One year's experience with the APACHE II severity of disease classification system in a general intensive care unit

Background: Bacteremia and sepsis are significant contributors to the morbidity, mortality, and economic burden of health care systems worldwide. Procalcitonin has been identified as a potentially useful marker of disease and severity in sepsis. However, the assumption that greater procalcitonin levels correlate with greater burden of disease has not been adequately studied. Methods: A retrospective chart review of adult patients admitted to an urban teaching hospital with suspected sepsis was undertaken to test the association of elevated procalcitonin (>30 ng/mL) with other markers of sepsis (lactic acid, white blood cell count, percent bands), severity of disease (Sequential Organ Failure Assessment [SOFA] and Acute Physiology and Chronic Health Evaluation–II [APACHE II] scores), and mortality. Results: In total, 168 patients were identified over 18 months (42% ward, 11% Stepdown, 44% medical intensive care unit [MICU], 2% surgical intensive care unit (STICU), 1% gynecology [GYN]). The Spearman correlation analysis showed that serum procalcitonin level did not correlate with SOFA ( P = .238) or APACHE II ( P = .918) scores on admission, and did not correlate with survival (Kruskal-Wallis test, P = .937). However, higher serum procalcitonin levels were associated with patients who had positive blood cultures (Kruskal-Wallis test, P = .0016 for Gram-positive and P = .0007 for Gram-negative bacteria). Lactic acid levels on admission strongly correlated with SOFA APACHE II (the Spearman correlation, P < .0001 for both) and mortality ( P = .0001 for both). Conclusions: Higher serum procalcitonin levels above 30 ng/mL failed to correlate with indicators of sepsis, severity of disease (SOFA and APACHE II scores), and mortality but were associated with positive blood cultures. Lactic acid levels did show correlation to both severity of disease and mortality. Serum procalcitonin levels >30 ng/mL do not appear to correlate with the severity of disease in a sample of patients with markedly elevated initial procalcitonin levels.

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Immature Platelet Fraction Predicts Outcome and Sepsis Development in Critically Ill Patients Admitted to a General Intensive Care Unit, but Not in Neutropenic Patients

Blood ◽

10.1182/blood.v124.21.2164.2164 ◽

2014 ◽

Vol 124 (21) ◽

pp. 2164-2164

Author(s):

Doaa Okasha ◽

Galit Sarig ◽

Noam Benyamini ◽

Ronit Tamir ◽

Ofrat Beyar Katz ◽

...

Keyword(s):

Intensive Care Unit ◽

Bone Marrow ◽

Intensive Care ◽

Neutropenic Fever ◽

Apache Ii ◽

General Intensive Care Unit ◽

Apache Ii Score ◽

Icu Patients ◽

Immature Platelet Fraction ◽

Neutropenic Patients

Abstract Introduction: Immature platelet fraction (IPF) is a new laboratory parameter, representing a fraction of young platelets in peripheral blood count which is known to correlate with thrombopoiesis. IPF can be reported in absolute numbers or expressed as percentage (IPF%) of total platelet count. IPF% can be used to differentiate individuals at higher risk for bleeding among patients suffering from immune thrombocytopenia and to predict recovery of blood counts after stem cell transplantation (SCT). Moreover, IPF% was also reported to predict the development of sepsis in patients admitted to the general intensive care unit. This study was aimed to prospectively evaluate the value of IPF% as a predictor of clinical outcome and/or mortality in patients susceptible to sepsis. Methods: Two different patient populations at high risk for life-threatening infection, i.e., patients presenting with fever and neutropenia and adults admitted to the general intensive care unit (ICU) of a tertiary health care center for various reasons apart from neutropenic fever were prospectively studied. IPF was measured using the Sysmex XE-2100 analyzer during the first 24 hours of hospitalization. In addition, C-reactive protein (CRP) and Interleukin-6 (IL-6) levels were tested in some of the patients. All patients were monitored and their vital signs, renal function, hemodynamic and respiratory state, as well as final outcome were recorded. For patients with neutropenic fever, the infectious pathogen was listed, whenever identified. Treating physicians were blinded to IPF% results to ensure that clinical decisions were not affected by consideration of this parameter. Results: One hundred and four adults with neutropenic fever and 138 additional adults admitted to the ICU were included in the study. A median age of patients admitted to ICU and those with neutropenic fever was 53 (range 17-88) and 55 (range 18-85) years; males composed 58% and 60% of the cohorts, respectively. A mean IPF% in patients admitted to ICU was significantly higher than that determined in neutropenic patients (8.6 vs 6.8). IPF% levels during the first 24 hours of admission, predicted mortality (p = 0.037) for patients admitted to ICU but not for patients presenting with neutropenic fever. In patients admitted to ICU, high IPF% was also associated with length of stay in the unit, poor hemodynamic status, and death. Neither IL-6 plasma level nor CRP correlated with these clinical outcomes. APACHE-II score (a known disease severity scale in ICU patients) and IPF% were not correlated by Pearson test (p=0.09). Conclusion: IPF% is a valuable biomarker for predicting prognosis in ICU patients independent of APACHE-II score. This study suggests that the validity of IPF% as a predictor of outcome depends on the bone marrow (BM) capacity. In patients with normal bone marrow admitted to ICU, IPF% correlates with the significance of stress and severity of the disease. In patients presenting with neutropenic fever, BM reserve is impaired due to chemotherapy. Larger studies are needed to evaluate the role of IPF% in different patient populations and to determine its application to patients with impaired BM reserves such as immunocompromised patients and those at older age. Disclosures No relevant conflicts of interest to declare.

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APACHE II-A Severity of Disease Classification System

Critical Care Medicine ◽

10.1097/00003246-198608000-00027 ◽

1986 ◽

Vol 14 (8) ◽

pp. 754 ◽

Cited By ~ 16

Author(s):

Jean-Roger Le Gall ◽

P. Loirat ◽

A. Alpcrovitch

Keyword(s):

Classification System ◽

Disease Classification ◽

Apache Ii ◽

Severity Of Disease

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Alterações glicêmicas e pressóricas em pacientes críticos

Revista de Enfermagem UFPE on line ◽

10.5205/1981-8963-v12i8a236609p2163-2169-2018 ◽

2018 ◽

Vol 12 (8) ◽

pp. 2163 ◽

Cited By ~ 1

Author(s):

Bruna Alves Baptista ◽

Letícia Felipe Felix ◽

Josiane Maria Oliveira Souza ◽

Tayse Tâmara Paixão Duarte ◽

Marcia Cristina Silva Magro

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Classification System ◽

Length Of Hospital Stay ◽

Disease Classification ◽

Apache Ii ◽

Diabetic Patients ◽

Chronic Health ◽

Hospitalization Period ◽

Terapia Intensiva

RESUMOObjetivo: descrever as repercussões das variações glicêmicas e pressóricas de pacientes hipertensos e diabéticos. Método: estudo quantitativo, descritivo e exploratório, com 14 pacientes internados na unidade de terapia intensiva (UTI). Utilizou-se questionário estruturado para coleta de dados. Considerou-se significativo resultado com p < 0,05. Resultados: 78,5% dos pacientes se caracterizavam como hipertensos e 43% diabéticos. O período de internação compreendeu 66±84 dias e o período de ventilação mecânica foi de 70±95 dias. O Acute Physiology and Chronic Health Disease Classification System II (APACHE II) de 26±4 sinalizou a gravidade dos pacientes. Glicemia capilar, tempo de internação e de ventilação mecânica se associaram significativamente ao pior desfecho/óbito (p ≤ 0,05). Conclusão: uma das repercussões das alterações glicêmicas e pressóricas se associou ao risco de lesão renal. Além disso, a inexistência de um controle seguro e eficaz da glicemia conduziu os pacientes ao pior desfecho/óbito. Destaca-se a participação do enfermeiro não apenas para controlar as oscilações glicêmicas, mas também proporcionar um cuidado seguro e auxiliar a tomada de decisão, a fim de aumentar a sobrevida do paciente e garantir uma assistência eficaz e de qualidade. Descritores: Glicemia; Hipertensão; Enfermagem; Unidade de Terapia Intensiva; Avaliação em Saúde; Mortalidade. ABSTRACT Objective: to describe the repercussions of glycemic and pressure variations in hypertensive and diabetic patients. Method: quantitative, descriptive, and exploratory study with 14 patients admitted to the intensive care unit (ICU). A structured questionnaire was used to collect data. A result with p < 0.05 was considered significant. Results: 78.5% of the patients were hypertensive and 43% were diabetic. The hospitalization period was 66±84 days and the mechanical ventilation period was 70±95 days. The Acute Physiology and Chronic Health Disease Classification System II (APACHE II) with 26±4 signaled the patients’ severity. Capillary glycemia, length of hospital stay, and mechanical ventilation time were significantly associated with the worst outcome/death (p ≤ 0.05). Conclusion: one of the repercussions of glycemic and pressure changes was associated with risk for kidney injury. Besides, the lack of a safe and effective glycemic control has led patients to the worst outcome/death. Nurse participation is highlighted not only to control glycemic oscillations, but also to provide safe care and help decision making, in order to increase patient survival and ensure effective and good-quality care. Descriptors: Blood Glucose; Hypertension; Nursing; Intensive Care Units; Health Evaluation; Mortality. RESUMEN Objetivo: describir las repercusiones de las variaciones glucémicas y presóricas de pacientes hipertensos y diabéticos. Método: estudio cuantitativo, descriptivo y exploratorio con 14 pacientes que ingresaron en la unidad de cuidados intensivos (UCI). Se utilizó un cuestionario estructurado recogida de datos. Un resultado con p < 0,05 se consideró significativo. Resultados: 78,5% de los pacientes se caracterizaban como hipertensos y 43% como diabéticos. El período de hospitalización fue de 66±84 días y el período de ventilación mecánica fue de 70±95 días. El Acute Physiology and Chronic Health Disease Classification System II (APACHE II) de 26±4 señaló la gravedad de los pacientes. Glucemia capilar, tiempo de hospitalización y de ventilación mecánica se asociaron significativamente con el peor resultado/la muerte (p ≤ 0,05). Conclusión: una de las repercusiones de los cambios glucémicos y presóricos se asoció con el riesgo de lesión renal. Además, la inexistencia de un control glucémico seguro y eficaz ha llevado a los pacientes al peor resultado/la muerte. La participación del enfermero se destaca no solo para controlar las oscilaciones glucémicas, sino también para proporcionar un cuidado seguro y ayudar a la toma de decisiones, a fin de aumentar la supervivencia del paciente y garantizar una atención eficaz y de buena calidad. Descriptores: Glucemia; Hipertensión; Enfermería; Unidades de Cuidados Intensivos; Evaluación en Salud; Mortalidad.

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Evaluation of proposed casemix criteria as a basis for costing patients in the adult general intensive care unit

Anaesthesia ◽

10.1046/j.1365-2044.1998.00576.x ◽

1998 ◽

Vol 53 (10) ◽

pp. 944-950 ◽

Cited By ~ 10

Author(s):

V. G. Stevens ◽

C. L. Hibbert ◽

D. L. Edbrooke

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

General Intensive Care Unit

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