scholarly journals Perbandingan Validitas Sistem Skoring Apache II, SOFA, Dan Customized Sequential Organ Failure Assessment (Csofa) Untuk Memperkirakan Mortalitas Pasien Non-Bedah Yang Dirawat Di Ruang Perawatan Intensif

2015 ◽  
Vol 7 (2) ◽  
pp. 102 ◽  
Author(s):  
Stefanus Taofik ◽  
Tjokorda Agung Senapathi ◽  
I Made Wiryana
Keyword(s):  
Sequential Organ Failure Assessment ◽  
Receiver Operating Characteristic ◽  
Organ Failure ◽  
Operating Characteristic ◽  
Apache Ii ◽  
Missing Value ◽  
Failure Assessment ◽  
Receiver Operating

Latar Belakang : Penerapan Sistem Jaminan Kesehatan Nasional (SJKN) dalam pelayanan ICU mendorong pelayanan ICU untuk lebih efektif dan efisien. Prediksi hasil perawatan penting baik secara administrasi ataupun klinis dalam manajemen ICU. Pasien non-bedah meskipun jumlahnya tidak banyak, namun memiliki angka mortalitas yang tinggi.Tujuan : Untuk mendapatkan sistem skoring yang baik dan mudah diterapkan dilakukan penilaian missing value, dan diskriminasi dari masing masing sistem skoring.Metode : Penelitian ini melibatkan 184 pasien non-bedah yang dirawat di ICU RSUP Sanglah Denpasar yang diambil secara retrospektif dari data tanggal 1 Januari 2014 sampai dengan 31 Desember 2014. Semua pasien dilakukan penilaian APACHE II, SOFA, dan CSOFA. Uji analisis regresi logistik dilakukan untuk menilai pengaruh masing masing sub variabel terhadap mortalitas, dan selanjutnya mencari cut off point dari analisis kurva ROC untuk mendapatkan sensitifitas dan spesifisitas masing masing.Hasil : Area under Receiver Operating Characteristic (AuROC) pada APACHE II, SOFA, dan CSOFA berturut turut didapatkan 0,892, 0,919, dan 0,9172. Missing value terbanyak didapatkan berturut turut pada SOFA, APACHE II, dan CSOFA sebesar 84,23%, 8,15%, dan 1,65%, dengan dominan sub variabel hepar (bilirubin). Uji regresi logistik memperlihatkan sub variabel neurologi, kardiovaskular, dan respirasi memberikan hubungan bermakna terhadap mortalitas dengan RO 4,58, 2,24, dan 1,47. Sub variabel lain yang berpengaruh antara lain AKI, sepsis, dan penyakit kronis dengan RO 8,14, 3,89 dan 2,42.Simpulan : CSOFA lebih valid dalam memperkirakan mortalitas pasien di ICU RSUP Sanglah Denpasar, karena mempunyai nilai diskriminasi yang lebih baik dan missing value yang lebih sedikit dibandingkan dengan sistem skoring APACHE II dan SOFA

Prognostic performance of pancreatic stone protein in critically ill patients with sepsis

2019 ◽  
Vol 13 (17) ◽  
pp. 1469-1480
Author(s):  
Luis García de Guadiana-Romualdo ◽  
María Dolores Albaladejo-Otón ◽  
Mario Berger ◽  
Enrique Jiménez-Santos ◽  
Roberto Jiménez-Sánchez ◽  
...  
Keyword(s):  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Operating Characteristic ◽  
Pancreatic Stone ◽  
Assessment Score ◽  
Unit Management ◽  
Failure Assessment ◽  
Intensive Care Unit Management

Aim: To assess the prognostic value for 28-day mortality of PSP in critically ill patients with sepsis. Material & methods: 122 consecutive patients with sepsis were enrolled in this study. Blood samples were collected on admission and day 2. Results: On admission, the combination of PSP and lactate achieved an area under the receiver operating characteristic (AUC-ROC) of 0.796, similar to sequential organ failure assessment score alone (AUC-ROC: 0.826). On day 2, PSP was the biomarker with the highest performance (AUC-ROC: 0.844), although lower (p = 0.041) than sequential organ failure assessment score (AUC-ROC: 0.923). Conclusion: The combination of PSP and lactate and PSP alone, on day 2, have a good performance for prognosis of 28-day mortality and could help to identify patients who may benefit most from tailored intensive care unit management.

scholarly journals Η άλφα1-μικροσφαιρίνη ως δείκτης πρώιμης νεφρικής βλάβης σε βαρέως πάσχοντες σηπτικούς ασθενείς της Μ.Ε.Θ.

2015 ◽  
Author(s):  
Ειρήνη Τερζή
Keyword(s):  
Acute Kidney Injury ◽  
Receiver Operating Characteristic ◽  
Roc Curve ◽  
Operating Characteristic ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Apache Ii ◽  
Receiver Operating

Μελετήθηκε η συμβολή της άλφα1-μικροσφαιρίνης (alpha1-microglobulin, α1M) - ενός μέλους της οικογένειας των λιποκαλινών, που αποτελεί δείκτη εγγύς νεφροσωληναριακής δυσλειτουργίας - στην πρώιμη διαγνωστική της σχετιζόμενης με την σήψη οξείας νεφρικής βλάβης (acute kidney injury, AKI). Η μελέτη επικεντρώθηκε σε βαρέως πάσχοντες ασθενείς μιας πολυδύναμης Μονάδας Εντατικής Θεραπείας (Μ.Ε.Θ.). Από την προοπτική παρακολούθηση 290 ασθενών που εισήχθησαν για νοσηλεία σε διάστημα ενός έτους, μελετήθηκαν 45 σηπτικοί ασθενείς, εκ των οποίων οι 16 (35.6%) εκδήλωσαν νεφρική ανεπάρκεια. Η α1Μ προσδιορίσθηκε σε δείγματα ούρων από συλλογές ούρων 24ώρου κατά το σηπτικό επεισόδιο και σε συγκεκριμένα χρονικά διαστήματα έκτοτε. Η διαγνωστική ικανότητα του βιοδείκτη εκτιμήθηκε με τον μη παραμετρικό υπολογισμό της περιοχής κάτω από την καμπύλη μίας καμπύλης λειτουργικού χαρακτηριστικού δέκτη (area under the curve (AUC) of the receiver operating characteristic (ROC) curve, AUCROC). Τα επίπεδα της α1Μ ήταν σημαντικά υψηλότερα σε όλους τους σηπτικούς ασθενείς (μέση τιμή επιπέδων σε όλα τα δείγματα στο σηπτικό επεισόδιο 46.02 ± 7.17 mg/l) και παρουσίασαν αυξητική τάση στους ασθενείς που τελικά ανέπτυξαν σηπτική νεφρική ανεπάρκεια. Η AUCROC για την πρόβλεψη της σηπτικής ΑKΙ σύμφωνα με τα επίπεδα της α1M 24 ώρες πριν την εμφάνιση της νεφρικής προσβολής ήταν 0.739 (ευαισθησία 87.5%, ειδικότητα 62.07%, τιμή-όριο 47.9 mg/l). Τα επίπεδα της α1Μ 24 ώρες πριν την σηπτική νεφρική προσβολή, η κρεατινίνη ορού και η βαθμολογία βαρύτητας νόσου κατά APACHE II στο επεισόδιο της σήψης, αναδείχθηκαν ως οι σημαντικότεροι ανεξάρτητοι προγνωστικοί παράγοντες πρόβλεψης της ΑΚΙ. Ο συνδυασμός των ανωτέρω τριών παραμέτρων βελτίωσε την AUCROC της πρόγνωση της AKI σε 0.944. Τα αποτελέσματα υποστηρίζουν την ιδέα πως τα επίπεδα της α1Μ στα ούρα θα μπορούσαν να συμβάλουν στην πρώιμη διάκριση των σηπτικών ασθενών που εξελίσσονται σε ΑΚΙ και μπορεί να αποδειχθούν χρήσιμος βιοδείκτης. Παράλληλα, αναδεικνύουν ως θέμα για περαιτέρω έρευνα την παθογενετική εμπλοκή της α1Μ στην σήψη και στην σηπτική ΑΚΙ.

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 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.

Analisis Sistem Skoring APACHE II dan SOFA Terhadap Outcome di Intensive Care Unit RSUD Dr. Soetomo Surabaya

2021 ◽  
Vol 13 (2) ◽  
pp. 99-113
Author(s):  
Habibah Teniya Ariq Fauziyah ◽  
Bambang Pujo Semedi ◽  
Pudji Lestari ◽  
Maulydia Maulydia
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Chronic Health Evaluation ◽  
Apache Ii ◽  
Health Evaluation ◽  
Scatter Plot ◽  
Chronic Health ◽  
Failure Assessment

Latar belakang: Intensive care unit (ICU) adalah suatu ruangan dari rumah sakit yang khusus untuk merawat pasien yang menderita penyakit, cedera, atau komplikasi yang mengancam jiwa. Pasien yang sedang dilakukan perawatan di ICU dapat diperkirakan prognosisnya menggunakan sistem skoring.Tujuan: Untuk mengetahui hubungan antara sistem skoring acute physiological chronic health evaluation (APACHE II), sequential organ failure assessment (SOFA) hari pertama, SOFA hari ketiga, SOFA hari kelima dengan outcome pasien di ICU RSUD Dr. Soetomo Surabaya.Metode: Prospektif studi analitik observasional. Pengumpulan data dari rekam medis ICU RSUD Dr. Soetomo Surabaya. Subjek penelitiannya adalah pasien berumur ≥17 tahun yang dirawat di ICU minimal lima hari untuk kemudian dibandingkan sistem skoring APACHE II, SOFA hari pertama, SOFA hari ketiga dan SOFA hari kelima terhadap outcome pasien. Sampel penelitian bulan September 2019 hingga Januari 2020 sebanyak 110 pasien, namun yang masuk kriteria inklusi hanya 30 pasien. Data dianalisis menggunakan software SPSS 16 menggunakan uji spearman dan scatter plot.Hasil: Dari 30 pasien ICU, 56.7% berjenis kelamin laki-laki dan 43.3% berjenis kelamin perempuan, kelompok umur terbanyak 46-65 tahun (50%), indeks massa tubuh (IMT) tertinggi pada kategori IMT Normal (60%), diagnosis terbanyak adalah Sepsis sebanyak 14 pasien. (46.7%), pasien tanpa komorbiditas lebih dominan 15 pasien (50%), kondisi akhir pasien lebih banyak pada pasien yang hidup 18 pasien (60%). Hasil uji Spearman dan scatter plot menunjukkan adanya hubungan antara SOFA hari kelima dengan outcome ICU (p <0.05).Kesimpulan: Sistem penilaian SOFA hari kelima dapat memprediksi outcome ICU. Sedangkan APACHE II dan SOFA pada hari pertama dan ketiga tidak dapat memprediksi outcome ICU.

scholarly journals Συγκριτική αξιολόγηση των δεικτών βαρύτητας APACHE II και SOFA στην εκτίμηση της πρόγνωσης σε ασθενείς καρδιολογικών μονάδων

2016 ◽  
Author(s):  
Γεώργιος Αργυρίου
Keyword(s):  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Chronic Health Evaluation ◽  
Apache Ii ◽  
Brier Score ◽  
Health Evaluation ◽  
Chronic Health ◽  
Failure Assessment

Σκοπός: Η συγκριτική αξιολόγηση των προγνωστικών δεικτών βαρύτητας acute physiology and chronic health evaluation (APACHE) II και sequential organ failure assessment (SOFA) σε καρδιολογικές μονάδες εντατικής θεραπείας (ΚΜΕΘ).Μέθοδος: Πρόκειται για μονοκεντρική, προοπτική μελέτη παρατήρησης, σε ασθενείς με οξέα καρδιολογικά προβλήματα που εισήχθησαν σε ΚΜΕΘ. Τα APACHE II και SOFA υπολογίσθηκαν κατά την είσοδο των ασθενών στην ΚΜΕΘ λαμβάνοντας υπόψη τις χειρότερες τιμές του πρώτου 24ώρου νοσηλείας. Η περιοχή κάτω από την καμπύλη (AUC) χρησιμοποιήθηκε για να αξιολογήσει τη διακριτική ικανότητα των δεικτών στην πρόβλεψη της επιβίωσης στην ΚΜΕΘ, στο νοσοκομείο και 6 μήνες μετά την έξοδο από αυτό. Η βαθμονόμηση και η ακρίβεια των δεικτών ελέχθησαν με τη χρήση του Hosmer-Lemeshow (HL) test και του Brier score. Οι αναλύσεις έγιναν στο σύνολο του δείγματος και χωριστά σε ασθενείς με οξύ στεφανιαίο σύνδρομο (ΟΣΣ).Αποτελέσματα: Από τους 300 ασθενείς που εισήχθησαν οι 206 είχαν ΟΣΣ. Και οι δύο δείκτες παρουσίασαν καλή διακριτική ικανότητα (AUC εύρος 0,84-0,92) και οι AUC δε διέφεραν σημαντικά μεταξύ τους. Οι τιμές του HL test ήταν υψηλότερες (0,151-0,949 έναντι 0,033-0,531) και του Brier score κοντά στο μηδέν (0,0864-0,1570 έναντι 0,1039-0,1264) για το APACHE II σε σύγκριση με το SOFA. To APACHE II αποτέλεσε τον καλύτερο παράγοντα κινδύνου για την αξιολόγηση της θνησιμότητας στην ΚΜΕΘ (OR=1,24, 95% CI: 1,13-1,37, p<0,001).Συμπέρασμα: Τα APACHE II και SOFA έχουν καλή και συγκρίσιμη διακριτική ικανότητα για την πρόβλεψη της έκβασης. Η βαθμονόμηση και οι δείκτες ακρίβειας είναι καλύτεροι για το APACHE II.

scholarly journals Prognostic Accuracy of a Novel Prognostic Score Using a Combination of PCT, DDi, and Lactate Biomarkers in Patients With Sepsis: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Yansong miao ◽  
LiFeng Xing
Keyword(s):  
Receiver Operating Characteristic Curve ◽  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Prognostic Score ◽  
Laboratory Data ◽  
Apache Ii ◽  
Cutoff Points ◽  
Operating Characteristic Curve ◽  
Receiver Operating

Abstract Background A combination of multiple biomarkers will be more accurate in predicting the mortality of sepsis patients. Herein, we aimed to assess the ability to predict adverse outcomes of a novel scoring system using the combination of PCT, DDi, and lactate (PDLS) in patients with sepsis from the emergency department (ED) of a hospital. Methods The patients’ baseline characteristics, main laboratory data and outcome were collected from the patient's electronic medical record. A receiver operating characteristic curve (ROC) analysis determine the optimal cutoff points for biomarkers PCT, DDi and lactate and establish a PDLS system based on their cutoff points. ROC was used to compare the accuracy of PDLS to Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores in predicting short-term mortality in patients with sepsis. Results The analysis cohort included 1001 patients. 117 sepsis patients died in 28 days. An increase in PDLS was associated with higher mortality and adverse events including MV, VD, AICU, and CRRT. PDLS was an independent predictor of 28-day mortality, MV, VD, AICU, and CRRT. The Area Under the Receiver Operating Characteristic curve (AUROC) of PDLS (0.96; Cl=0.94-0.98) was significantly higher than that of SOFA (0.84; Cl=0.80-0.89) and APACHE II (0.84; Cl=0.79-0.88). Conclusion PDLS is an independent prognostic predictor of adverse clinical outcomes for sepsis patients and was superior to other prognostic scores, including SOFA and APACHE II.

scholarly journals Comparison of Intensive Care Outcome Prediction Models Based on Admission Scores With those Based on 24-Hour Data

2008 ◽  
Vol 36 (6) ◽  
pp. 845-849 ◽  
Author(s):  
G. J. Duke ◽  
M. Piercy ◽  
D. Digiantomasso ◽  
J. V. Green
Keyword(s):  
Intensive Care ◽  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Outcome Prediction ◽  
Prediction Models ◽  
Apache Ii ◽  
Standardised Mortality Ratio ◽  
Receiver Operating Characteristic Plot ◽  
Mortality Ratio ◽  
Receiver Operating

We compared the performance of six outcome prediction models - three based on 24-hour data and three based on admission-only data - in a metropolitan university-affiliated teaching hospital with a 10-bed intensive care unit. The Acute Physiology and Chronic Health Evaluation models, version II (APACHE II) and version III-J, and the Simplified Acute Physiology Score version II (SAPS II) are based on 24-hour data and were compared with the Mortality Prediction Model version II and the SAPS version III using international and Australian coefficients (SAPS IIIA). Data were collected prospectively according to the standard methodologies for each model. Calibration and discrimination for each model were assessed by the standardised mortality ratio, area under the receiver operating characteristic plot and Hosmer-Lemeshow contingency tables and chi-squared statistics (C10 and H10). Predetermined criteria were area under the receiver operating characteristic plot >0.8, standardised mortality ratio 95% confidence interval includes 1.0, and C10 and H10 P values >0.05. Between October 1, 2005 and December 31, 2007, 1843 consecutive admissions were screened and after the standard exclusions, 1741 were included in the analysis. The SAAPS II and SAPS IIIA models fulfilled and the APACHE II model failed all criteria. The other models satisfied the discrimination criterion but significantly over-predicted mortality risk and require recalibration. Outcome prediction models based on admission-only data compared favourably to those based on 24-hour data.

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