THE APACHE II SCORE IN TRAUMA PATIENTS - A SYSTEMATIC UNDER-ESTIMATION OF RISK OF DEATH

Shock ◽  
1997 ◽  
Vol 7 (Supplement) ◽  
pp. 14-15
Author(s):  
R. Lefering ◽  
H. J. Goller ◽  
B. Böttcher ◽  
E. Neugebauer
Keyword(s):  
Apache Ii ◽  
Apache Ii Score ◽  
Trauma Patients ◽  
Risk Of Death ◽  
Estimation Of Risk

scholarly journals Influencing Factors and Prevention of Sepsis or Acute Kidney Injury in 85 Patients with Severe Trauma

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Hong Zhang ◽  
Dan Chen ◽  
Lihua Wang ◽  
Bing Li
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Influencing Factors ◽  
Severe Trauma ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Trauma Patients ◽  
Risk Of Death ◽  
Disturbance Of Consciousness ◽  
Prevention And Treatment

Severe trauma can cause systemic reactions, leading to massive bleeding, shock, asphyxia, and disturbance of consciousness. At the same time, patients with severe trauma are at high risk of sepsis and acute renal injury. The occurrence of complications will increase the difficulty of clinical treatment, improve the mortality rate, and bring heavy physical and mental burdens and economic pressure to patients and their families. It is of great clinical significance to understand the high risk factors of sepsis and AKI and actively formulate prevention and treatment measures. In this study, the clinical data of 85 patients with severe trauma were analyzed by univariate and multivariate logistic regression to identify the risk factors leading to sepsis or AKI and analyze the prevention and treatment strategies. The results showed that multiple injuries, APACHE II score on admission, SOFA score on admission, and mechanical ventilation were independent influencing factors of sepsis in patients with severe trauma, while hemorrhagic shock, APACHE II score on admission, CRRT, and sepsis were independent influencing factors of AKI in patients with severe trauma. Severe trauma patients complicated with sepsis or AKI will increase the risk of death. In the course of treatment, prevention and intervention should be given as far as possible to reduce the incidence of complications.

Prediction of the risk of death by APACHE II scoring in critically ill trauma patients without head injury

1996 ◽  
Vol 83 (8) ◽  
pp. 1123-1127 ◽  
Author(s):  
D. J. J. Muckart ◽  
S. Bhagwanjee ◽  
P. A. Neijenhuis
Keyword(s):  
Head Injury ◽  
Critically Ill ◽  
Apache Ii ◽  
Trauma Patients ◽  
Risk Of Death

scholarly journals The Results of the Russian Clinical Trial of Mesenchymal Stromal Cells (MSCs) in Severe Neutropenic Patients (pts) with Septic Shock (SS) (RUMCESS trial)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2220-2220 ◽  
Author(s):  
Gennadii M. Galstian ◽  
Elena N. Parovichnikova ◽  
Polina M. Makarova ◽  
Larisa A. Kuzmina ◽  
Vera V. Troitskaya ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Organ Dysfunction ◽  
Sofa Score ◽  
Conflicts Of Interest ◽  
Survival Rates ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Complication Rates ◽  
Term Survival ◽  
Risk Of Death

Abstract Background: Recent evidence suggests that MSCs might improve survival during sepsis in animal models. However, no study has investigated the effects of MSC therapy on the survival of pts with sepsis and SS, especially severe-neutropenic pts. Aim: The aim of this study was to investigate the efficacy of the administration of MSCs for the treatment of SS in neutropenic pts. Patients and Methods: This prospective, single-center, randomized Russian clinical trial of MSCs in severe neutropenic pts with SS (RUMCESS) (NCT 01849237) was approved by the local ethics committee and was begun in December 2012. Neutropenic pts (WBC < 0.5x109/l) with SS were enrolled on to the study. The pts were randomly assigned (1:1) to receive either conventional therapy (CT) of SS (CT group), or CT plus donor MSCs at a dose of 106/kg intravenously within the first 10 hours after SS onset (CT+MSCs group). Written informed consent was obtained for all pts. All pts were admitted and treated in the ICU of the National Research Center for Hematology (Moscow). The Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sepsis-related Organ Failure Assessment (SOFA) score were employed to determine the severity of illness. Pts were followed up for 28 days after enrolment in the study, and 28-day all-cause mortality was assessed. Pts characteristics and complication rates were compared using Fisher's exact test. The Kaplan-Meier method with the log-rank test, and Cox proportional hazard regression model were used to determine the statistical significance of the relationship between overall survival (OS) and the treatment regimen. Statistical analyses were performed using SAS 9.1. Results: Of the 27 neutropenic pts with SS, 13 received CT and 14 received CT+MSCs. There were no statistically significant differences in the demographic variables between groups . The CT group included 7 males, 6 females, aged 33-81 yrs, median 55 yrs. The CT+MSCs group included 6 males, 8 females, aged 30-75 yrs, median 48 yrs. Hematological disorders were also similar in the two groups: AML (4), NHL (4), HL (1), MM (3), MDS (1) in the CT group, and AML (5), NHL (7), MM (1) in the CT+MSCs group. In all pts, except for one with MDS, neutropenia developed after chemotherapy. In 8/13 pts in the CT group and 9/14 pts in the CT+MSCs group blood cultures were found positive, mostly gram-negative. Baseline APACHE II scores (34.2 [95% CI 28.3-43.1] and 32.2 [95% CI 26.2-37.5] in the CT- and CT+MSC-groups, respectively), and SOFA scores (17.9 [95% CI 13.5-22.2] and 15.1 [95% CI 11.0-19.2] respectively), were similar in the two groups. 28-day survival rates were 15% (2 out of 13 pts) in the CT group and 57% (8 out of 14 pts) in the CT+MSCs group (P=0.04) (Figure 1). The significant increase in 28 days OS of the pts in CT+MCSs group was associated with SOFA score decrease, which was started in three days after onset of SS. Despite higher 28-day survival rates only 3 pts treated with CT+MSCs remained alive after 3 months, and 5 of 8 pts from the CT+MSCs-group who survived 28 days died later because of sepsis-related organ dysfunction. Conclusions: Administration of MSCs in the first hours of SS might improve short-term survival in neutropenic pts, but does not prevent death from sepsis-related organ dysfunction in the long term. Perhaps repeated administration of MSC is required. Figure 1. Comparison of OS rates between the two groups of pts in the ICU. There was a statistically significant increase of the 28-day OS rates (42% vs. 15%; P=0.04) and a statistically significant decrease of the risk of death (HR 0.35; 95% CI 0.13 - 0.91; P=0.04) in the CT+MCSs group vs. the CT group. Figure 1. Comparison of OS rates between the two groups of pts in the ICU. There was a statistically significant increase of the 28-day OS rates (42% vs. 15%; P=0.04) and a statistically significant decrease of the risk of death (HR 0.35; 95% CI 0.13 - 0.91; P=0.04) in the CT+MCSs group vs. the CT group. Disclosures No relevant conflicts of interest to declare.

scholarly journals Prognostic value of presepsin (soluble CD14-subtype) in diagnosis of ventilator-associated pneumonia and sepsis in trauma patients

2018 ◽  
Vol 75 (10) ◽  
pp. 968-977
Author(s):  
Bojan Jovanovic ◽  
Olivera Djuric ◽  
Ljiljana Markovic-Denic ◽  
Aleksandra Isakovic ◽  
Krstina Doklestic ◽  
...  
Keyword(s):  
Septic Shock ◽  
Injury Severity ◽  
Medical Condition ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Soluble Cd14 ◽  
Sepsis And Septic Shock ◽  
Injured Patients

Background/Aim. Presepsin (soluble CD14-subtype) is a fragment of CD14 produced in response to bacterial infections and a novel biomarker of pneumonia, sepsis and septic shock. The aim of this study was to compare sensitivity and specificity of persepsin, soluble CD14-subtype (sCD14-ST) with other biomarkers: procalcitonine (PCT), C-reactive protein (CRP) and leukocyte count (Le) in mechanically ventilated injured patients, as a marker of pneumonia, sepsis and septic shock. Methods. The prospective study was undertaken in trauma and surgery intensive care unit of the Emergency Center, the Clinical Center of Serbia from January to April 2013. The study included 39 trauma patients requiring mechanical ventilation, and who developed one of the following inclusion criteria: Systemic Inflammatory Response Syndrome (SIRS), ventilator associated pneumonia (VAP), sepsis and/or septic shock. On admission Acute Physiology and Chronic Health Evaluation II (APACHE II) Score and Injury Severity Score (ISS) were calculated. Seventy-two measurements of four biomarkers (presepsin, PCT, CRP and Le) were performed in 39 patients at the moments of diagnosis of SIRS, VAP, sepsis and/or septic shock (21 when SIRS diagnosis was established, 21 after the diagnosis of VAP, 18 at the moment of diagnosis of sepsis and the remaining 12 measurements were conducted while diagnosing the septic shock). The Sequential Organ Failure Assessment (SOFA) score was calculated at these points as well. Results. Patients were mainly severely injured (mean ISS = 24.2) and had moderately severe medical condition at admission (mean Apache II score, 14.5). Presepsin concentration significantly differed among all the four groups, except between sepsis and septic shock. The strongest positive correlation of presepsin evinced with PCT (r = 0.741, p < 0.001). The sCD14-ST indicated better performance in diagnosis of both VAP (AUC = 0.909) and sepsis (AUC = 0.899), compared to PCT (AUCs: 0.863, 0.885, respectively), CRP (AUCs: 0.703, 0.677, respectively) and Le (AUCs: 0.668, 0.700, respectively). Conclusion. This study revealed that sCD14-ST is a reliable biomarker for distinguishing sepsis severity. It also showed a good correlation with the infection development as well as worsening in injured patients.

scholarly journals Effect of Nebulized Amphotericin B in Critically ill Patients With Respiratory Candida spp. De-colonization: A Retrospective Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Hangxiang Du ◽  
Limin Wei ◽  
Wenzhe Li ◽  
Bixia Huang ◽  
Yongan Liu ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Control Groups ◽  
Candida Spp ◽  
Risk Of Death ◽  
Alternative Treatment Option ◽  
And Control

The potential relationship among airway Candida spp. de-colonization, nebulized amphotericin B (NAB), and occurrence of ventilator-associated pneumonia (VAP) in patients who are critically ill has not been fully investigated, especially concerning effects on survival. In this observational, retrospective, cohort study in a 22-bed central intensive care unit, we included patients aged &gt;18 years who required mechanical ventilation (MV) for &gt;48 h, with at least two consecutive positive Candida spp. test results. Patients were categorized into NAB and no NAB (control) groups. Propensity matching at 1:1 was performed according to strict standards, and multiple Cox proportional hazard model and multivariate analyses were performed to evaluate the effects of NAB treatment. Throughout an 8-year study period, 526 patients had received MV and had positive respiratory tract Candida spp. cultures. Of these, we included 275 patients and excluded 251 patients. In total, we successfully matched 110 patients from the two groups (each group, n = 55; total population median age, 64 years; Acute Physiology and Chronic Health Evaluation II [APACHE II] score, 25.5; sequential organ failure assessment score, 9). The Candida spp. de-colonization rate was 69.1% in patients treated with NAB. VAP incidence did not differ significantly between the NAB (10.91%) and control (16.36%) groups (P = 0.405). Pseudomonas aeruginosa-related VAP rates differed significantly between the NAB (10.91%) and control (25.45%) groups (P = 0.048). Five (9.1%) patients in the NAB group died during hospitalization compared with 17 (30.9%) controls (P = 0.014). At 28 days, 9 (16.4%) and 16 (29.1%) deaths occurred in the NAB and control groups, respectively, (P = 0.088). The cumulative 90-day mortality rate differed significantly between the two groups (23.6 vs. 43.6%, P = 0.015). Multivariate logistic regression analyses indicated a decreased 90-day mortality in the NAB group (adjusted odds ratio 0.413; 95% confidence interval 0.210–0.812; P = 0.01). In subgroup analyses, the NAB-associated decreased risk of death at 90 days was consistent across subgroups of patients with a Candida score of 2, younger age (&lt;64 years), a higher APACHE II score (≥25), fewer Candida sites (&lt;2), or MV at admission. NAB treatment contributed to Candida spp. airway de-colonization, was associated with a reduced risk of P. aeruginosa-related VAP, and improved 90-day mortality in patients critically ill with Candida spp. tracheobronchial colonization who had received MV for &gt;2 days. NAB may be an alternative treatment option for critically ill patients with VAP.

scholarly journals Comparison of APACHE II and three abbreviated APACHE II scores for predicting outcome among emergency trauma patients

2014 ◽  
Vol 60 (4) ◽  
pp. 381-386 ◽  
Author(s):  
Jorge Roberto Polita ◽  
Jussara Gomez ◽  
Gilberto Friedman ◽  
Sérgio Pinto Ribeiro
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Operating Characteristic ◽  
Laboratory Data ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Trauma Patients ◽  
Individual Data ◽  
Predicting Outcome ◽  
Similar Accuracy

Objective: to compare the ability of the APACHE II score and three different abbreviated APACHE II scores: simplified APACHE II (s-APACHE II), Rapid Acute Physiology score (RAPS) and Rapid Emergency Medicine score to evaluate in-hospital mortality of trauma patients at the emergency department (ED). Methods: retrospective analysis of a prospective cohort study. All patients' victims of trauma admitted to the ED, during a 5 months period. For all entries to the ED, APACHE II score was calculated. APACHE II system was abbreviated by excluding the laboratory data to calculate s-APACHE II score for each patient. Individual data were reanalyzed to calculate RAPS and REMS. APACHE II score and its subcomponents were collected, and in-hospital mortality was assessed. The area under the receiver operating characteristic (AUROC) curve was used to determine the predictive value of each score. Results: 163 patients were analyzed. In-hospital mortality rate was 10.4%. s-APACHE II, RAPS and REMS scores were correlated with APACHE II score (r2= 0.96, r2= 0.82, r2= 0.92; p < 0.0001). Scores had similar accuracy in predicting mortality ([AUROC 0.777 [95% CI 0.705 to 0.838] for APACHE II, AUROC 0.788 [95% CI 0.717 to 0.848] for s-APACHE II, AUROC 0.806 [95% CI 0.737 to 0.864] for RAPS, AUROC 0.761 [95% CI 0.688 to 0.824] for REMS. Conclusion: abbreviated APACHE II scores have similar ability to evaluate in-hospital mortality of emergency trauma patients in comparison to APACHE II score.

Does Acute Physiology and Chronic Health Evaluation II Provide a Valid Metric to Directly Compare Disease Severity in Trauma versus Surgical Intensive Care Unit Patients?

2012 ◽  
Vol 78 (11) ◽  
pp. 1261-1269
Author(s):  
Robert D. Becher ◽  
Michael C. Chang ◽  
J. Jason Hoth ◽  
Jennifer L. Kendall ◽  
H. Randall Beard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Disease Severity ◽  
Chronic Health Evaluation ◽  
Apache Ii ◽  
Surgical Intensive Care Unit ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Chronic Health ◽  
Risk Of Death

The Acute Physiology and Chronic Health Evaluation II (APACHE II) score has never been validated to risk-adjust between critically ill trauma (TICU) and general surgical (SICU) intensive care unit patients, yet it is commonly used for such a purpose. To study this, we evaluated risk of death in TICU and SICU patients with pneumonia. We hypothesized that mortality for a given APACHE II would be significantly different and that using APACHE II to directly compare TICU and SICU patients would not be appropriate. We conducted a retrospective review of patients admitted to the TICU or SICU at a tertiary medical center over an 18-month period with pneumonia. Admission APACHE II scores, in-hospital mortality, demographics, and illness characteristics were recorded. One hundred eighty patients met inclusion criteria, 116 in the TICU and 64 in the SICU. Average APACHE II scores were not significantly different in the TICU versus SICU (25 vs 24; P = 0.4607), indicating similar disease severity; overall mortality rates, however, were significantly different (24 vs 50%; P = 0.0004). Components of APACHE II, which contributed to this mortality differential, were Glasgow Coma Score, age, presence of chronic health problems, and operative intervention. APACHE II fails to provide a valid metric to directly compare the severity of disease between TICU and SICU patients with pneumonia. These groups represent distinct populations and should be separated when benchmarking outcomes or creating performance metrics in ICU patients. Improved severity scoring systems are needed to conduct clinically relevant and methodologically valid comparisons between these unique groups.

Peritoneal dialysis with a lower dosage versus conventional intermittent hemodialysis in acute kidney injury: A propensity-matched study

2020 ◽  
pp. 089686082097085
Author(s):  
Watanyu Parapiboon ◽  
Thosapol Chumsungnern ◽  
Treechada Chamradpan
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Intermittent Hemodialysis ◽  
Risk Of Death ◽  
Risk Of Mortality

Background: Literature regarding the outcomes of lower dosage peritoneal dialysis (PD) in treating acute kidney injury (AKI) among resource-limited setting is sparse. This study aims to compare the risk of mortality in patients with AKI receiving lower PD dosage and conventional intermittent hemodialysis (IHD) in Thailand. Methods: In a tertiary center in Thailand, a matched case–control study using propensity scores in patients with AKI was conducted to compare the outcomes between lower PD dosage (18 L per day for first two sessions, weekly Kt/ V 2.2) and IHD (three times a week) from February 2015 to January 2016. The primary outcome was a 30-day in-hospital mortality rate. Secondary outcomes included dialysis dependence at 90 days. Results: Eighty-four patients were included (28 PD and 56 IHD). Patient characteristics were comparable between two treatment groups. Overall, the mean age was 58 years. Most of the patients were critically ill (87% need mechanical ventilator; mean acute physiological and chronic health evaluation (APACHE II) score: 25). The 30-day in-hospital mortality rate was similar between the PD and IHD patients (57% vs. 46%, p = 0.36). The dialysis dependence rate was also comparable at 90 days. The risk of death among AKI patients was higher in those with respiratory failure, higher APACHE II score, and starting dialysis with blood urea nitrogen greater than 70 mg dL−1. Conclusion: Clinical outcomes, including risk of mortality and 90-day dialysis dependence among patients with AKI, appear to be comparable between lower dosage PD and IHD.

scholarly journals Impact of Operator Expertise on Collection of the APACHE II Score and on the Derived Risk of Death and Standardized Mortality Ratio

2005 ◽  
Vol 33 (5) ◽  
pp. 585-590 ◽  
Author(s):  
D. Ledoux ◽  
S. Finfer ◽  
S. Mckinley
Keyword(s):  
Goodness Of Fit ◽  
Characteristic Curve ◽  
Receiver Operator Characteristic Curve ◽  
Clinical Staff ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Standardized Mortality Ratio ◽  
Risk Of Death ◽  
Mortality Ratio ◽  
The Impact

We assessed the impact of operator expertise on collection of the APACHE II score, the derived risk of death and standardized mortality ratio in 465 consecutive patients admitted to a multi-disciplinary tertiary hospital ICU. Research coordinators and junior clinical staff independently collected the APACHE II variables; experts (senior clinical staff) rescored 20 % of the records. Agreement was moderate between junior clinical staff and research coordinators or senior clinical staff for most variables of the acute physiology score (weighted κ<0.6); agreement between research coordinators and senior clinical staff data collectors was good (weighted κ >0.75). The APACHE II score and its derived risk of death (ROD) were significantly lower using the junior clinical staff dataset compared to research coordinators and senior clinical staff (APACHE II score: 13.4±9.2 vs 16.8±8.5 vs 17.1±7.7, P<0.001; ROD: 14.7%±22.4% vs 21.6%±22.6% vs 20.8%±22.4%, P<0.01 respectively). The discriminative capacity was not altered by the lack of agreement (area under Receiver Operator Characteristic curve >0.8) but calibration of ROD from the junior clinical staff dataset was poor (Goodness-of-fit: P=0.001). The standardized mortality ratio (SMR) was higher with the junior clinical staff dataset (SMR: 1.22, 95% CI: 0.96-1.52 vs 0.87, 95% CI: 0.70-1.06 vs 0.76, 95% CI: 0.40-1.3 calculated from junior clinical staff, research coordinators and senior clinical staff data-sets respectively). We conclude that the expertise of data collectors significantly influences the APACHE II score, the derived risk of death and the standardized mortality ratio. Given the importance of such scores, ICUs should be provided with sufficient resources to train and employ dedicated data collectors.

scholarly journals Low triiodothyronine (T3) state: a predictor of outcome in respiratory failure? Results of a clinical pilot study

2004 ◽  
pp. 557-560 ◽  
Author(s):  
E Scoscia ◽  
S Baglioni ◽  
A Eslami ◽  
G Iervasi ◽  
S Monti ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Thyroid Function ◽  
Plasma Levels ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Univariate Logistic Regression Analysis ◽  
Risk Of Death ◽  
Arterial Blood ◽  
Low T3 ◽  
Increased Risk

BACKGROUND AND AIM: Various low triiodothyronine (T3) states have been described in severe nonthyroidal diseases and associated with a poor prognosis in cardiovascular disease patients. We assessed thyroid function in patients with severe respiratory failure from pulmonary disorders, and needing invasive or noninvasive mechanical ventilation, in order to evaluate the prognostic value of nonthyroidal illness syndrome. METHODS: We studied 32 consecutive patients with acute or acute-on-chronic respiratory failure. Measured variables upon admission included APACHE II score, the ratio of the partial pressure of oxygen in arterial blood to the fraction of oxygen in inspired gas (PaO(2)/FiO(2)), and plasma levels of free T3 (fT3) and free thyroxine (fT4), and TSH levels. Thyroid function was further evaluated at discharge. RESULTS: Plasma levels of fT3 were below normal in 17 patients (53%). Plasma fT3 was correlated with PaO(2)/FiO(2) (P<0.001), and with APACHE II score (P=0.003). In four patients (12.5%) who died, fT3 levels were significantly lower (P=0.002) than in patients who survived. In univariate logistic regression analysis, fT3 was the only factor significantly associated with an increased risk of death (odds ratio, 64.23; 95% confidence interval, 1.78-2316.86, P=0.023). Normalization of thyroid function was observed at discharge with a significant correlation between the percent increase in both fT3 and PaO(2)/FiO(2) (P=0.015). P values were calculated using Spearman's Correlation Coefficient. CONCLUSION: Our preliminary data suggest that the low T3 state is a predictor of outcome in pulmonary patients with respiratory failure.

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