CORRELATION BETWEEN APACHE II SCORE, MORTALITY, AND LENGTH OF STAY IN THE FIRST 24 HOURS OF SHOCK IN INTENSIVE CARE UNIT (ICU) PATIENTS

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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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.

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Cardiac Safety of Clonidine and Quetiapine in Post-Cardiac Surgery Intensive Care Unit Patients

Journal of Pharmacy Practice ◽

10.1177/08971900211044687 ◽

2021 ◽

pp. 089719002110446

Author(s):

Abdulrahman I. Alshaya ◽

James F. Gilmore ◽

Rebecca M. Nashett ◽

Mary P. Kovacevic ◽

Kevin M. Dube ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Apache Ii Score ◽

Cardiac Safety ◽

Icu Patients ◽

Safety Outcomes

Background: Clonidine and quetiapine are frequently used medications in the cardiac surgery intensive care unit (ICU). Objective: The purpose of this study is to assess the impact of clonidine compared to quetiapine on cardiac safety outcomes in adult cardiac surgery ICU patients. Methods: This was a single-center, retrospective observational analysis at a tertiary care, academic medical center. Results: One hundred and sixty-one cardiac surgery patients who were administered clonidine or quetiapine during their ICU stay were included between June 2015 and May 2017. The major endpoint of this study was a cardiac safety composite of bradycardia, hypotension, and QTc prolongation. Minor endpoints included ICU and hospital length of stay, and in-hospital mortality. There were 115 patients included in the clonidine arm and 46 patients in the quetiapine arm. There was no difference between groups with regard to the major endpoint (30.43% vs 33.15%; P < .8). There was a shorter ICU and hospital length of stay in the clonidine arm compared to quetiapine P < .0001. All other endpoints were not statistically significant. Conclusion: Patients who received clonidine tended to have undergone less complex procedures, be younger, and have a lower APACHE II score than patients who received quetiapine. The incidence of composite cardiac safety outcomes was not different in clonidine compared to quetiapine in cardiac surgery ICU patients.

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Cohort study of the APACHE II score and mortality for different types of intensive care unit patients

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2021-140376 ◽

2021 ◽

pp. postgradmedj-2021-140376

Author(s):

Veli Sungono ◽

Hori Hariyanto ◽

Tri Edhi Budhi Soesilo ◽

Asri C Adisasmita ◽

Syahrizal Syarif ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Goodness Of Fit ◽

Characteristic Curve ◽

Secondary Data ◽

Apache Ii ◽

Surgical Patients ◽

Medical Emergency ◽

Apache Ii Score ◽

Icu Patients

ObjectivesFind the discriminant and calibration of APACHE II (Acute Physiology And Chronic Health Evaluation) score to predict mortality for different type of intensive care unit (ICU) patients.MethodsThis is a cohort retrospective study using secondary data of ICU patients admitted to Siloam Hospital of Lippo Village from 2014 to 2018 with minimum age ≥17 years. The analysis uses the receiver operating characteristic curve, student t-test and logistic regression to find significant variables needed to predict mortality.ResultsA total of 2181 ICU patients: men (55.52%) and women (44.48%) with an average age of 53.8 years old and length of stay 3.92 days were included in this study. Patients were admitted from medical emergency (30.5%), neurosurgical (52.1%) and surgical (17.4%) departments, with 10% of mortality proportion. Patients admitted from the medical emergency had the highest average APACHE score, 23.14±8.5, compared with patients admitted from neurosurgery 15.3±6.6 and surgical 15.8±6.8. The mortality rate of patients from medical emergency (24.5%) was higher than patients from neurosurgery (3.5%) or surgical (5.3%) departments. Area under curve of APACHE II score showed 0.8536 (95% CI 0.827 to 0.879). The goodness of fit Hosmer-Lemeshow show p=0.000 with all ICU patients’ mortality; p=0.641 with medical emergency, p=0.0001 with neurosurgical and p=0.000 with surgical patients.ConclusionAPACHE II has a good discriminant for predicting mortality among ICU patients in Siloam Hospital but poor calibration score. However, it demonstrates poor calibration in neurosurgical and surgical patients while demonstrating adequate calibration in medical emergency patients.

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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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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.

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APACHE II Score and Evaluation of Intensive Care Unit Patients

Korean Journal of Anesthesiology ◽

10.4097/kjae.1994.27.2.191 ◽

1994 ◽

Vol 27 (2) ◽

pp. 191

Author(s):

Kyoung Min Lee ◽

Gie Hoan Lee ◽

Dae Ja Um ◽

Ryoung Choi

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Apache Ii ◽

Apache Ii Score

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Effectiveness of Oral Rinse with Chlorhexidine in Preventing Nosocomial Respiratory Tract Infections among Intensive Care Unit Patients

Infection Control and Hospital Epidemiology ◽

10.1086/605722 ◽

2009 ◽

Vol 30 (10) ◽

pp. 952-958 ◽

Cited By ~ 43

Author(s):

Fernando Bellissimo-Rodrigues ◽

Wanessa Teixeira Bellissimo-Rodrigues ◽

Jaciara Machado Viana ◽

Gil Cezar Alkmim Teixeira ◽

Edson Nicolini ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Respiratory Tract Infections ◽

Icu Patients ◽

Oral Application ◽

Tract Infections

Objective.To evaluate the effectiveness of the oral application of a 0.12% solution of Chlorhexidine for prevention of respiratory tract infections among intensive care unit (ICU) patients.Design.The study design was a double-blind, randomized, placebo-controlled trial.Setting.The study was performed in an ICU in a tertiary care hospital at a public university.Patients.Study participants comprised 194 patients admitted to the ICU with a prospective length of stay greater than 48 hours, randomized into 2 groups: those who received Chlorhexidine (n = 98) and those who received a placebo (n = 96).Intervention.Oral rinses with Chlorhexidine or a placebo were performed 3 times a day throughout the duration of the patient's stay in the ICU. Clinical data were collected prospectively.Results.Both groups displayed similar baseline clinical features. The overall incidence of respiratory tract infections (RR, 1.0 [95% confidence interval [CI], 0.63-1.60]) and the rates of ventilator-associated pneumonia per 1,000 ventilator-days were similar in both experimental and control groups (22.6 vs 22.3; P = .95). Respiratory tract infection-free survival time (7.8 vs 6.9 days; P = .61), duration of mechanical ventilation (11.1 vs 11.0 days; P = .61), and length of stay (9.7 vs 10.4 days; P = .67) did not differ between the Chlorhexidine and placebo groups. However, patients in the Chlorhexidine group exhibited a larger interval between ICU admission and onset of the first respiratory tract infection (11.3 vs 7.6 days; P = .05). The chances of surviving the ICU stay were similar (RR, 1.08 [95% CI, 0.72-1.63]).Conclusion.Oral application of a 0.12% solution of Chlorhexidine does not prevent respiratory tract infections among ICU patients, although it may retard their onset.

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Prognostic factors and outcome of adult allogeneic hematopoietic stem cell transplantation patients admitted to intensive care unit during transplant hospitalization

Scientific Reports ◽

10.1038/s41598-019-56322-0 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Christian S. Michel ◽

Daniel Teschner ◽

Irene Schmidtmann ◽

Matthias Theobald ◽

Beate Hauptrock ◽

...

Keyword(s):

Intensive Care Unit ◽

Stem Cell ◽

Intensive Care ◽

Hematopoietic Stem Cell Transplantation ◽

Apache Ii ◽

Prognostic Scores ◽

Apache Ii Score ◽

Hematopoietic Stem ◽

Short And Long Term

AbstractPatients undergoing allogeneic hematopoietic stem cell transplantation have a high morbidity and mortality, especially after admission to intensive care unit (ICU) during peri-transplant period. The objective of this study was to identify new clinical and biological parameters and validate prognostic scores associated with ICU, short-and long-term survival. Significant differences between ICU survivors and ICU non-survivors for the clinical parameters invasive mechanical ventilation, urine output, heart rate, mean arterial pressure, and amount of vasopressors have been measured. Among prognostic scores (SOFA, SAPSII, PICAT, APACHE II, APACHE IV) assessing severity of disease and predicting outcome of critically ill patients on ICU, the APACHE II score has shown most significant difference (p = 0.002) and the highest discriminative power (area under the ROC curve (AUC) 0.74). An elevated level of lactate at day of admission was associated with poor survival on ICU and the most significant independent parameter (p < 0.001). In our cohort kidney damage with low urine output has a highly relevant impact on ICU, short- and long-term overall survival. The APACHE II score was superior predicting ICU mortality compared to all other tested prognostic scores for patients on ICU during peri-transplant period.

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