Outcomes of Critically Ill Gynecological Cancer Patients Admitted to Intensive Care Unit

Purpose: To assess the characteristics of critically ill patients with gynecological cancer, and to evaluate their prognosis. Methods: Fifty-two critically ill patients with gynecological cancer admitted to intensive care unit (ICU) were included. Univariate and multivariate logistic regressions were used to identify factors associated with hospital mortality. Results: Thirty-five patients (67.3%) had carcinoma of the cervix uteri and 11 (21.2%) had ovarian cancer. The mortality rate in the ICU was 17.3% (9 of 52) and hospital mortality rate were 23%(12 of 52). In the multivariate analysis, independent prognostic factors for hospital mortality were vasopressor use (odds ratio [OR] = 8.60, 95% confidence interval [CI] 2.05-36; P = .03) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 1.43, 95% CI 1.01-2.09; P = .048). Conclusions: The independent prognostic factors for hospital mortality were the need for vasopressors and the APACHE II score.

Download Full-text

Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit

Journal of International Medical Research ◽

10.1177/0300060517744427 ◽

2018 ◽

Vol 46 (3) ◽

pp. 1254-1262 ◽

Cited By ~ 3

Author(s):

Surat Tongyoo ◽

Tanuwong Viarasilpa ◽

Chairat Permpikul

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Serum Potassium ◽

Critically Ill Patients ◽

Medical Intensive Care Unit ◽

Apache Ii ◽

Apache Ii Score ◽

Icu Mortality ◽

Medical Intensive Care

Objective To compare the outcomes of patients with and without a mean serum potassium (K+) level within the recommended range (3.5–4.5 mEq/L). Methods This prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients’ baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K+ level, and hospital outcomes were recorded. Patients with a mean K+ level of 3.5 to 4.5 mEq/L and with all individual K+ values of 3.0 to 5.0 mEq/L were allocated to the normal K+ group. The remaining patients were allocated to the abnormal K+ group. Results In total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K+ group comprised 74 (46.3%) patients. The abnormal K+ group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal serum K+ level was associated with significantly higher ICU mortality and incidence of ventricular fibrillation. Conclusion Critically ill patients with abnormal K+ levels had a higher incidence of ventricular arrhythmia and ICU mortality than patients with normal K+ levels.

Download Full-text

Influence of time elapsed from end of emergency surgery until admission to intensive care unit, on Acute Physiology and Chronic Health Evaluation II (APACHE II) prediction and patient mortality rate

Sao Paulo Medical Journal ◽

10.1590/s1516-31802005000400003 ◽

2005 ◽

Vol 123 (4) ◽

pp. 167-174 ◽

Cited By ~ 12

Author(s):

Paulo Antonio Chiavone ◽

Samir Rasslan

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Length Of Stay ◽

Hospital Mortality ◽

Emergency Surgery ◽

Apache Ii ◽

Apache Ii Score ◽

Death Risk ◽

Expected Mortality

CONTEXT AND OBJECTIVE: Patients are often admitted to intensive care units with delay in relation to when this service was indicated. The objective was to verify whether this delay influences hospital mortality, length of stay in the unit and hospital, and APACHE II prediction. DESIGN AND SETTING: Prospective and accuracy study, in intensive care unit of Santa Casa de São Paulo, a tertiary university hospital. METHODS: We evaluated all 94 patients admitted following emergency surgery, from August 2002 to July 2003. The variables studied were APACHE II, death risk, length of stay in the unit and hospital, and hospital mortality rate. The patients were divided into two groups according to the time elapsed between end of surgery and admission to the unit: up to 12 hours and over 12 hours. RESULTS: The groups were similar regarding gender, age, diagnosis, APACHE II score and hospital stay. The death risk factors were age, APACHE II and elapsed time (p < 0.02). The mortality rate for the over 12-hour group was higher (54% versus 26.1%; p = 0.018). For the over 12-hour group, observed mortality was higher than expected mortality (p = 0.015). For the up to 12-hour group, observed and expected mortality were similar (p = 0.288). CONCLUSION: APACHE II foresaw the mortality rate among patients that arrived faster to the intensive care unit, while the mortality rate was higher among those patients whose admission to the intensive care unit took longer.

Download Full-text

Invasive Blood Pressure Measurement and In-hospital Mortality in Critically Ill Patients With Hypertension

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.720605 ◽

2021 ◽

Vol 8 ◽

Author(s):

Bin Zhou ◽

Liang-Ying Lin ◽

Xiao-Ai Liu ◽

Ye-Sheng Ling ◽

Yuan-Yuan Zhang ◽

...

Keyword(s):

Blood Pressure ◽

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Confidence Interval ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Odds Ratio ◽

Invasive Blood Pressure

Background: Invasive blood pressure (IBP) measurement is common in the intensive care unit, although its association with in-hospital mortality in critically ill patients with hypertension is poorly understood.Methods and Results: A total of 11,732 critically ill patients with hypertension from the eICU-Collaborative Research Database (eICU-CRD) were enrolled. Patients were divided into 2 groups according to whether they received IBP. The primary outcome in this study was in-hospital mortality. Propensity score matching (PSM) and inverse probability of treatment weighing (IPTW) models were used to balance the confounding covariates. Multivariable logistic regression was used to evaluate the association between IBP measurement and hospital mortality. The IBP group had a higher in-hospital mortality rate than the no IBP group in the primary cohort [238 (8.7%) vs. 581 (6.5%), p < 0.001]. In the PSM cohort, the IBP group had a lower in-hospital mortality rate than the no IBP group [187 (8.0%) vs. 241 (10.3%), p = 0.006]. IBP measurement was associated with lower in-hospital mortality in the PSM cohort (odds ratio, 0.73, 95% confidence interval, 0.59–0.92) and in the IPTW cohort (odds ratio, 0.81, 95% confidence interval, 0.67–0.99). Sensitivity analyses showed similar results in the subgroups with high body mass index and no sepsis.Conclusions: In conclusion, IBP measurement was associated with lower in-hospital mortality in critically ill patients with hypertension, highlighting the importance of IBP measurement in the intensive care unit.

Download Full-text

Feasibility of transitioning from APACHE II to SAPS III as prognostic model in a Brazilian general intensive care unit. A retrospective study

Sao Paulo Medical Journal ◽

10.1590/1516-3180.2013.8120014 ◽

2014 ◽

Vol 133 (3) ◽

pp. 199-205 ◽

Cited By ~ 6

Author(s):

Ary Serpa Neto ◽

Murillo Santucci Cesar de Assunção ◽

Andréia Pardini ◽

Eliézer Silva

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Retrospective Study ◽

Hospital Mortality ◽

Critically Ill ◽

Predictive Models ◽

Critically Ill Patients ◽

Goodness Of Fit ◽

Apache Ii ◽

Goodness Of Fit Test

CONTEXT AND OBJECTIVE: Prognostic models reflect the population characteristics of the countries from which they originate. Predictive models should be customized to fit the general population where they will be used. The aim here was to perform external validation on two predictive models and compare their performance in a mixed population of critically ill patients in Brazil.DESIGN AND SETTING: Retrospective study in a Brazilian general intensive care unit (ICU).METHODS: This was a retrospective review of all patients admitted to a 41-bed mixed ICU from August 2011 to September 2012. Calibration (assessed using the Hosmer-Lemeshow goodness-of-fit test) and discrimination (assessed using area under the curve) of APACHE II and SAPS III were compared. The standardized mortality ratio (SMR) was calculated by dividing the number of observed deaths by the number of expected deaths.RESULTS: A total of 3,333 ICU patients were enrolled. The Hosmer-Lemeshow goodness-of-fit test showed good calibration for all models in relation to hospital mortality. For in-hospital mortality there was a worse fit for APACHE II in clinical patients. Discrimination was better for SAPS III for in-ICU and in-hospital mortality (P = 0.042). The SMRs for the whole population were 0.27 (confidence interval [CI]: 0.23 - 0.33) for APACHE II and 0.28 (CI: 0.22 - 0.36) for SAPS III.CONCLUSIONS: In this group of critically ill patients, SAPS III was a better prognostic score, with higher discrimination and calibration power.

Download Full-text

Evaluation of acute physiology and chronic health evaluation (APACHE) II in predicting ICU mortality among critically ill

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20175168 ◽

2017 ◽

Vol 4 (6) ◽

pp. 1566

Author(s):

Sariga J. Theresa ◽

Fathima Latheef

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Critically Ill ◽

Clinical Decision Making ◽

Scoring Systems ◽

Apache Ii ◽

Apache Ii Score ◽

Icu Mortality ◽

Mortality And Morbidity

Background: Clinical assessment of the severity of illness among critically ill patients is an essential component to predict the mortality and morbidity in intensive care units. Scoring systems estimate the prognosis and help in clinical decision making thus enhance the quality of care in Intensive care units.Methods: A descriptive study including 122 patients admitted to medical intensive care unit was performed from January 2017-March 2017 in Southern Kerala. APACHE II score for the first 24 hours of admission to the intensive care unit was calculated. SPSS 20 was applied for statistical analysis, and clinical parameters were investigated with descriptive statistics.Results: The actual ICU mortality rate (9%) was less than the predicted mortality rate (43.6%) obtained using the APACHE II. Majority of patients 98(80%) had APACHE score >15. There was a statistically significant correlation observed between age and predicted mortality score of critically ill (r=.434 p=0.01).Conclusions: APACHE II scoring system has been successful in predicting the mortality of critically ill. Healthcare professionals should therefore incorporate the disease severity measuring tools in their clinical practice to prioritize and optimize the care rendered in critical care units.

Download Full-text

Abstract 15293: Noninvasive Echocardiographic Cardiac Power Output Predicts Mortality in Cardiac Intensive Care Unit Patients

Circulation ◽

10.1161/circ.142.suppl_3.15293 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Barry Burstein ◽

Vidhu Anand ◽

Bradley Ternus ◽

Meir Tabi ◽

Nandan S Anavekar ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Critically Ill ◽

Power Output ◽

Critically Ill Patients ◽

Cardiac Intensive Care Unit ◽

Cardiac Power ◽

The Mean ◽

Cardiac Intensive Care

Introduction: A low cardiac power output (CPO), measured invasively, identifies critically ill patients at increased risk of mortality. CPO can also be measured non-invasively with transthoracic echocardiography (TTE), although prognostic data in critically ill patients is not available. Hypothesis: Reduced CPO measured by TTE is associated with increased hospital mortality in cardiac intensive care unit (CICU) patients. Methods: Using a database of CICU patients admitted between 2007 and 2018, we identified patients with TTE within one day (before or after) of CICU admission who had data necessary for calculation of CPO. Multivariable logistic regression determined the relationship between CPO and adjusted hospital mortality. Results: We included 5,585 patients with a mean age of 68.3±14.8 years, including 36.7% females. Admission diagnoses included acute coronary syndrome (ACS) in 57%, heart failure (HF) in 50%, cardiac arrest (CA) in 12%, and cardiogenic shock (CS) in 13%. The mean left ventricular ejection fraction (LVEF) was 47±16%, and the mean CPO was 1.0±0.4 W. CPO was inversely associated with the risk of hospital mortality (Figure A), including among patients with ACS, HF, and CS (Figure B). On multivariable analysis, lower CPO was associated with higher hospital mortality (OR 0.96 per 0.1 W, 95% CI 0.0.93-0.99, p=0.03). Hospital mortality was highest in patients with low CPO coupled with reduced LVEF, increased vasopressor requirements, or higher admission lactate. Hospital mortality was higher among patients with a CPO <0.6 W (adjusted OR 1.57, 95% CI 1.13-2.19, p = 0.007), particularly in the presence of admission lactate level >4 mmol/L (50.9%). Conclusions: Echocardiographic CPO was inversely associated with hospital mortality in CICU patients, particularly among patients with increased lactate and vasopressor requirements. Routine measurement of CPO provides important information beyond LVEF and should be considered in CICU patients.

Download Full-text