The Relationship of the ACCP/SCCM Consensus Conference Classification of Sepsis to Mortality and Multiorgan Dysfunction among Medical ICU Patients

To determine the relation between the proposed ACCP/SCCM Consensus Conference classification of sepsis and hospital outcomes, we conducted a single-center, prospective observational study at Barnes Hospital, St. Louis, MO, an academic tertiary care hospital. A total of 324 consecutive patients admitted to the medical intensive care unit (ICU) were studied for prospective patient surveillance and data collection. The main outcome measures were the number of acquired organ system derangements and hospital mortality. Fifty-seven (17.6%) patients died during the study period. The proposed classifications of sepsis (e.g., systemic inflammatory response syndrome [SIRS], sepsis, severe sepsis, septic shock) correlated with hospital mortality ( r = 0.330; p < 0.001) and development of an Organ System Failure Index (OSFI) of 3 or greater ( r = 0.426; p < 0.001). Independent determinants of hospital mortality for this patient cohort ( p < 0.05) were development of an OSFI of 3 or greater (adjusted odds ratio [AOR], 13.9; 95% confidence interval [CI], 6.4–30.2; p < 0.001); presence of severe sepsis or septic shock (AOR, 2.6; 95% CI, 1.2–5.6; p = 0.002), and an APACHE II score ≥ of 18 or greater (AOR, 2.4; 95% CI, 1.0–5.8; p = 0.045). Intra-abdominal infection (AOR, 19.1; 95% CI, 1.6–230.1; p = 0.011), an APACHE II score ≥ of 18 or greater (AOR, 8.9; 95% CI, 4.2–18.6; p < 0.001), and presence of severe sepsis or septic shock (AOR, 2.9; 95% CI, 1.5–5.4; p = 0.001) were independently associated with development of an OSFI of 3 or greater. These data confirm that acquired multiorgan dysfunction is the most important predictor of mortality among medical ICU patients. In addition, they identify the proposed ACCP/SCCM Consensus Conference classification of sepsis as an additional independent determinant of both hospital mortality and multiorgan dysfunction.

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Comparative analysis of survival between elderly and non-elderly severe sepsis and septic shock resuscitated patients

Einstein (São Paulo) ◽

10.1590/s1679-45082015ao3313 ◽

2015 ◽

Vol 13 (3) ◽

pp. 357-363 ◽

Cited By ~ 6

Author(s):

Henrique Palomba ◽

Thiago Domingos Corrêa ◽

Eliézer Silva ◽

Andreia Pardini ◽

Murillo Santucci Cesar de Assuncao

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Elderly Patients ◽

Hospital Mortality ◽

Length Of Hospital Stay ◽

Apache Ii ◽

Apache Ii Score ◽

Resuscitated Patients ◽

Long Term Impact ◽

Sepsis And Septic Shock

Objective To compare outcomes between elderly (≥65 years old) and non-elderly (<65 years old) resuscitated severe sepsis and septic shock patients and determine predictors of death among elderly patients.Methods Retrospective cohort study including 848 severe sepsis and septic shock patients admitted to the intensive care unit between January 2006 and March 2012.Results Elderly patients accounted for 62.6% (531/848) and non-elderly patients for 37.4% (317/848). Elderly patients had a higher APACHE II score [22 (18-28)versus 19 (15-24); p<0.001], compared to non-elderly patients, although the number of organ dysfunctions did not differ between the groups. No significant differences were found in 28-day and in-hospital mortality rates between elderly and non-elderly patients. The length of hospital stay was higher in elderly compared to non-elderly patients admitted with severe sepsis and septic shock [18 (10-41)versus 14 (8-29) days, respectively; p=0.0001]. Predictors of death among elderly patients included age, site of diagnosis, APACHE II score, need for mechanical ventilation and vasopressors.Conclusion In this study population early resuscitation of elderly patients was not associated with increased in-hospital mortality. Prospective studies addressing the long-term impact on functional status and quality of life are necessary.

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Traditional Chinese Medicine Diagnosis “Yang-Xu Zheng”: Significant Prognostic Predictor for Patients with Severe Sepsis and Septic Shock

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2013/759748 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Sunny Jui-Shan Lin ◽

Yung-Yen Cheng ◽

Chih-Hung Chang ◽

Cheng-Hung Lee ◽

Yi-Chia Huang ◽

...

Keyword(s):

Septic Shock ◽

Regression Analysis ◽

Severe Sepsis ◽

Host Response ◽

Multivariate Logistic Regression Analysis ◽

Apache Ii ◽

Apache Ii Score ◽

Multivariate Logistic Regression ◽

Sepsis Mortality ◽

Sepsis And Septic Shock

Pathogenesis of sepsis includes complex interaction between pathogen activities and host response, manifesting highly variable signs and symptoms, possibly delaying diagnosis and timely life-saving interventions. This study applies traditional Chinese medicine (TCM)Zhengdiagnosis in patients with severe sepsis and septic shock to evaluate its adaptability and use as an early predictor of sepsis mortality. Three-year prospective observational study enrolled 126 septic patients. TCMZhengdiagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and blood samples for host response cytokines measurement (tumor necrosis factor-α, Interleukin-6, Interleukin-8, Interleukin-10, Interleukin-18) were collected within 24 hours after admission to Intensive Care Unit. Main outcome was 28-day mortality; multivariate logistic regression analysis served to determine predictive variables of the sepsis mortality. APACHE II score, frequency ofNutrient-phase heat, andQi-XuandYang-Xu Zhengswere significantly higher in nonsurvivors. The multivariate logistic regression analysis identifiedYang-Xu Zhengas the outcome predictor. APACHE II score and levels of five host response cytokines between patients with and withoutYang-Xu Zhengrevealed significant differences. Furthermore, cool extremities and weak pulse, both diagnostic signs ofYang-Xu Zheng, were also proven independent predictors of sepsis mortality. TCM diagnosis “Yang-Xu Zheng” may provide a new mortality predictor for septic patients.

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The Utility of Acute Physiology and Chronic Health Evaluation II Scores for Prediction of Mortality among Intensive Care Unit (ICU) and Non-ICU Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia

Infection Control and Hospital Epidemiology ◽

10.1086/665731 ◽

2012 ◽

Vol 33 (6) ◽

pp. 558-564 ◽

Cited By ~ 15

Author(s):

Vanessa Stevens ◽

Thomas P. Lodise ◽

Brian Tsuji ◽

Meagan Stringham ◽

Jill Butterfield ◽

...

Keyword(s):

Intensive Care Unit ◽

Staphylococcus Aureus ◽

Intensive Care ◽

Hospital Mortality ◽

Chronic Health Evaluation ◽

Apache Ii ◽

Apache Ii Score ◽

Health Evaluation ◽

Icu Patients ◽

Time Points

Objective.Bloodstream infections due to methicillin-resistant Staphylococcus aureus (MRSA) have been associated with significant risk of in-hospital mortality. The acute physiology and chronic health evaluation (APACHE) II score was developed and validated for use among intensive care unit (ICU) patients, but its utility among non-ICU patients is unknown. The aim of this study was to determine the ability of APACHE II to predict death at multiple time points among ICU and non-ICU patients with MRSA bacteremia.Design.Retrospective cohort study.Participants.Secondary analysis of data from 200 patients with MRSA bacteremia at 2 hospitals.Methods.Logistic regression models were constructed to predict overall in-hospital mortality and mortality at 48 hours, 7 days, 14 days, and 30 days using APACHE II scores separately in ICU and non-ICU patients. The performance of APACHE II scores was compared with age adjustment alone among all patients. Discriminatory ability was assessed using the c-statistic and was compared at each time point using X2 tests. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test.Results.APACHE II was a significant predictor of death at all time points in both ICU and non-ICU patients. Discrimination was high in all models, with c-statistics ranging from 0.72 to 0.84, and was similar between ICU and non-ICU patients at all time points. APACHE II scores significantly improved the prediction of overall and 48-hour mortality compared with age adjustment alone.Conclusions.The APACHE II score may be a valid tool to control for confounding or for the prediction of death among ICU and non-ICU patients with MRSA bacteremia.

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Extracorporeal cytokine adsorption: Significant reduction of catecholamine requirement in patients with AKI and septic shock after cardiac surgery

PLoS ONE ◽

10.1371/journal.pone.0246299 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246299

Author(s):

Kristina Boss ◽

Michael Jahn ◽

Daniel Wendt ◽

Zaki Haidari ◽

Ender Demircioglu ◽

...

Keyword(s):

Septic Shock ◽

Cardiac Surgery ◽

Mortality Rate ◽

Hospital Mortality ◽

Sofa Score ◽

Statistical Significance ◽

Apache Ii ◽

Apache Ii Score ◽

Additional Measure ◽

The Mean

Background Extracorporeal cytokine adsorption is an option in septic shock as an additional measure to treat a pathological immune response. Purpose of this study was to investigate the effects of extracorporeal cytokine adsorption on hemodynamic parameters in patients with acute kidney injury (AKI) on continuous renal replacement therapy (CRRT) and septic shock after cardiac surgery. Methods In this retrospective study, a total of 98 patients were evaluated. Hemoadsorption was performed by the CytoSorb® adsorber. In all patients cytokine adsorption was applied for at least 15 hours and at least one adsorber was used per patient. To compare cumulative inotrope need in order to maintain a mean arterial pressure (MAP) of ≥ 65 mmHg, we applied vasoactive score (VAS) for each patient before and after cytokine adsorption. A paired t-test has been performed to determine statistical significance. Results Before cytokine adsorption the mean VAS was 56.7 points. This was statistically significant decreased after cytokine adsorption (27.7 points, p< 0.0001). Before cytokine adsorption, the mean noradrenalin dose to reach a MAP of ≥ 65 mmHg was 0.49 μg/kg bw/min, the mean adrenalin dose was 0.12 μg/kg bw/min. After cytokine adsorption, significantly reduced catecholamine doses were necessary to maintain a MAP of ≥ 65 mmHg (0.24 μg/kg bw/min noradrenalin; p< 0.0001 and 0.07 μg/kg bw/min adrenalin; p < 0.0001). Moreover, there was a significant reduction of serum lactate levels after treatment (p< 0.0001). The mean SOFA-score for these patients with septic shock and AKI before cytokine adsorption was 16.7 points, the mean APACHE II-score was 30.2 points. The mean predicted in-hospital mortality rate based on this SOFA-score of 16.7 points was 77,0%, respectively 73,0% on APACHE II-score, while the all-cause in-hospital mortality rate of the patients in this study was 59.2%. Conclusion In patients with septic shock and AKI undergoing cardiac surgery, extracorporeal cytokine adsorption could significantly lower the need for postoperative inotropes. Additionally, observed versus SOFA- and APACHE II-score predicted in-hospital mortality rate was decreased.

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Improving of APACHE II score at the early phase using CTR-001 direct hemoperfusion in patients with severe sepsis and septic shock

Critical Care ◽

10.1186/cc7449 ◽

2009 ◽

Vol 13 (Suppl 1) ◽

pp. P285 ◽

Cited By ~ 1

Author(s):

Y Suzuki ◽

N Sato ◽

M Kojika ◽

T Kikkawa ◽

T Shouzushima ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Early Phase ◽

Apache Ii ◽

Apache Ii Score ◽

Direct Hemoperfusion ◽

Sepsis And Septic Shock

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The epidemiology of, and risk factors for, mortality from severe sepsis and septic shock in a tertiary-care university hospital setting

Epidemiology and Infection ◽

10.1017/s0950268809002027 ◽

2009 ◽

Vol 137 (9) ◽

pp. 1333-1341 ◽

Cited By ~ 32

Author(s):

B. KHWANNIMIT ◽

R. BHURAYANONTACHAI

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Severe Sepsis ◽

Hospital Mortality ◽

Tertiary Care ◽

Hospital Setting ◽

University Hospital ◽

Apache Ii Score ◽

Sepsis And Septic Shock ◽

Hospital Acquired

SUMMARYThis study investigated the clinical characteristics of, and outcomes and risk factors for hospital mortality of 390 patients admitted with severe sepsis or septic shock in an intensive care unit (ICU). Prospectively collected data from patients collected between 1 July 2004 and 30 June 2006 were analysed. Overall hospital mortality was 49·7% and comorbidities were found in 40·3% of patients, the most common of which was haematological malignancy. The respiratory tract was the most common site of infection (50%). Hospital-acquired infections accounted for 55·6% of patients with Gram-negative bacteria predominant (68%). Multivariate analysis showed that acute respiratory distress syndrome, pulmonary artery catheter placement, comorbidities, hospital-acquired infection, APACHE II score and maximum LOD score, were independent risk factors for hospital mortality. In conclusion, severe sepsis and septic shock are common causes of ICU admission. Patients with risk factors for increased mortality should be carefully monitored and aggressive treatment administered.

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Prognostic value of ADAMTS13 in patients with severe sepsis and septic shock

Clinical & Investigative Medicine ◽

10.25011/cim.v40i2.28195 ◽

2017 ◽

Vol 40 (2) ◽

pp. 49 ◽

Cited By ~ 7

Author(s):

M Feroz Azfar ◽

M Faisal Khan ◽

S Shahid Habib ◽

Z Al Aseri ◽

A Mohammad Zubaidi ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Significant Risk ◽

Area Under The Curve ◽

Apache Ii ◽

University Hospital ◽

Apache Ii Score ◽

Surgical Intensive Care ◽

Vasopressor Agents ◽

Sepsis And Septic Shock

Purpose: ADAMTS13 level was evaluated as a predictor of mortality in patients with severe sepsis and septic shock, and compared with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. Methods: This prospective observational study was conducted in the Medical and Surgical Intensive Care Units of King Khalid University Hospital. Detailed clinical evaluations were performed on 84 patients (56.08±18.18 years of age) with severe sepsis and septic shock. ADAMTS13 levels were determined (three blood samples at 24 hours intervals) and APACHE II scores, hematological profiles, indices of organ hypo-perfusion, renal functions and coagulation profiles were recorded. Primary outcome was 30 days ICU mortality and secondary outcomes were its comparison with APACHE II score, length of ICU stay and use of vasopressor agents. Results: Hypertension (53.6%) and diabetic mellitus (45.2%) were the commonest comorbidities. The median ADAMTS13 levels were 336.65, 339.35 and 313.9, respectively. ROC analysis showed maximum area under the curve for second ADAMTS13 (AUC=0.760) compared with first (AUC=0.660) and third samples (AUC=0.707) and APACHE II scores (AUC=0.662). Patients were divided into low and high ADAMTS13 groups according to the best cut-off point. Mortality was high in the low ADAMTS13 level group [OR=4.5]and was significantly associated with age, DBP, ADAMTS13, APACHE II score, DIC score and platelet count. ADAMTS13 (OR=5.3), APACHE II (OR=4.13) and DIC scores (OR=7.32) were significant risk factors for mortality. Conclusions: Low ADAMTS13 was associated with increased mortality in patients with severe sepsis and septic shock and was comparable to APACHE II scores for predicting mortality.

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Epidemiology and Changes in Mortality of Sepsis After the Implementation of Surviving Sepsis Campaign Guidelines

Journal of Intensive Care Medicine ◽

10.1177/0885066617711882 ◽

2017 ◽

Vol 34 (9) ◽

pp. 740-750 ◽

Cited By ~ 12

Author(s):

Rubén Herrán-Monge ◽

Arturo Muriel-Bombín ◽

Marta M. García-García ◽

Pedro A. Merino-García ◽

Miguel Martínez-Barrios ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Population Based ◽

Mortality Prediction ◽

Apache Ii ◽

Apache Ii Score ◽

Surviving Sepsis Campaign ◽

Multicenter Observational Study ◽

Source Of Infection ◽

Logistic Organ Dysfunction

Purpose: To determine the epidemiology and outcome of severe sepsis and septic shock after 9 years of the implementation of the Surviving Sepsis Campaign (SSC) and to build a mortality prediction model. Methods: This is a prospective, multicenter, observational study performed during a 5-month period in 2011 in a network of 11 intensive care units (ICUs). We compared our findings with those obtained in the same ICUs in a study conducted in 2002. Results: The current cohort included 262 episodes of severe sepsis and/or septic shock, and the 2002 cohort included 324. The prevalence was 14% (95% confidence interval: 12.5-15.7) with no differences to 2002. The population-based incidence was 31 cases/100 000 inhabitants/year. Patients in 2011 had a significantly lower Acute Physiology and Chronic Health Evaluation II (APACHE II; 21.9 ± 6.6 vs 25.5 ± 7.07), Logistic Organ Dysfunction Score (5.6 ± 3.2 vs 6.3 ± 3.6), and Sequential Organ Failure Assessment (SOFA) scores on day 1 (8 ± 3.5 vs 9.6 ± 3.7; P < .01). The main source of infection was intraabdominal (32.5%) although microbiologic isolation was possible in 56.7% of cases. The 2011 cohort had a marked reduction in 48-hour (7% vs 14.8%), ICU (27.2% vs 48.2%), and in-hospital (36.7% vs 54.3%) mortalities. Most relevant factors associated with death were APACHE II score, age, previous immunosuppression and liver insufficiency, alcoholism, nosocomial infection, and Delta SOFA score. Conclusion: Although the incidence of sepsis/septic shock remained unchanged during a 10-year period, the implementation of the SSC guidelines resulted in a marked decrease in the overall mortality. The lower severity of patients on ICU admission and the reduced early mortality suggest an improvement in early diagnosis, better initial management, and earlier antibiotic treatment.

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Dynamic APACHE II Score to Predict Outcome Among Intensive Care Unit Patients

10.21203/rs.3.rs-642050/v1 ◽

2021 ◽

Author(s):

Yao Tian ◽

Yang YAO ◽

Jing Zhou ◽

Xin Diao ◽

Hui Chen ◽

...

Keyword(s):

Intensive Care ◽

Hospital Mortality ◽

Goodness Of Fit ◽

Apache Ii ◽

Secondary Outcome ◽

Apache Ii Score ◽

Optimal Timing ◽

Goodness Of Fit Test ◽

Icu Patients ◽

Mimic Iii

Abstract Purpose: The Acute Physiology and Chronic Health Evaluation II (APACHE II) score is used to determine disease severity and predict outcomes in critically ill patients. However, there is no dynamic APACHE II score for predicting outcomes among ICU patients.The aim of this study is to explore the optimal timing to predict the outcomes of ICU patients by dynamically evaluating APACHE II score.Methods: Study data of demographics and comorbidities from the first 24 h after ICU admission were retrospectively extracted from MIMIC-III, a multiparameter intensive care database. The primary outcome was hospital mortality. 90-day mortality was a secondary outcome. APACHE II scores on days 1, 2, 3, 5, 7, 14 and 28 were compared using area under the receiver operating characteristic (AUROC) analysis. Hospital survival was visualised using Kaplan-Meier Curves.Results:A total of 6374 eligible subjects were extracted from the MIMIC-III. Mean APACHE II score on day 1 were 18.4±6.3, hospital and 90-day mortality was 19.1% and 25.8%, respectively.The optimal timing where predicted hospital mortality was on day 3 with an area under the cure of 0.666 (0.607-0.726)(P＜0.0001). The best tradeoff for preciction was found at 17 score, more than 17 score predicted mortality of non-survivors with a sensitivity of 92.8% and PPV of 23.1%. Hosmer-lemeshow goodness of fit test showed that APACHE II 3 has a good predictive calibration ability (X2 =6.198, P=0.625) and consistency of predicted death and actual death was 79.4%. The calibration of APACHE II 1 was poor (X2=294.898, P<0.001).Conclusions: APACHE II on 3 dayis the optimal prognostic marker and 17 score provided the best dignostic accuracy to predict outcomes for ICU patients. These finding will help medical make clinical judgment.

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Diseño y validación de una escala basada en el concepto PIRO, una aproximación empírica a un modelo de pronóstico de los pacientes con sepsis

Universidad y Salud ◽

10.22267/rus.161802.32 ◽

2016 ◽

Vol 18 (2) ◽

pp. 214

Author(s):

María Eugenia Niño-Mantilla

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Roc Curve ◽

Apache Ii ◽

Outcome Variable ◽

Race And Gender ◽

Baseline Evaluation ◽

And Gender ◽

Sepsis And Septic Shock

Resumen Introducción: La sepsis es un síndrome de respuesta inflamatoria sistémica secundaria a la infección, la cual ocasiona entre un 40%-50% de los casos de muerte en unidades de cuidado intensivo, el concepto PIRO fue propuesto como un nuevo elemento de clasificación de la sepsis. Objetivo: Analizar algunos elementos correspondientes a esta clasificación en relación con la supervivencia de los participantes en los siguientes 28 días posteriores al egreso. Materiales y métodos: Se analizaron 559 pacientes con diagnóstico de sepsis, sepsis severa y choque séptico, a los cuales se les realizó una evaluación basal de las escalas Apache II, Charlson, SOFA, edad, leucocitos y niveles de PCR durante el primer día del ingreso, adicionalmente se realizaron evaluaciones a los 28 días del egreso. Se realizó un análisis log binomial de estos predictores y se asignó un puntaje a aquellos que presentaran una asociación estadísticamente significativa. Esta escala fue comparada mediante una curva ROC con la mortalidad a los 28 días del egreso hospitalario. Resultados: La edad, la raza, el género fueron incluidas en el análisis como variables índices de predisposición (P), el sitio de infección (I) los niveles de leucocitos y PCR (R ) como variable de respuesta y la clasificación de sepsis, sepsis severa y choque séptico como variable de resultado (O). Conclusiones: La escala basada en el concepto PIRO aplicada a población colombiana, presenta puntajes relacionados con un área bajo la curva ROC de 0.75 lo cual la clasifica como una escala aceptable para evaluar a los pacientes con riesgo de mortalidad. Abstract Introduction: Sepsis is a syndrome of secondary systemic inflammatory response to infection, which causes between 40% -50% of cases of death in intensive care units. The PIRO concept was proposed as a new element of classification of sepsis. Objective: To analyze some relevant elements to this classification in relation to the survival of the participants in the following 28 days after discharge. Materials and methods: 559 patients diagnosed with sepsis, severe sepsis and septic shock, who underwent a baseline evaluation of the APACHE II, Charlson, SOFA scale, age, leukocytes and CRP levels during the first day of admission were analyzed; additionally, assessments were done after 28 days of discharge. A binomial log analysis of these predictors was performed and a score was assigned to those who submit a statistically significant association. This scale was compared using a ROC curve with mortality after 28 days of hospital discharge. Results: Age, race and gender were included in the analysis as index variables of predisposition (P), the site of infection (I) levels of leukocytes and PCR (R) as the response variable, and classification of sepsis, severe sepsis and septic shock as an outcome variable (O). Conclusions: The scale based on the PIRO concept applied to Colombian population presents scores related to an area under the ROC curve above 0.70 which acceptably classifies patients with high mortality risk.

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