scholarly journals The Impact of Serum Glucose on the Predictive Value of Serum Lactate for Hospital Mortality in Critically Ill Surgical Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Xue Chen ◽  
Jianbin Bi ◽  
Jia Zhang ◽  
Zhaoqing Du ◽  
Yifan Ren ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
High Glucose ◽  
Predictive Ability ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Glucose Levels ◽  
Glucose Group

Background. Lactate has been widely used as a risk indicator of outcomes in critically ill patients due to its ready measurement and good predictive ability. However, the interconnections between lactate metabolism and glucose metabolism have not been sufficiently explored, yet. In this study, we aimed to investigate whether glucose levels could influence the predictive ability of lactate and design a more comprehensive strategy to assess the in-hospital mortality of critically ill patients. Methods. We analyzed the clinical data of 293 critically ill patients. The primary outcome was in-hospital mortality. The logistic regression analysis and the area under the receiver operating characteristic curve (AUROC) were applied to evaluate the predictive ability of lactate in association with glucose. Results. The lactate level showed significant association with in-hospital mortality, and its predictive ability was also comparable to other prognostic scores such as the SOFA score and APACHE II score. We further divided 293 patients into three groups based on glucose levels: low-glucose group (<7 mmol/L), medium-glucose group (7-9 mmol/L), and high-glucose group (>9 mmol/L). The lactate level was associated with in-hospital mortality in the low- and high- glucose groups, but not in the medium-glucose group, whereas the SOFA score and APACHE II score were associated with in-hospital mortality in all three glucose groups. The AUROC of lactate in the medium-glucose group was also the lowest among the three glucose groups, indicating a decrease in its predictive ability. Conclusions. Our findings demonstrated that the predictive ability of lactate to assess in-hospital mortality could be influenced by glucose levels. In the medium glucose level (i.e., 7-9 mmol/L), lactate was inadequate to predict in-hospital mortality and the SOFA score; the APACHE II score should be utilized as a complementation in order to obtain a more accurate prediction.

scholarly journals A Comparison of Severity Systems APACHE II and SAPS II in Critically ill Patients

2013 ◽  
Vol 1 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Mohammad Omar Faruq ◽  
Mohammad Rashed Mahmud ◽  
Tanjima Begum ◽  
ASM Areef Ahsan ◽  
Kaniz Fatema ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Goodness Of Fit ◽  
Care Quality ◽  
Apache Ii ◽  
Goodness Of Fit Test ◽  
Saps Ii ◽  
Icu Discharge ◽  
Saps Ii Score

Objective: To assess the performance of Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in Bangladeshi critically ill patients. Material and Method: Prospective observational cohort study conducted between January 1, 2008 and December 31, 2008 in the Intensive Care Unit (ICU) of BIRDEM Hospital, an 600-beds tertiary referral Postgraduate hospital and October to December 2008 in ICU, Ibn Sina Hospital Dhaka. Results: One hundred ninety four patients were enrolled. There were 58 deaths (42.65%) at ICU discharge. APACHE II and SAPS II predicted hospital mortality 35.32 ± 21.81and 37.11 ± 27.34 respectively. Both models showed excellent discrimination. The overall discriminatory capability, as measured by the aROC, was generally good for two models and ranged from 0.78 to 0.89. APACHE II is slightly better compared to SAPS II score but not significantly better than SAPS II. Both systems exhibited good calibration ( = 8.304, p = 0.40 for APACHE II, = 9.040, p = 0.34 for SAPS II). Hosmer- Lemeshow goodness-of-fit test revealed a good performance for APACHE II scores. Conclusion: APACHE II provided better performance than SAPS II in predicting mortality in our ICU patients but SAPS II also performed well. Our observed mortality was similar with the predicted mortality from APACHE II and SAPS II scores, which suggests that the result of this study reveals good intensive care quality. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14362 Bangladesh Crit Care J March 2013; 1: 27-32

scholarly journals Nutritional Assessment in the Critically Ill Patients

2020 ◽  
Author(s):  
Elham Bagheri ◽  
Farzaneh Hematian ◽  
Mandana Izadpanah ◽  
Mahbobeh Rashidi
Keyword(s):  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Nutritional Assessment ◽  
Apache Ii ◽  
Nutritional Risk ◽  
Apache Ii Score ◽  
Number Of Patients ◽  
Study Results ◽  
The Impact

Background: Malnutrition is a prevalent complication among critically ill patients. It has very detrimental effects on the patients' clinical course. This study aimed to investigate the impact of nutrition in the intensive care unit (ICU) patients. Methods: In this epidemiologic-analytic study conducted in the surgical ICU of Imam Khomeini hospital, Ahvaz, Iran, 34 patients were selected and divided into two groups. The first group of patients received the appropriate nutrition. The second group received an inappropriate diet, and the nutritional risk was evaluated according to the modified- Nutrition Risk in Critically ill (m-NUTRIC) score. The energy was calculated by using 25 Kcal/kg, also the two groups were compared in terms of ICU mortality, ICU stays, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II Scoring, and the Sequential Organ Failure Assessment (SOFA) Score. Results: Baseline data, such as APACHE II score and mean age, except sex, were not significantly different between the two groups. In this study, results were toward shorter ICU stay, less mortality, and better SOFA score in the group receiving appropriate nutrition compared to the other group. However, due to the low number of patients, no significant differences were observed in the two groups. Conclusion: Our data suggest that nutritional support should be considered as an essential part of the medication during critical illness.

scholarly journals Circulating levels of GH predict mortality and complement prognostic scores in critically ill medical patients

2009 ◽  
Vol 160 (2) ◽  
pp. 157-163 ◽  
Author(s):  
Philipp Schuetz ◽  
Beat Müller ◽  
Charly Nusbaumer ◽  
Melanie Wieland ◽  
Mirjam Christ-Crain
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Plasma Concentrations ◽  
Clinical Severity ◽  
Apache Ii ◽  
Saps Ii ◽  
Prognostic Accuracy ◽  
Saps Ii Score ◽  
Circulating Levels ◽  
Igfbp 3

BackgroundCirculating levels of GH are increased during critical illness and correlate with outcome in children with meningococcal sepsis. We assessed the prognostic implications of GH on admission and during follow-up in critically ill adult patients admitted to a medical intensive care unit.Materials and methodsWe measured GH, IGF1 and IGF-binding protein3 (IGFBP-3) plasma concentrations in 103 consecutive critically ill patients and compared it with two clinical severity scores (APACHE II, SAPS II).ResultsMedian GH levels on admission were similar in septic (n=53) and non-septic (n=50) patients and about 7-fold increased in the 24 non-survivors as compared with survivors (9.50 (interquartile ranges (IQR) 3.53–18.40) vs 1.4 (IQR 0.63–5.04), P<0.0001). GH levels increased with increasing severity of sepsis (sepsis, severe sepsis, and septic shock, P=0.019). By contrast, IGF1 and IGFBP-3 did not correlate with severity of disease or mortality. Logistic regression models showed that GH and both clinical scores were independent predictors of mortality with a similar prognostic accuracy (GH: area under the curve (AUC) 0.81 (95% confidence interval (CI), 0.71–0.92), APACHE II: AUC 0.71 (95% CI, 0.58–0.83), P=0.16, SAPS II: AUC 0.75 (95% CI, 0.63–0.86, P=0.36)). GH improved the prognostic accuracy of the APACHE II score to an AUC of 0.78 (95% CI, 0.66–090, P=0.04) and tended to improve the SAPS II score to an AUC of 0.79 (95% CI, 0.67–0.90, P=0.09).ConclusionGH plasma concentrations on admission are independent predictors for mortality in adult critically ill patients and may complement existing risk prediction scores, namely the APACHE II and the SAPS II score.

scholarly journals Comparing the APACHE II, SOFA, LOD, and SAPS II scores in patients who have developed a nosocomial infection

2014 ◽  
Vol 2 (1) ◽  
pp. 4-9
Author(s):  
Ahmed Haddadi ◽  
Mohamed Ledmani ◽  
Marc Gainier ◽  
Hubert Hubert ◽  
P Lafaye De Micheaux
Keyword(s):  
Intensive Care ◽  
Nosocomial Infection ◽  
Sofa Score ◽  
Apache Ii ◽  
Apache Ii Score ◽  
The Third ◽  
Saps Ii ◽  
Icu Stay ◽  
Logistic Organ Dysfunction ◽  
Saps Ii Score

Background: There have been numerous scores intended to evaluate the severity of patients’ condition upon admission and during their intensive care unit (ICU) stay. However, to our knowledge, no study has ever evaluated the predictive abilities of these scores among nosocomial patients during their ICU stay. The aim of our study is to compare the predictive performances of the Acute Physiology, and, Chronic Health Evaluation (APACHE II) score, Simplified Acute Physiologic Score (SAPS II), Logistic Organ Dysfunction (LOD), and Sequential Organ Failure Assessment (SOFA) scores among intensive care patients who have developed a nosocomial infection. Methods: The study is monocentric and retrospective. The APACHE II, SAPS II, LOD, and SOFA scores were reported from the third day of the patient’s hospital stay, preceding the diagnosis of the first nosocomial event up to the third post diagnosis day. Results: Out of 46 patients contracting at least one ICU-acquired infection, the multiple analyses indicated that on the day of diagnosis, the SOFA score is the most predictive (odds ratio [OR]: 12.3; 95% confidence interval [CI]: 2.33–64.91). The second most predictive was the APACHE II score (OR: 8.29; 95% CI: 1.43–48.14). The third and fourth most predictive were the LOD score (OR: 4.06; 95% CI: 0.81–20.26) and the SAPS II score (OR: 2.26; 95% CI: 0.55–9.24), respectively. Conclusion: The analysis of the receiver operating characteristic areas under the curve of the reported scores in the present study showed that the best predictive performance is in favor of the SOFA score. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19949 Bangladesh Crit Care J March 2014; 2 (1): 4-9

scholarly journals Relationships between serum procalcitonin level, severity and different stresses of non-septic critically ill patients

2020 ◽  
Vol 28 (1) ◽  
pp. 49-56
Author(s):  
Juncheng Shi ◽  
Qiankun Shi ◽  
Shoutao Yuan ◽  
Wenhao Zhang
Keyword(s):  
Mortality Rate ◽  
Critically Ill ◽  
Traumatic Stress ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Stress Group ◽  
Inflammatory Stress ◽  
Induced Stress

AbstractBackground: To explore the relationships between serum procalcitonin (PCT) level, severity and different stresses of non-septic critically ill patients.Materials and Methods: Patients were divided into traumatic stress, stroke-induced stress and non-infectious inflammatory stress groups. According to 28-day prognosis, they were divided into survival and death groups. The factors affecting prognosis were studied by multivariate logistic regression analysis.Results: PCT level was significantly positively correlated with Acute Physiology and Chronic Health Evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores (P=0.001). The PCT level and abnormality rate of the traumatic stress group significantly exceeded those of other groups (P---lt---0.05). The APACHE II score, SOFA score and 28-day mortality rate of traumatic stress and stroke-induced stress groups significantly exceeded those of the non-infectious inflammatory stress group (P---lt---0.05). The PCT level, APACHE II score and SOFA score of the death group significantly surpassed those of the survival group (P---lt---0.05). With rising PCT level, APACHE II score, SOFA score and 28-day mortality rate all increased, with significant intergroup differences (P---lt---0.01). Multivariate logistic analysis showed that serum PCT level, APACHE II score and SOFA score were independent risk factors for prognosis. The area under ROC curve for prognosis evaluated by PCT level was 0.797 (95%CI = 0.710~0.878, P=0.000). At a 4.3 μg/L cut-off, the sensitivity and specificity for predicting 28-day mortality were 87.4% and 78.1%, respectively.Conclusion: The serum PCT level of non-septic critically ill patient was positively correlated with severity, which was more likely elevated by traumatic stress than other stresses.

scholarly journals Risk factors for mortality in critically ill patients with COVID-19: a multicenter retrospective case-control study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jinghua Gao ◽  
Li Zhong ◽  
Ming Wu ◽  
Jingjing Ji ◽  
Zheying Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Organ Failure ◽  
Critically Ill ◽  
Sofa Score ◽  
Lymphocyte Count ◽  
Cox Regression ◽  
Survival Curve ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Hospital Death

Abstract Background Coronavirus disease 2019 (COVID-19) has spread around the world, until now, the number of positive and death cases is still increasing. Therefore, it remains important to identify risk factors for death in critically patients. Methods We collected demographic and clinical data on all severe inpatients with COVID-19. We used univariable and multivariable Cox regression methods to determine the independent risk factors related to likelihood of 28-day and 60-day survival, performing survival curve analysis. Results Of 325 patients enrolled in the study, Multi-factor Cox analysis showed increasing odds of in-hospital death associated with basic illness (hazard ratio [HR] 6.455, 95% Confidence Interval [CI] 1.658–25.139, P = 0.007), lymphopenia (HR 0.373, 95% CI 0.148–0.944, P = 0.037), higher Sequential Organ Failure Assessment (SOFA) score on admission (HR 1.171, 95% CI 1.013–1.354, P = 0.033) and being critically ill (HR 0.191, 95% CI 0.053–0.687, P = 0.011). Increasing 28-day and 60-day mortality, declining survival time and more serious inflammation and organ failure were associated with lymphocyte count < 0.8 × 109/L, SOFA score > 3, Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 7, PaO2/FiO2 < 200 mmHg, IL-6 > 120 pg/ml, and CRP > 52 mg/L. Conclusions Being critically ill and lymphocyte count, SOFA score, APACHE II score, PaO2/FiO2, IL-6, and CRP on admission were associated with poor prognosis in COVID-19 patients.

Sign in / Sign up

Export Citation Format

Share Document