scholarly journals Circulating levels of GH predict mortality and complement prognostic scores in critically ill medical patients

2009 ◽  
Vol 160 (2) ◽  
pp. 157-163 ◽  
Author(s):  
Philipp Schuetz ◽  
Beat Müller ◽  
Charly Nusbaumer ◽  
Melanie Wieland ◽  
Mirjam Christ-Crain
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Plasma Concentrations ◽  
Clinical Severity ◽  
Apache Ii ◽  
Saps Ii ◽  
Prognostic Accuracy ◽  
Saps Ii Score ◽  
Circulating Levels ◽  
Igfbp 3

BackgroundCirculating levels of GH are increased during critical illness and correlate with outcome in children with meningococcal sepsis. We assessed the prognostic implications of GH on admission and during follow-up in critically ill adult patients admitted to a medical intensive care unit.Materials and methodsWe measured GH, IGF1 and IGF-binding protein3 (IGFBP-3) plasma concentrations in 103 consecutive critically ill patients and compared it with two clinical severity scores (APACHE II, SAPS II).ResultsMedian GH levels on admission were similar in septic (n=53) and non-septic (n=50) patients and about 7-fold increased in the 24 non-survivors as compared with survivors (9.50 (interquartile ranges (IQR) 3.53–18.40) vs 1.4 (IQR 0.63–5.04), P<0.0001). GH levels increased with increasing severity of sepsis (sepsis, severe sepsis, and septic shock, P=0.019). By contrast, IGF1 and IGFBP-3 did not correlate with severity of disease or mortality. Logistic regression models showed that GH and both clinical scores were independent predictors of mortality with a similar prognostic accuracy (GH: area under the curve (AUC) 0.81 (95% confidence interval (CI), 0.71–0.92), APACHE II: AUC 0.71 (95% CI, 0.58–0.83), P=0.16, SAPS II: AUC 0.75 (95% CI, 0.63–0.86, P=0.36)). GH improved the prognostic accuracy of the APACHE II score to an AUC of 0.78 (95% CI, 0.66–090, P=0.04) and tended to improve the SAPS II score to an AUC of 0.79 (95% CI, 0.67–0.90, P=0.09).ConclusionGH plasma concentrations on admission are independent predictors for mortality in adult critically ill patients and may complement existing risk prediction scores, namely the APACHE II and the SAPS II score.

Prognostic Value of Lactate / Albumin Ratio combined with APACHE II, SAPS II and SOFA Score for Predicting Mortality in Critically Ill Patients with Septic Shock

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Walid H Nofal ◽  
Sahar K Abo Alela ◽  
Moustafa M Aldeeb ◽  
Gamal M Elewa
Keyword(s):  
Septic Shock ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Predictive Value ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Albumin Ratio ◽  
Saps Ii ◽  
Saps Ii Score

Abstract Background Despite all worldwide efforts towards sepsis, more than 5.3 million patients die annually. Till now, there is no parameter or score to detect mortality in septic patients precisely. Objectives The aim of this study was to evaluate the prognostic performance of the lactate/albumin (L/A) ratio when combined with APACHE II score, SOFA score and SAPS II for predicting 28-day mortality in critically ill patients with septic shock. Patients and Methods After approval of the Medical Ethics Committee of Ain Shams Faculty of Medicine, an informed consent was taken from the patient or next of kin to include his/her data in this study. All patients who were admitted to the intensive care units (ICUs) with septic shock from 1st of September, 2019 to 30th of March, 2020 were assessed for enrollment in this study. Results In this prospective observational study, 100 adult patients of both sexes with septic shock were enrolled. They were categorized into two groups according to the primary endpoint (outcome) “28-days mortality”. Sixty-one patients (61%) died (non-survivors’ group) and thirtynine patients (39%) survived (survivors group). The most significant factors which affecting the mortality were LAR, SOFA score on admission, APACHE II, and SAPS II score. Prediction performance of the four variables for estimating 28 days mortality. When combined LAR + SOFA, LAR + APACHE, LAR + SAPS II, Overall score the ROC (AUROC, 0.867,0.847,0.849,,0.899 respectively) was the highest, compared to the other single models and lower cutoff (&gt;0.48, &gt;0.53, &gt;0.42, &gt;0.47 respectively)in comparison to single scores. Moreover, the overall score (including the 4 parameters together) gave the best predictive value for 28 day mortality Conclusion Lactate/Albumin ratio combined with APACHI II, SOFA and SAPS scores gave the best predictive value for 28 day mortality in septic shock patients, when compared with each separate score Recommendations combined LAR + SOFA, LAR + APACHE, LAR + SAPS II, Overall score recommended to use to predictho spital mortality, Further research on large sample sizeto study the risk stratification and implementing new scores using the lactate/albumin ratio (LAR) is needed. Simple, available and cheap markers should be used in developing new prediction scores.

scholarly journals A Comparison of Severity Systems APACHE II and SAPS II in Critically ill Patients

2013 ◽  
Vol 1 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Mohammad Omar Faruq ◽  
Mohammad Rashed Mahmud ◽  
Tanjima Begum ◽  
ASM Areef Ahsan ◽  
Kaniz Fatema ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Goodness Of Fit ◽  
Care Quality ◽  
Apache Ii ◽  
Goodness Of Fit Test ◽  
Saps Ii ◽  
Icu Discharge ◽  
Saps Ii Score

Objective: To assess the performance of Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in Bangladeshi critically ill patients. Material and Method: Prospective observational cohort study conducted between January 1, 2008 and December 31, 2008 in the Intensive Care Unit (ICU) of BIRDEM Hospital, an 600-beds tertiary referral Postgraduate hospital and October to December 2008 in ICU, Ibn Sina Hospital Dhaka. Results: One hundred ninety four patients were enrolled. There were 58 deaths (42.65%) at ICU discharge. APACHE II and SAPS II predicted hospital mortality 35.32 ± 21.81and 37.11 ± 27.34 respectively. Both models showed excellent discrimination. The overall discriminatory capability, as measured by the aROC, was generally good for two models and ranged from 0.78 to 0.89. APACHE II is slightly better compared to SAPS II score but not significantly better than SAPS II. Both systems exhibited good calibration ( = 8.304, p = 0.40 for APACHE II, = 9.040, p = 0.34 for SAPS II). Hosmer- Lemeshow goodness-of-fit test revealed a good performance for APACHE II scores. Conclusion: APACHE II provided better performance than SAPS II in predicting mortality in our ICU patients but SAPS II also performed well. Our observed mortality was similar with the predicted mortality from APACHE II and SAPS II scores, which suggests that the result of this study reveals good intensive care quality. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14362 Bangladesh Crit Care J March 2013; 1: 27-32

scholarly journals Investigate predictive capacity of in-hospital mortality of four severity score systems on critically ill patients with acute kidney injury

2019 ◽  
Vol 67 (8) ◽  
pp. 1103-1109 ◽  
Author(s):  
Yu Gong ◽  
Feng Ding ◽  
Fen Zhang ◽  
Yong Gu
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Mortality Prediction ◽  
Apache Ii ◽  
University Teaching ◽  
Predictive Capacity ◽  
Saps Ii

Although significant improvements have been achieved in the renal replacement therapy of acute kidney injury (AKI), the mortality of patients with AKI remains high. The aim of this study is to prospectively investigate the capacity of Acute Physiology and Chronic Health Evaluation version II (APACHE II), Simplified Acute Physiology Score version II (SAPS II), Sepsis-related Organ Failure Assessment (SOFA) and Acute Tubular Necrosis Individual Severity Index (ATN-ISI) to predict in-hospital mortality of critically ill patients with AKI. A prospective observational study was conducted in a university teaching hospital. 189 consecutive critically ill patients with AKI were selected according Risk, Injury, Failure, Loss, or End-stage kidney disease criteria. APACHE II, SAPS II, SOFA and ATN-ISI counts were obtained within the first 24 hours following admission. Receiver operating characteristic analyses (ROCs) were applied. Area under the ROC curve (AUC) was calculated. Sensitivity and specificity of in-hospital mortality prediction were calculated. In this study, the in-hospital mortality of critically ill patients with AKI was 37.04% (70/189). AUC of APACHE II, SAPS II, SOFA and ATN-ISI was 0.903 (95% CI 0.856 to 0.950), 0.893 (95% CI 0.847 to 0.940), 0.908 (95% CI 0.866 to 0.950) and 0.889 (95% CI 0.841 to 0.937) and sensitivity was 90.76%, 89.92%, 90.76% and 89.08% and specificity was 77.14%, 70.00%, 71.43% and 71.43%, respectively. In this study, it was found APACHE II, SAPS II, SOFA and ATN-ISI are reliable in-hospital mortality predictors of critically ill patients with AKI. Trial registration number: NCT00953992.

scholarly journals Comparative study of scoring systems in ICU and emergency department in predicting mortality of critically ill

2017 ◽  
Vol 5 (4) ◽  
pp. 1352 ◽  
Author(s):  
Sasi Sekhar T. V. D. ◽  
Anjani Kumar C. ◽  
Bhavya Ch. ◽  
Sameera B. ◽  
Rama Devi Ch.
Keyword(s):  
Emergency Department ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Decision Making ◽  
Predictive Accuracy ◽  
Laboratory Data ◽  
Scoring Systems ◽  
Apache Ii ◽  
Early Warning Score ◽  
Saps Ii

Background: Scoring systems can be used to define critically ill patients, estimate their prognosis, help in clinical decision making, and guide the allocation of resources and to estimate the quality of care.  It remains unclear whether the additional data needed to compute ICU scores improves mortality prediction for critically ill patients compared to the simpler ED scores.Methods: We have done a prospective observational study of consecutively admitted 400 critically ill patients to ICU directly from Emergency Department in Dr PSIMS and RF over a period of 2 years. Clinical and laboratory data conforming to the modified early warning score (MEWS), rapid emergency medicine score (REMS), acute physiology and chronic health evaluation (APACHE II), and simplified acute physiology score (SAPS II) were recorded for all patients. A comparison was made between ED scoring systems MEWS, REMS and ICU scoring systems APACHE II, SAPSII. The outcome was recorded in two categories: survived and non-survived with a primary end point of 30-day mortality. Discrimination was evaluated using receiver operating characteristic (ROC) curves.Results: The ICU scores outperformed the ED scores with more area under curve values. The predicted mortality percentage of ICU based scoring systems is high compared to emergency scores (predicted mortality % of SAPS II-63%, APACHE II-33.3%, MEWS-18.5%, REMS-14.8%).Conclusions: ICU scores showed more predictive accuracy than ED scores in prognosticating the outcomes in critically ill patients. This difference is seemed more due to complexity of ICU scores.

scholarly journals Soluble neprilysin and survival in critically ill patients

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Lenz ◽  
KA Krychtiuk ◽  
M Brekalo ◽  
C Hengstenberg ◽  
K Huber ◽  
...  
Keyword(s):  
Critically Ill ◽  
Heart Valve ◽  
Critically Ill Patients ◽  
University Hospital ◽  
Medical Patients ◽  
Cardiovascular Research ◽  
Icu Admission ◽  
Saps Ii Score ◽  
Admission Type ◽  
Circulating Levels

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): -) Association for the Promotion of Research on Arteriosclerosis, Thrombosis and Vascular Biology (ATVB) -) Ludwig Boltzmann Cluster for Cardiovascular Research BACKGROUND Critically ill patients admitted to an intensive care unit (ICU) exhibit a high mortality rate irrespective of the initial cause of hospitalization. Neprilysin is a neutral endopeptidase degrading an array of vasoactive peptides, including bradykinin, adrenomedullin and natriuretic peptides and became a drug target within the treatment of heart failure with reduced ejection fraction. The aim of this study was to analyze whether circulating levels of neprilysin at ICU admission are associated with 30-day mortality, due to its physiologic effects. METHODS In this single-center prospective observational study, 222 consecutive patients admitted to a tertiary ICU at a university hospital were included. Blood was drawn at admission and soluble neprilysin levels were measured using ELISA. RESULTS Median simplified acute physiology score was 44 and 30-day mortality was 35.1% in medical patients (n = 151) and 7.1% in patients after surgery and heart valve interventions (n = 71). Neprilysin levels did not differ according to survival status after 30 days and admission type. When assessing neprilysin and survival according to admission type, no association was found in medical patients, while in patients after surgery or heart valve intervention, 30-day survivors exhibited significantly lower neprilysin levels as compared to those that died within 30 days (660.2, IQR: 156.4 – 2512.5 pg/ml versus 6532.6, IQR: 1840.1 – 10000.0 pg/ml; p = 0.02). Neprilysin predicted mortality independently from age, gender, NT-proBNP, and SAPS II score (OR per 1-SD increase of neprilysin: 2.52, 95%CI 1.01–6.32; p = 0.049). Additionally, neprilysin was markedly elevated in patients with sepsis and septic shock (p &lt; 0.05). CONCLUSION At the time of ICU-admission, circulating levels of neprilysin independently predicted 30-day mortality in patients following cardiac surgery or heart valve intervention, but not in critically ill medical patients.

scholarly journals Elevated Serum Tenascin-C Predicts Mortality in Critically Ill Patients With Multiple Organ Dysfunction

2021 ◽  
Vol 8 ◽  
Author(s):  
Yunyu Xu ◽  
Nanyang Li ◽  
Jiamin Gao ◽  
Da Shang ◽  
Min Zhang ◽  
...  
Keyword(s):  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Elevated Serum ◽  
Multiple Organ ◽  
Apache Ii ◽  
Consecutive Series ◽  
Multiple Organ Dysfunction ◽  
Tenascin C ◽  
Saps Ii

Background: Multiple organ dysfunction is a complex and lethal clinical feature with heterogeneous causes and is usually characterized by tissue injury of multiple organs. Tenascin-C (TNC) is a matricellular protein that is rarely expressed in most of the adult tissues, but re-induced following injury. This study aimed to evaluate serum TNC in predicting mortality in critically ill patients with multiple organ dysfunction.Methods: Adult critically ill patients with at least two organs dysfunction and an increase of Sequential Organ Failure Assess (SOFA) score ≥ 2 points within 7 days were prospectively enrolled into two independent cohorts. The emergency (derivation) cohort was a consecutive series and the patients were from Emergency Department. The inpatient (validation) cohort was a convenience series and the patients were from medical wards. Their serum samples at the first 24 h after enrollment were collected and subjected to TNC measurement using ELISA. The association between serum TNC level and 28-day all-cause mortality was investigated, and then the predictive value of serum TNC was analyzed.Results: A total of 110 patients with a median age of 64 years (53, 73) were enrolled in the emergency cohort. Compared to the survivors, serum TNC in the non-survivors was significantly higher (467.7 vs. 197.5 ng/ml, p &lt; 0.001). Multivariate logistic regression analysis revealed that the association between serum TNC and 28-day mortality was independent of sepsis or critical illness scores such as SOFA, Acute Physiology and Chronic Health Evaluation (APACHE II), and Simplified Acute Physiology Score (SAPS II), respectively (p &lt; 0.001 for each). The area under receiver operating characteristic curve of serum TNC for predicting mortality was 0.803 (0.717–0.888) (p &lt; 0.001), similar with SOFA 0.808 (0.725–0.891), APACHE II 0.762 (0.667–0.857), and SAPS II 0.779 (0.685–0.872). The optimal cut-off value of serum TNC was 298.2 ng/ml. Kaplan–Meier analysis showed that the survival of patients with serum TNC ≥ 300 ng/ml was significantly worse than that of patients with serum TNC &lt; 300 ng/ml. This result was validated in the inpatient cohort. The sensitivity and specificity of serum TNC ≥ 300 ng/ml for predicting mortality were 74.3 and 74.7% in the emergency cohort, and 63.0 and 70.1% in the inpatient cohort, respectively.Conclusion: Serum TNC was associated with mortality in critically ill patients with multiple organ dysfunction, and would be used as a prognostic tool for predicting mortality in this population.

scholarly journals Can the cytokine adsorber CytoSorb® help to mitigate cytokine storm and reduce mortality in critically ill patients? A propensity score matching analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Christina Scharf ◽  
Ines Schroeder ◽  
Michael Paal ◽  
Martin Winkels ◽  
Michael Irlbeck ◽  
...  
Keyword(s):  
Propensity Score ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Wilcoxon Test ◽  
Relative Reduction ◽  
Cytokine Storm ◽  
Saps Ii ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Abstract Background A cytokine storm is life threatening for critically ill patients and is mainly caused by sepsis or severe trauma. In combination with supportive therapy, the cytokine adsorber Cytosorb® (CS) is increasingly used for the treatment of cytokine storm. However, it is questionable whether its use is actually beneficial in these patients. Methods Patients with an interleukin-6 (IL-6) > 10,000 pg/ml were retrospectively included between October 2014 and May 2020 and were divided into two groups (group 1: CS therapy; group 2: no CS therapy). Inclusion criteria were a regularly measured IL-6 and, for patients allocated to group 1, CS therapy for at least 90 min. A propensity score (PS) matching analysis with significant baseline differences as predictors (Simplified Acute Physiology Score (SAPS) II, extracorporeal membrane oxygenation, renal replacement therapy, IL-6, lactate and norepinephrine demand) was performed to compare both groups (adjustment tolerance: < 0.05; standardization tolerance: < 10%). U-test and Fisher’s-test were used for independent variables and the Wilcoxon test was used for dependent variables. Results In total, 143 patients were included in the initial evaluation (group 1: 38; group 2: 105). Nineteen comparable pairings could be formed (mean initial IL-6: 58,385 vs. 59,812 pg/ml; mean SAPS II: 77 vs. 75). There was a significant reduction in IL-6 in patients with (p < 0.001) and without CS treatment (p = 0.005). However, there was no significant difference (p = 0.708) in the median relative reduction in both groups (89% vs. 80%). Furthermore, there was no significant difference in the relative change in C-reactive protein, lactate, or norepinephrine demand in either group and the in-hospital mortality was similar between groups (73.7%). Conclusion Our study showed no difference in IL-6 reduction, hemodynamic stabilization, or mortality in patients with Cytosorb® treatment compared to a matched patient population.

scholarly journals Severe liver dysfunction complicating course of COVID-19 in the critically ill: multifactorial cause or direct viral effect?

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kevin Roedl ◽  
Dominik Jarczak ◽  
Andreas Drolz ◽  
Dominic Wichmann ◽  
Olaf Boenisch ◽  
...  
Keyword(s):  
Critically Ill ◽  
Liver Dysfunction ◽  
Critically Ill Patients ◽  
Severity Of Illness ◽  
University Hospital ◽  
Severe Liver ◽  
Saps Ii ◽  
Severe Liver Dysfunction ◽  
Global Threat ◽  
The University

Abstract Background SARS-CoV-2 caused a pandemic and global threat for human health. Presence of liver injury was commonly reported in patients with coronavirus disease 2019 (COVID-19). However, reports on severe liver dysfunction (SLD) in critically ill with COVID-19 are lacking. We evaluated the occurrence, clinical characteristics and outcome of SLD in critically ill patients with COVID-19. Methods Clinical course and laboratory was analyzed from all patients with confirmed COVID-19 admitted to ICU of the university hospital. SLD was defined as: bilirubin ≥ 2 mg/dl or elevation of aminotransferase levels (> 20-fold ULN). Results 72 critically ill patients were identified, 22 (31%) patients developed SLD. Presenting characteristics including age, gender, comorbidities as well as clinical presentation regarding COVID-19 overlapped substantially in both groups. Patients with SLD had more severe respiratory failure (paO2/FiO2: 82 (58–114) vs. 117 (83–155); p < 0.05). Thus, required more frequently mechanical ventilation (95% vs. 64%; p < 0.01), rescue therapies (ECMO) (27% vs. 12%; p = 0.106), vasopressor (95% vs. 72%; p < 0.05) and renal replacement therapy (86% vs. 30%; p < 0.001). Severity of illness was significantly higher (SAPS II: 48 (39–52) vs. 40 (32–45); p < 0.01). Patients with SLD and without presented viremic during ICU stay in 68% and 34%, respectively (p = 0.002). Occurrence of SLD was independently associated with presence of viremia [OR 6.359; 95% CI 1.336–30.253; p < 0.05] and severity of illness (SAPS II) [OR 1.078; 95% CI 1.004–1.157; p < 0.05]. Mortality was high in patients with SLD compared to other patients (68% vs. 16%, p < 0.001). After adjustment for confounders, SLD was independently associated with mortality [HR3.347; 95% CI 1.401–7.999; p < 0.01]. Conclusion One-third of critically ill patients with COVID-19 suffer from SLD, which is associated with high mortality. Occurrence of viremia and severity of illness seem to contribute to occurrence of SLD and underline the multifactorial cause.

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