scholarly journals Παράγοντες κινδύνου πρώτου 24ώρου νοσηλείας που επηρεάζουν την τελική έκβαση ασθενών ΜΕΘ

2018 ◽  
Author(s):  
Σοφία Φίκα
Keyword(s):  
Organ Failure ◽  
Sofa Score ◽  
Therapeutic Intervention ◽  
Glasgow Coma Score ◽  
Scoring System ◽  
Simplified Acute Physiology Score ◽  
Apache Ii ◽  
Therapeutic Intervention Scoring System ◽  
Failure Assessment ◽  
Nursing Activity

Εισαγωγή: Στις Μονάδες Εντατικής Θεραπείας (ΜΕΘ), η ικανότητα πρόβλεψης της έκβασης μέσω των ειδικών συστημάτων με ακρίβεια και εγκυρότητα είναι πολύ χρήσιμη, καθώς έχει πολλές εφαρμογές στην κλινική πράξη. Στην βιβλιογραφία συστήνονται πολυάριθμες νέες μεταβλητές που φαίνεται να επηρεάζουν την τελική έκβαση των ασθενών και θα μπορούσαν δυνητικά να συμπεριληφθούν στα νέα προγνωστικά συστήματα που θα δημιουργηθούν στο μέλλον, με σκοπό να έχουν καλύτερη προγνωστική ικανότητα. Σκοπός: Ο κύριος σκοπός της παρούσας μελέτης ήταν η δημιουργία και αξιολόγηση τριών νέων προγνωστικών συστημάτων πρόβλεψης της θνησιμότητας των ασθενών της ΜΕΘ, χρησιμοποιώντας δεδομένα από το πρώτο 24ωρο της παραμονής τους σε αυτή. Τα τρία προγνωστικά συστήματα αφορούν στα τρία διαφορετικά είδη εκβάσεων: 1) θάνατος στη ΜΕΘ, 2) θάνατος στο νοσοκομείο και 3) θάνατος στο νοσοκομείο μόνο για τους ασθενείς που έχουν ήδη πάρει εξιτήριο από τη ΜΕΘ. Οι επιμέρους στόχοι ήταν: α) η σύγκριση της απόδοσης των νέων συστημάτων με τα ευρέως χρησιμοποιούμενα συμβατικά υπολογιστικά συστήματα πρόγνωσης και β) να αναδειχθούν οι παράγοντες κινδύνου που επηρεάζουν την τελική έκβαση των ασθενών στη ΜΕΘ. Υλικό και Μέθοδος: Πρόκειται για προοπτική, μη πειραματική μελέτη παρατήρησης σε μία παθολογική/χειρουργική, πολυδύναμη, πανεπιστημιακή ΜΕΘ ενός γενικού νοσοκομείου της Αττικής. Συνολικά μελετήθηκαν 436 ασθενείς που εισήχθησαν διαδοχικά στη ΜΕΘ, για το χρονικό διάστημα: Ιανουάριος 2012 - Ιούλιος 2013. Για τη συλλογή των δεδομένων αναπτύχθηκε ειδική φόρμα καταγραφής των δημογραφικών και κλινικών χαρακτηριστικών των ασθενών καθώς και ο κλινικοεργαστηριακός έλεγχος του πρώτου 24ώρου στη ΜΕΘ και η εκτίμηση της βαρύτητας της νόσου και του φόρτου νοσηλευτικής εργασίας, με βάση τα συστήματα: APACHE II (acute, physiology, age, chronic), SAPS III (Simplified Acute Physiology Score), SOFA score (Sepsis-Related Organ Failure Assessment), Κλίμακα Γλασκώβης (Glasgow Coma Score, GCS), TISS-28 (Therapeutic Intervention Scoring System) και NAS (Nursing Activity Score). Μόνο για τις δύο πρώτες εκβάσεις, το αρχικό δείγμα χωρίστηκε σε δύο υποσύνολα: στο δείγμα ανάπτυξης (Ν=400 ασθενείς) και στο δείγμα αξιολόγησης (Ν=36 ασθενείς). Από το δείγμα ανάπτυξης δημιουργήθηκαν τα νέα τελικά μοντέλα, ενώ από το δείγμα αξιολόγησης αξιολογήθηκε η απόδοση των μοντέλων αυτών για την ακριβή πρόβλεψη του θανάτου. Για τη δημιουργία των νέων συστημάτων και στις τρεις περιπτώσεις χρησιμοποιήθηκαν μέθοδοι πολλαπλής λογιστικής παλινδρόμησης. Αποτελέσματα: Δημιουργήθηκαν τρία τελικά μοντέλα πρόβλεψης του θανάτου σε ασθενείς ΜΕΘ, για τα τρία είδη των εκβάσεων: 1) Το νέο τελικό μοντέλο πρόβλεψης του θανάτου στη ΜΕΘ, είναι ένα πρωτότυπο, απλό και εύχρηστο εργαλείο, που αποτελείται από 12 μεταβλητές. Φαίνεται να έχει καλύτερη απόδοση (ROC AUC=0,85, SMR=1,25), σε σχέση τα συμβατικά προγνωστικά συστήματα (APACHE II: AUC=0,76, SMR=2,50, SAPS III: AUC=0,76, SMR=1,50) καθώς και καλύτερη προγνωστική ικανότητα (προβλεπόμενη θνησιμότητα: 41,63±31,61, παρατηρούμενη θνησιμότητα: 41,67%). 2) Το νέο τελικό μοντέλο πρόβλεψης του συνολικού θανάτου στο νοσοκομείο αποτελείται από 11 μεταβλητές. Φαίνεται να έχει καλύτερη διακριτική ικανότητα (ROC AUC=0,80, SMR=0,85) σε σχέση με συμβατικά προγνωστικά συστήματα (APACHE II: AUC=0,78, SMR=1,13, SAPS III: AUC=0,77, SMR=0,94) και επιτυγχάνει ικανοποιητική προγνωστική ικανότητα (προβλεπόμενη θνησιμότητα: 55,25±32,24, παρατηρούμενη θνησιμότητα: 47,22%). Όσον αφορά στο SOFA (ROC AUC=0,81, SMR=0,85), παρόλο που αυτό παρουσιάζει ελαφρώς καλύτερη απόδοση από το νέο σύστημα, δεν είναι τόσο ειδικό στην εκτίμηση της βαρύτητας της νόσου και στην πρόβλεψη της έκβασης, αλλά στην εκτίμηση της οργανικής δυσλειτουργίας. 3) Το νέο τελικό μοντέλο πρόβλεψης της νοσοκομειακής θνησιμότητας για τους ασθενείς που έχουν εξέλθει της ΜΕΘ είναι ένα πολύ απλό και εύχρηστο εργαλείο και αποτελείται από 7 μεταβλητές. Φαίνεται να έχει καλύτερη προσαρμογή (ROC AUC=0,85, SMR=1,62) σε σχέση τα συμβατικά προγνωστικά συστήματα (APACHE II: AUC=0,75, SMR=3,52, SAPS III: AUC=0,80, SMR=4,00) καθώς και καλύτερη προγνωστική ικανότητα (προβλεπόμενη θνησιμότητα: 20,67±22,14, παρατηρούμενη θνησιμότητα: 20,69%). Ωστόσο, αυτά τα αποτελέσματα δεν είναι τόσο αξιόπιστα, καθώς το μοντέλο αυτό δεν αξιολογήθηκε με ξεχωριστό δείγμα αξιολόγησης, λόγω του μικρού μεγέθους δείγματος και χρήζει περαιτέρω αξιολόγησης. Συμπεράσματα: Τα νέα μοντέλα που αναπτύχθηκαν είναι αρκετά απλά, εύχρηστα και πρωτότυπα εργαλεία, καθώς στα δύο από αυτά περιλαμβάνεται για πρώτη φορά ο ρυθμός μεταβολής της συγκέντρωσης του γαλακτικού οξέος στον ορό του ασθενούς κατά την πρώτη ημέρα παραμονής του στη ΜΕΘ. Φαίνεται ότι τα νέα αυτά μοντέλα ταιριάζουν καλύτερα στον τοπικό πληθυσμό των ασθενών που νοσηλεύονται στη δική μας ΜΕΘ, καθώς έχουν καλύτερη απόδοση και προγνωστική ικανότητα από τα συστήματα APACHE II, SAPS III και SOFA. Προς το παρόν, τα νέα μοντέλα φαίνονται να είναι καλύτερα από τα συμβατικά και αρκετά αξιόπιστοι δείκτες της θνησιμότητας, παρά τους διάφορους περιορισμούς της μελέτης. Προτείνεται επιπλέον μελλοντική έρευνα με σκοπό την αξιολόγηση τους με μεγαλύτερο μέγεθος δείγματος αξιολόγησης προκειμένου να επικυρωθούν και να χρησιμοποιηθούν και σε άλλες ΜΕΘ.

scholarly journals Análise do poder de discriminação de índices prognósticos em pacientes queimados

2019 ◽  
Vol 26 (1) ◽  
pp. 24
Author(s):  
Thalita Talizin ◽  
Elza Anami ◽  
Otavio Tavela ◽  
Eder Hilario ◽  
Sara Carolina Souza ◽  
...  
Keyword(s):  
Therapeutic Intervention ◽  
Scoring System ◽  
Operating Characteristic ◽  
Severity Index ◽  
Apache Ii ◽  
Burn Severity ◽  
Health Evaluation ◽  
Therapeutic Intervention Scoring System ◽  
Failure Assessment ◽  
Terapia Intensiva

Introdução: As queimaduras são um grave problema de saúde pública. Os índices prognósticos estimam probabilidade prognóstica e ajudam a quantificar a gravidade do paciente. Objetivo: Avaliar o poder de discriminação dos índices Abbreviated Burn Severity Index (ABSI), Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) e Therapeutic Intervention Scoring System 28 (TISS 28) da admissão em pacientes de uma Unidade de Terapia Intensiva (UTI) especializada no tratamento de queimados. Casuística e Métodos: Estudo longitudinal prospectivo, realizado em uma Unidade de Terapia Intensiva especializada no atendimento ao paciente queimado, no período de maio de 2011 a maio de 2013. Foram excluídos pacientes com menos de 18 anos e com menos de 24 horas de internação. Foram coletados dados clínicos e demográficos e calculados os escores prognósticos estudados. A acurácia dos índices foi avaliada pela curva Receiver Operating Characteristic (ROC), discriminando o desfecho do paciente (sobrevivente e não sobrevivente). Foi calculada a área sob a curva (AUC). Resultados: Foram incluídos 180 pacientes no período de estudo, sendo 72,8% do sexo masculino (n=131). A mediana de idade foi de 40 anos (ITQ: 30 – 52,5). A mortalidade hospitalar foi de 37,2% (n=67). A maior AUC foi a do escore APACHE II, com valor de 0,837 (ponto de corte do escore = 14, sensibilidade de 83,6% e especificidade de 72,3%). Na análise de pontuação dos escores entre sobreviventes e não sobreviventes, observou-se diferença estatisticamente significativa entre os valores de todos os índices estudados. Conclusões: Os escores ABSI, APACHE II, SOFA e TISS 28 na admissão da UTI mostraram bom poder de discriminação para sobrevivência entre pacientes queimados.

scholarly journals Critérios de admissão do paciente oncológico em Unidades de Terapia Intensiva de hospitais gerais

2019 ◽  
Vol 27 (2) ◽  
pp. 73
Author(s):  
Thaína Dalla Valle ◽  
Paulo Carlos Garcia
Keyword(s):  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Simplified Acute Physiology Score ◽  
Acute Physiology Score ◽  
Apache Ii ◽  
Electronic Library ◽  
Failure Assessment ◽  
Terapia Intensiva

A função da Unidade de Terapia Intensiva é de suporte terapêutico ao paciente. O paciente com câncer muitas vezes necessita de suporte intensivo. Nesse contexto, a gravidade das disfunções orgânicas, o comprometimento da capacidade funcional, o estadiamento do câncer e a aplicação de índices prognósticos são considerados na discussão para admissão na Unidade de Terapia Intensiva. Este artigo tem como objetivo identificar os critérios para admissão do paciente oncológico nas Unidade de Terapia Intensiva de hospitais gerais, através de uma revisão integrativa, com estudos de 2007 a 2017 disponíveis em versão completa e gratuita nas bases de dados digitais: Biblioteca Virtual em Saúde, Scientific Electronic Library Online e no portal PubMed. Foram encontradas 58 publicações potenciais. Após análise preliminar dos títulos e resumos e aplicação dos critérios de inclusão e exclusão, 23 artigos seguiram para leitura na íntegra, sendo que 10 compuseram a amostra final. Sete estudos (70%) citaram o escore prognóstico APACHE II, quatro (40%) utilizaram Simplified Acute Physiology Score, dois (20%) o Sequential Organ Failure Assessment e seis (60%) utilizaram mais de um instrumento. O câncer é uma doença grave, entretanto a decisão de indicação para tratamento intensivo não deve ser baseada em apenas uma morbidade. Pacientes oncológicos podem ter benefícios ao receberem suporte intensivo. Estudos que determinam critérios objetivos para admissão e avaliam o benefício da admissão do paciente oncológico nas Unidade de Terapia Intensiva de hospitais gerais devem ser incentivados a fim de melhor definir a utilização adequada dos recursos.

scholarly journals Haemogram-Derived Indices for Screening and Prognostication in Critically Ill Septic Shock Patients: A Case-Control Study

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 638
Author(s):  
Piotr S. Liberski ◽  
Michał Szewczyk ◽  
Łukasz J. Krzych
Keyword(s):  
Septic Shock ◽  
Organ Failure ◽  
Simplified Acute Physiology Score ◽  
Mortality Prediction ◽  
Apache Ii ◽  
Icu Mortality ◽  
Reactive Protein ◽  
Saps Ii ◽  
Multi Organ Failure ◽  
Failure Assessment

This study aimed (1) to assess the diagnostic accuracy of neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), monocyte-to-lymphocyte (MLR) and platelet count-to-mean platelet volume (PLT/MPV) ratios in predicting septic shock in patients on admission to the intensive care unit (ICU) and (2) to compare it with the role of C-reactive protein (CRP), procalcitonin (PCT) and lactate level. We also sought (3) to verify whether the indices could be useful in ICU mortality prediction and (4) to compare them with Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment (SOFA) scores. This retrospective study covered 138 patients, including 61 subjects with multi-organ failure due to septic shock (study group) and 77 sex- and age-matched controls. Septic patients had significantly higher NLR (p < 0.01) and NLR predicted septic shock occurrence (area under the ROC curve, AUROC = 0.66; 95% CI 0.58–0.74). PLR, MLR and PLT/MPV were impractical in sepsis prediction. Combination of CRP with NLR improved septic shock prediction (AUROC = 0.88; 95% CI 0.81–0.93). All indices failed to predict ICU mortality. APACHE II and SAPS II predicted mortality with AUROC = 0.68; 95% CI 0.54–0.78 and AUROC = 0.7; 95% CI 0.57–0.81, respectively. High NLR may be useful to identify patients with multi-organ failure due to septic shock but should be interpreted along with CRP or PCT. The investigated indices are not related with mortality in this specific clinical setting.

Effectiveness of the sequential organ failure assessment, acute physiology and chronic health evaluation II, and simplified acute physiology score II prognostic scoring systems in paraquat-poisoned patients in the intensive care unit

2016 ◽  
Vol 36 (5) ◽  
pp. 431-437 ◽  
Author(s):  
Jun Ho Lee ◽  
Seong Youn Hwang ◽  
Hye Ran Kim ◽  
Yang Won Kim ◽  
Mun Ju Kang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Sofa Score ◽  
Scoring Systems ◽  
Simplified Acute Physiology Score ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Saps Ii ◽  
Failure Assessment ◽  
Score Apache

Objective: This study was conducted to assess the ability of the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II scoring systems, as well as the simplified acute physiology score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with paraquat. This will assist physicians with risk stratification. Material and methods: The medical records of 244 paraquat-poisoned patients admitted to the ICU from January 2010 to April 2015 were examined retrospectively. The SOFA, APACHE II, and SAPS II scores were calculated based on initial laboratory data in the emergency department and during the first 24 h of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II. The ability of the SOFA score, APACHE II score, and SAPS II method to predict group mortality was assessed using a receiver operating characteristic (ROC) curve and calibration analyses. Results: A total of 219 patients (mean age, 63 years) were enrolled. Sensitivities, specificities, and accuracies were 58.5%, 86.1%, and 64.0% for the SOFA, respectively; 75.1%, 86.1%, and 77.6% for the APACHE II scoring systems, respectively; and 76.1%, 79.1%, and 76.7% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.716, 0.850, and 0.835, respectively. Conclusion: The SOFA, APACHE II, and SAPS II had different capabilities to discriminate and estimate early in-hospital mortality of paraquat-poisoned patients. Our results show that although the SOFA and SAPS II are easier and more quickly calculated than APACHE II, the APACHE II is superior for predicting mortality. We recommend use of the APACHE II for outcome predictions and risk stratification in paraquat-poisoned patients in the ICU.

scholarly journals Combination of Sequential Organ Failure Assessment (SOFA) score and Charlson Comorbidity Index (CCI) could predict the severity and prognosis of candidemia more accurately than the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) score

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nobuhiro Asai ◽  
Wataru Ohashi ◽  
Daisuke Sakanashi ◽  
Hiroyuki Suematsu ◽  
Hideo Kato ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Charlson Comorbidity Index ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Failure Assessment ◽  
Comorbidity Index

Abstract Background Candidemia has emerged as an important nosocomial infection, with a mortality rate of 30–50%. It is the fourth most common nosocomial bloodstream infection (BSI) in the United States and the seventh most common nosocomial BSI in Europe and Japan. The aim of this study was to assess the performance of the Sequential Organ Failure Assessment (SOFA) score for determining the severity and prognosis of candidemia. Methods We performed a retrospective study of patients admitted to hospital with candidemia between September 2014 and May 2018. The severity of candidemia was evaluated using the SOFA score and the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) score. Patients’ underlying diseases were assessed by the Charlson Comorbidity Index (CCI). Results Of 70 patients enrolled, 41 (59%) were males, and 29 (41%) were females. Their median age was 73 years (range: 36–93 years). The most common infection site was catheter-related bloodstream infection (n=36, 51%).The 30-day, and in-hospital mortality rates were 36 and 43%, respectively. Univariate analysis showed that SOFA score ≥5, APACHE II score ≥13, initial antifungal treatment with echinocandin, albumin < 2.3, C-reactive protein > 6, disturbance of consciousness, and CCI ≥3 were related with 30-day mortality. Of these 7, multivariate analysis showed that the combination of SOFA score ≥5 and CCI ≥3 was the best independent prognostic indicator for 30-day and in-hospital mortality. Conclusions The combined SOFA score and CCI was a better predictor of the 30-day mortality and in-hospital mortality than the APACHE II score alone.

scholarly journals Current Utility of Sequential Organ Failure Assessment Score: A Literature Review and Future Directions

2021 ◽  
Vol 15 (1) ◽  
pp. 1-6
Author(s):  
Rahul Kashyap ◽  
Khalid M. Sherani ◽  
Taru Dutt ◽  
Karthik Gnanapandithan ◽  
Malvika Sagar ◽  
...  
Keyword(s):  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Scoring System ◽  
Richmond Agitation Sedation Scale ◽  
Future Directions ◽  
Care Environment ◽  
Medical Trauma ◽  
Organ Systems ◽  
Failure Assessment

The Sequential Organ Failure Assessment (SOFA) score is commonly used in the Intensive Care Unit (ICU) to evaluate, prognosticate and assess patients. Since its validation, the SOFA score has served in various settings, including medical, trauma, surgical, cardiac, and neurological ICUs. It has been a strong mortality predictor and literature over the years has documented the ability of the SOFA score to accurately distinguish survivors from non-survivors on admission. Over the years, multiple variations have been proposed to the SOFA score, which have led to the evolution of alternate validated scoring models replacing one or more components of the SOFA scoring system. Various SOFA based models have been used to evaluate specific clinical populations, such as patients with cardiac dysfunction, hepatic failure, renal failure, different races and public health illnesses, etc. This study is aimed to conduct a review of modifications in SOFA score in the past several years. We review the literature evaluating various modifications to the SOFA score such as modified SOFA, Modified SOFA, modified Cardiovascular SOFA, Extra-renal SOFA, Chronic Liver Failure SOFA, Mexican SOFA, quick SOFA, Lactic acid quick SOFA (LqSOFA), SOFA in hematological malignancies, SOFA with Richmond Agitation-Sedation scale and Pediatric SOFA. Various organ systems, their relevant scoring and the proposed modifications in each of these systems are presented in detail. There is a need to incorporate the most recent literature into the SOFA scoring system to make it more relevant and accurate in this rapidly evolving critical care environment. For future directions, we plan to put together most if not all updates in SOFA score and probably validate it in a large database a single institution and validate it in multisite data base.

scholarly journals Establishment of a prognostic model based on the Sequential Organ Failure Assessment score for patients with first-time acute myocardial infarction

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110119
Author(s):  
Shuai Zheng ◽  
Jun Lyu ◽  
Didi Han ◽  
Fengshuo Xu ◽  
Chengzhuo Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Cardiovascular Events ◽  
Failure Assessment ◽  
First Time

Objective This study aimed to identify the prognostic factors of patients with first-time acute myocardial infarction (AMI) and to establish a nomogram for prognostic modeling. Methods We studied 985 patients with first-time AMI using data from the Multi-parameter Intelligent Monitoring for Intensive Care database and extracted their demographic data. Cox proportional hazards regression was used to examine outcome-related variables. We also tested a new predictive model that includes the Sequential Organ Failure Assessment (SOFA) score and compared it with the SOFA-only model. Results An older age, higher SOFA score, and higher Acute Physiology III score were risk factors for the prognosis of AMI. The risk of further cardiovascular events was 1.54-fold higher in women than in men. Patients in the cardiac surgery intensive care unit had a better prognosis than those in the coronary heart disease intensive care unit. Pressurized drug use was a protective factor and the risk of further cardiovascular events was 1.36-fold higher in nonusers. Conclusion The prognosis of AMI is affected by age, the SOFA score, the Acute Physiology III score, sex, admission location, type of care unit, and vasopressin use. Our new predictive model for AMI has better performance than the SOFA model alone.

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