Study of spectrum of sepsis and prediction of its outcome in patients admitted to ICU using different scoring systems

Background: Although sepsis is one of the leading causes of mortality in hospitalized patients, information regarding early predictive factors for mortality and morbidity is limited. The aim was to identify reliable and early prognostic variables predicting mortality in patients admitted to ICU with sepsis.Methods: Patients fulfilling the Surviving Sepsis Campaign 2012 guidelines criteria for sepsis within the ICU were included over two years. Apart from baseline haematological, biochemical and metabolic parameters, APACHE II, SAPS II and SOFA scores were calculated on day 1 of admission. Patients were followed till death or discharge from the ICU. Chi-square test, student t-test, receiver operating curve analyses were done.Results: 100 patients were enrolled during the study period. The overall mortality was 35% (68.6% in males and 31.4% in females). Mortality was 88.6% and 11.4% in patients with septic shock and severe sepsis and none in the sepsis group, respectively. On multivariate analysis, significant predictors of mortality were APACHE II score greater than 27, SAPS II score greater than 43 and SOFA score greater than 11 on day the of admission. On ROC analysis APACHE II had the highest sensitivity (92.3%) and SAPS II had the highest specificity (82.9%).Conclusions: All three scores performed well in predicting the mortality. Overall, APACHE II had highest sensitivity, hence was the best predictor of mortality in critically ill patients. SAPS II had the highest specificity, hence it predicted improvement better than death. SOFA had intermediate sensitivity and specificity.

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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 ◽

10.1093/qjmed/hcab086.084 ◽

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 (>0.48, >0.53, >0.42, >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.

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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

Human & Experimental Toxicology ◽

10.1177/0960327116657602 ◽

2016 ◽

Vol 36 (5) ◽

pp. 431-437 ◽

Cited By ~ 6

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.

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The Predictive Value of the Oxford Acute Disease Severity Score for Clinical Outcomes in Patients with Acute Kidney Injury: A Secondary Analysis of a Large Prospective Observational Study

10.21203/rs.3.rs-640541/v1 ◽

2021 ◽

Author(s):

Na Wang ◽

Mei-Ping Wang ◽

Li Jiang ◽

Bin Du ◽

Bo Zhu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Mortality Risk ◽

Predictive Accuracy ◽

Kidney Injury ◽

Scoring Systems ◽

Continuous Variable ◽

Apache Ii ◽

Apache Ii Score ◽

Significance Level ◽

Saps Ii

Abstract Background: To compare the performance of the Oxford Acute Severity of Illness Score (OASIS), the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, the Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA) score in predicting 28-day mortality in acute kidney injury (AKI) patients.Methods: Data were extracted from the Beijing Acute Kidney Injury Trial (BAKIT). 2,954 patients with complete clinical data were included in this study. We calculated the OASIS, APACHE II, SAPS II and SOFA within the first day of ICU admission. Receiver operating characteristic (ROC) curves were used to analyse and evaluate the predictive effects of the four scoring systems on the 28-day mortality risk of AKI patients and each subgroup. The best cut-off value was identified by the highest combined sensitivity and specificity using Youden’s index. The significance level was set at 5%.Results: Among the 2,954 patients, the 28-day mortality rate was 17.0% (501 patients died). The OASIS, APACHE II, SAPS II and SOFA of nonsurviving patients were higher than those of surviving patients with AKI. The 28-day mortality of AKI patients increased accordingly with the increase in OASIS. Among the four scoring systems, the area under the curve (AUC) of OASIS was the highest. The comparison of AUC values of different scoring systems showed that there were no significant differences among OASIS, APACHE II and SAPS II, which were better than SOFA. Moreover, logistic analysis revealed that OASIS was an independent risk factor for 28-day mortality in AKI patients, whether as a continuous variable or a categorical variable. OASIS also had good performance in predicting ICU mortality and in-hospital mortality in AKI patients and had good predictive ability for the 28-day mortality of each subgroup of AKI patients.Conclusion: OASIS, APACHE II and SAPS II all presented good discrimination and calibration in predicting the 28-day mortality risk of AKI patients. OASIS, APACHE II and SAPS II had better predictive accuracy than SOFA, but due to the complexity of APACHE II and SAPS II calculations, OASIS is a good substitute.Trial RegistrationThis study was registered at www.chictr.org.cn (registration number Chi CTR-ONC-11001875). Registered on 14 December 2011.

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Mortality rate of ICU patients according to APACHE II and SAPS II score

Health & Research Journal ◽

10.12681/healthresj.19297 ◽

2018 ◽

Vol 4 (4) ◽

pp. 219

Author(s):

Ariadni Kostoglou ◽

Anastasia Kotanidou ◽

Christina Marvaki ◽

Stylianos Orfanos

Keyword(s):

Disease Classification ◽

Apache Ii ◽

Apache Ii Score ◽

Continuous Variables ◽

Saps Ii ◽

Prediction Of Mortality ◽

Confounding Variables ◽

Saps Ii Score ◽

Kolmogorov Smirnov ◽

Trauma Mortality

Introduction: Two of the most important systems measuring the severity of disease classification in Intensive Care Unit (ICU) are APACHE II and SAPS II. The scores that the two systems generate can be the cause of increased mortality.Aim: of subject study is to record mortality of 28 days in ICU of a Hospital located in Piraeus and to investigate its dependence on the variables APACHE II and SAPS II. Material and Methods: Population of the study consisted of 200 patients, older than 18 years, admitted to ICU. The application of normal distribution for continuous variables has been evaluated based on Kolmogorov-Smirnov parametric analysis.Results: 62, 5% of the sample were male, while 37,5% were female. The average age of patients participating in the study was 58,02 years ± 19,085, average APACHE II score 22,33 ± 8,038 and average SAPS II score 37,03 ± 16,169. 51,5% of those patients were diagnosed with pathological problems, 25,5% with surgical problems and 23% had trauma. Mortality in ICU was 32%. The area below ROC curve for the prediction of mortality from APACHE II score was 0.748 (95% confidence interval: 0.684-0.808, p<0.001). Conclusions : From the regression ran based on multiple confounding variables (age, gender, diagnosis, APACHE II and SAPS II scores) we conclude that mortality of 28 days in a polyvalent ICU is affected only by APACHE II score, which predicted independently (p= 0.036) the mortality of the patients of the present study.

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Comparing the APACHE II, SOFA, LOD, and SAPS II scores in patients who have developed a nosocomial infection

Bangladesh Critical Care Journal ◽

10.3329/bccj.v2i1.19949 ◽

2014 ◽

Vol 2 (1) ◽

pp. 4-9

Author(s):

Ahmed Haddadi ◽

Mohamed Ledmani ◽

Marc Gainier ◽

Hubert Hubert ◽

P Lafaye De Micheaux

Keyword(s):

Intensive Care ◽

Nosocomial Infection ◽

Sofa Score ◽

Apache Ii ◽

Apache Ii Score ◽

The Third ◽

Saps Ii ◽

Icu Stay ◽

Logistic Organ Dysfunction ◽

Saps Ii Score

Background: There have been numerous scores intended to evaluate the severity of patients condition upon admission and during their intensive care unit (ICU) stay. However, to our knowledge, no study has ever evaluated the predictive abilities of these scores among nosocomial patients during their ICU stay. The aim of our study is to compare the predictive performances of the Acute Physiology, and, Chronic Health Evaluation (APACHE II) score, Simplified Acute Physiologic Score (SAPS II), Logistic Organ Dysfunction (LOD), and Sequential Organ Failure Assessment (SOFA) scores among intensive care patients who have developed a nosocomial infection. Methods: The study is monocentric and retrospective. The APACHE II, SAPS II, LOD, and SOFA scores were reported from the third day of the patients hospital stay, preceding the diagnosis of the first nosocomial event up to the third post diagnosis day. Results: Out of 46 patients contracting at least one ICU-acquired infection, the multiple analyses indicated that on the day of diagnosis, the SOFA score is the most predictive (odds ratio [OR]: 12.3; 95% confidence interval [CI]: 2.3364.91). The second most predictive was the APACHE II score (OR: 8.29; 95% CI: 1.4348.14). The third and fourth most predictive were the LOD score (OR: 4.06; 95% CI: 0.8120.26) and the SAPS II score (OR: 2.26; 95% CI: 0.559.24), respectively. Conclusion: The analysis of the receiver operating characteristic areas under the curve of the reported scores in the present study showed that the best predictive performance is in favor of the SOFA score. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19949 Bangladesh Crit Care J March 2014; 2 (1): 4-9

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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.

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Outcome Prediction in Patients with Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation—A Retrospective International Multicenter Study

Membranes ◽

10.3390/membranes11030170 ◽

2021 ◽

Vol 11 (3) ◽

pp. 170

Author(s):

Alexander Supady ◽

Jeff DellaVolpe ◽

Fabio Silvio Taccone ◽

Dominik Scharpf ◽

Matthias Ulmer ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

The United States ◽

Apache Ii ◽

Apache Ii Score ◽

Survival Prediction ◽

Study Cohort ◽

Additional Tool ◽

Saps Ii ◽

Membrane Oxygenation ◽

International Multicenter

The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19 acute respiratory distress syndrome (ARDS) is still under debate and conclusive data from large cohorts are scarce. Furthermore, criteria for the selection of patients that benefit most from this highly invasive and resource-demanding therapy are yet to be defined. In this study, we assess survival in an international multicenter cohort of COVID-19 patients treated with V-V ECMO and evaluate the performance of several clinical scores to predict 30-day survival. Methods: This is an investigator-initiated retrospective non-interventional international multicenter registry study (NCT04405973, first registered 28 May 2020). In 127 patients treated with V-V ECMO at 15 centers in Germany, Switzerland, Italy, Belgium, and the United States, we calculated the Sequential Organ Failure Assessment (SOFA) Score, Simplified Acute Physiology Score II (SAPS II), Acute Physiology And Chronic Health Evaluation II (APACHE II) Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score, Predicting Death for Severe ARDS on V‑V ECMO (PRESERVE) Score, and 30-day survival. Results: In our study cohort which enrolled 127 patients, overall 30-day survival was 54%. Median SOFA, SAPS II, APACHE II, RESP, and PRESERVE were 9, 36, 17, 1, and 4, respectively. The prognostic accuracy for all these scores (area under the receiver operating characteristic—AUROC) ranged between 0.548 and 0.605. Conclusions: The use of scores for the prediction of mortality cannot be recommended for treatment decisions in severe COVID-19 ARDS undergoing V-V ECMO; nevertheless, scoring results below or above a specific cut-off value may be considered as an additional tool in the evaluation of prognosis. Survival rates in this cohort of COVID-19 patients treated with V‑V ECMO were slightly lower than those reported in non-COVID-19 ARDS patients treated with V-V ECMO.

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The Characteristics of Mortality Predictor Scoring for Sepsis Patients in Haji Adam Malik Hospital

International Journal of Research and Review ◽

10.52403/ijrr.20211046 ◽

2021 ◽

Vol 8 (10) ◽

pp. 339-344

Author(s):

Abdul Halim Harahap ◽

Franciscus Ginting ◽

Lenni Evalena Sihotang

Keyword(s):

Sofa Score ◽

Scoring System ◽

Scoring Systems ◽

Developed Countries ◽

Apache Ii ◽

Apache Ii Score ◽

P Value ◽

Cross Sectional ◽

Cross Sectional Design ◽

Score Apache

Introduction: Sepsis is a leading cause of death in the Intensive Care Unit (ICU) in developed countries and its incidence is increasing. Many scoring systems are used to assess the severity of disease in patients admitted to the ICU. SOFA score to assess the degree of organ dysfunction in septic patients. The Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system is most often used for patients admitted to the ICU. CCI scoring system to assess the effect of comorbid disease in critically ill patients on mortality. The study aimed to describe the characteristics of the use of scoring to predict patients’ mortality admitted to Haji Adam Malik Hospital. Methods: This is an observational study with a cross-sectional design. A total of 299 study subjects met the inclusion criteria and exclusion criteria, three types of scoring, namely SOFA score, APACHE II score, and CCI score were used to assess the prognosis of septic patients. Data analysis was performed using SPSS. P-value <0.05 was considered statistically significant. Results: A total of 252 people (84.3%) of sepsis patients died. The mean age of the septic patients who died was 54.25 years. The SOFA score ranged from 0-24, the median SOFA score in deceased sepsis patients was 5.0. The APACHE II score ranged from 0-71, the median APACHE II score in deceased sepsis patients was 23.0. The CCI score ranged from 0-37, the median CCI score in deceased sepsis patients was 5.0. Conclusion: Higher scores are associated with an increased probability of death in septic patients. Keywords: Sepsis; mortality predictor; SOFA score; APACHE II score, CCI score.

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The Pros and Cons of the Prediction Game: The Never-ending Debate of Mortality in the Intensive Care Unit

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16183394 ◽

2019 ◽

Vol 16 (18) ◽

pp. 3394 ◽

Cited By ~ 3

Author(s):

Piotr A. Fuchs ◽

Iwona J. Czech ◽

Łukasz J. Krzych

Keyword(s):

Intensive Care ◽

Scoring Systems ◽

Roc Curves ◽

Simplified Acute Physiology Score ◽

Apache Ii ◽

Icu Mortality ◽

Saps Ii ◽

Icu Discharge ◽

Pros And Cons ◽

Long Term Prognosis

Background: The Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scales are scoring systems used in intensive care units (ICUs) worldwide. We aimed to investigate their usefulness in predicting short- and long-term prognosis in the local ICU. Methods: This single-center observational study covered 905 patients admitted from 1 January 2015 to 31 December 2017 to a tertiary mixed ICU. SAPS II, APACHE II, and SOFA scores were calculated based on the worst values from the first 24 h post-admission. Patients were divided into surgical (SP) and nonsurgical (NSP) subjects. Unadjusted ICU and post-ICU discharge mortality rates were considered the outcomes. Results: Baseline SAPS II, APACHE II, and SOFA scores were 41.1 ± 20.34, 14.07 ± 8.73, and 6.33 ± 4.12 points, respectively. All scores were significantly lower among SP compared to NSP (p < 0.05). ICU mortality reached 35.4% and was significantly lower for SP (25.3%) than NSP (57.9%) (p < 0.001). The areas under the receiver-operating characteristic (ROC) curves were 0.826, 0.836, and 0.788 for SAPS II, APACHE II, and SOFA scales, respectively, for predicting ICU prognosis, and 0.708, 0.709, and 0.661 for SAPS II, APACHE II, and SOFA, respectively, for post-ICU prognosis. Conclusions: Although APACHE II and SAPS II are good predictors of ICU mortality, they failed to predict survival after discharge. Surgical patients had a better prognosis than medical ICU patients.

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585. Shifting Focus Toward Healthcare-Associated Bloodstream Infections: Need for More NICU-Specific NHSN Definitions

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.654 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S276-S277

Author(s):

Sonali D Advani ◽

Thomas Murray ◽

Matthew Bizzarro

Keyword(s):

Neonatal Intensive Care ◽

Bloodstream Infections ◽

Central Line ◽

Mucosal Barrier ◽

Source Attribution ◽

Chi Square ◽

Mortality And Morbidity ◽

Source Of Infection ◽

Chi Square Test ◽

Healthcare Associated

Abstract Background Healthcare-associated bloodstream infections (HABSIs) are a significant cause of mortality and morbidity in the neonatal intensive care unit (NICU) population. Our objectives were to review the epidemiology of HABSIs in our NICU and to examine the applicability of National Healthcare Safety Network (NHSN) definitions to the NICU population. Methods We performed a retrospective review of all neonates admitted to the 54-bed level IV NICU at Yale-New Haven Children’s Hospital with a HABSI between January 1, 2013 and December 31, 2018. HABSI was defined as a positive blood culture at >72 hours of life growing an organism not considered a contaminant. Clinical definitions per treating NICU team and NHSN site-specific definitions were compared for source attribution using McNemar’s Chi-square test. Results We identified 88 HABSIs with an incidence rate of 0.81 per 1,000 patient-days. Only 13% of these were central line-associated bloodstream infections (CLABSIs). Infants with a HABSI had median birth weight and gestational age of 830 grams and 26 weeks, respectively, with a high percentage requiring mechanical ventilation parenteral nutrition and vascular access (Table 1). Sepsis-related mortality was 24%. The majority of HABSIs were caused by gram-positive and gram-negative bacteria (Figure 1). Most were secondary to necrotizing enterocolitis, pneumonia or a source that was not identified (Table 2). NHSN definitions were less likely to identify a source compared with clinical definitions per NICU treating team (P < 0.001, Table 2). Fifty percent of patients without an identified source of infection by NHSN criteria were identified with a Mucosal Barrier Injury (MBI) organism, likely causing bacteremia from gut translocation. Conclusion HABSIs occur in premature babies with comorbidities, and are more prevalent than CLABSIs. Gut translocation with MBI organisms may be an important unidentified source of HABSIs in neonates. With the increasing focus on HABSI prevention, there is a need for better NHSN definitions for source attribution of bloodstream infections in neonates. Disclosures All authors: No reported disclosures.

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