scholarly journals SOFA score is superior to APACHE-II score in predicting the prognosis of critically ill patients with acute renal injury undergoing continuous renal replacement therapy

2019 ◽  
Author(s):  
Hai Wang ◽  
Yu Shi ◽  
Zheng-hai Bai ◽  
Jun-hua LV ◽  
Jiang-li Sun ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Curve Analysis ◽  
Apache Ii ◽  
Receiver Operating Characteristics ◽  
Apache Ii Score ◽  
Acute Renal Injury ◽  
Operating Characteristics ◽  
Decision Curve Analysis

Abstract Background: Acute renal injury (AKI) is the most common cause of organ failure in multiple organ dysfunction syndrome and is associated with higher mortality, especially for patients requiring continuous renal replacement therapy (CRRT). At present, no effective approaches are in place to predict the prognosis of patients with AKI undergoing CRRT. Methods: A retrospective cohort study was carried to determine whether sequential organ failure assessment (SOFA) score may be a more valuable prognostic indicator than acute physiology and chronic health evaluation II (APACHE-II) score in patients with AKI undergoing CRRT. The multivariate analysis, sensitivity analysis, receiver operating characteristics (ROC) curve and decision curve analysis (DCA) were performed to determine the predictive value of SOFA and APACHE-II scores on 28- and 90-day mortality. Results: From January 2009 to September 2016, a total of 1128 cases were included. Multivariate logistic regression analysis showed that both APACHE-II and SOFA scores were associated with 28- and 90-day mortality of patients with AKI undergoing CRRT. The adjusted odds ratios (ORs) for SOFA and APACHE-II scores associated with 28-day mortality were 1.38 (1.27, 1.51) and 1.04 (1.01, 1.07), respectively, and the adjusted ORs for SOFA and APACHE-II scores associated with 90-day mortality were 1.40 (1.28, 1.52) and 1.04 (1.01, 1.07), respectively. decision curve analysis and receiver operating characteristics analyses showed that SOFA had a higher prediction accuracy than APACHE-II for 28- and 90-day mortality. The AUCs of SOFA and APACHE-II for 28-day mortality were 0.70 (0.67, 0.73) and 0.62 (0.58, 0.65), and for 90-day mortality, the AUCs were 0.71 (0.68, 0.78) and 0.62 (0.58, 0.65), respectively. Conclusion: SOFA score revealed higher accuracy than APACHE-II score in predicting the prognosis of critically ill patients with AKI undergoing CRRT.

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 (>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.

scholarly journals Combining Sequential Organ Failure Assessment (SOFA) Score with Acute Physiology and Chronic Health Evaluation (APACHE) II Score to Predict Hospital Mortality of Critically Ill Patients

2007 ◽  
Vol 35 (4) ◽  
pp. 515-521 ◽  
Author(s):  
K. M. Ho
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Characteristic Curve ◽  
Apache Ii ◽  
Brier Score ◽  
Apache Ii Score ◽  
Failure Assessment ◽  
Predict Hospital Mortality

The ability to accurately adjust for the severity of illness in outcome studies of critically ill patients is essential. Previous studies have showed that Sequential Organ Failure Assessment (SOFA) score and Acute Physiology and Chronic Health Evaluation (APACHE) II score can predict hospital mortality of critically ill patients. The effects of combining these two scores to predict hospital mortality of critically ill patients has not been evaluated. This cohort study evaluated the performance of combining the APACHE II score with SOFA score in predicting hospital mortality of critically ill patients. A total of 1,311 consecutive adult patients admitted to a tertiary 22-bed multidisciplinary intensive care unit (ICU) in Western Australia were considered. The APACHE II, Admission SOFA, Delta SOFA and maximum SOFA score were all related to hospital survival in the univariate analyses. Combining Max SOFA (area under receiver operating characteristic curve 0.875 vs. 0.858, P=0.014; Nagelkerke R2: 0.411 vs. 0.371; Brier Score: 0.086 vs. 0.090) or Delta SOFA score (area under receiver operating characteristic curve 0.874 vs. 0.858, P=0.003; Nagelkerke R2: 0.412 vs. 0.371; Brier Score: 0.086 vs. 0.090) with the APACHE II score improved the discrimination and overall performance of the predictions when compared with using the APACHE II score alone, especially in the emergency ICU admissions. Combining Max SOFA or Delta SOFA score with the APACHE II score may improve the accuracy of risk adjustment in outcome studies of critically ill patients.

scholarly journals The Impact of Serum Glucose on the Predictive Value of Serum Lactate for Hospital Mortality in Critically Ill Surgical Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Xue Chen ◽  
Jianbin Bi ◽  
Jia Zhang ◽  
Zhaoqing Du ◽  
Yifan Ren ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
High Glucose ◽  
Predictive Ability ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Glucose Levels ◽  
Glucose Group

Background. Lactate has been widely used as a risk indicator of outcomes in critically ill patients due to its ready measurement and good predictive ability. However, the interconnections between lactate metabolism and glucose metabolism have not been sufficiently explored, yet. In this study, we aimed to investigate whether glucose levels could influence the predictive ability of lactate and design a more comprehensive strategy to assess the in-hospital mortality of critically ill patients. Methods. We analyzed the clinical data of 293 critically ill patients. The primary outcome was in-hospital mortality. The logistic regression analysis and the area under the receiver operating characteristic curve (AUROC) were applied to evaluate the predictive ability of lactate in association with glucose. Results. The lactate level showed significant association with in-hospital mortality, and its predictive ability was also comparable to other prognostic scores such as the SOFA score and APACHE II score. We further divided 293 patients into three groups based on glucose levels: low-glucose group (<7 mmol/L), medium-glucose group (7-9 mmol/L), and high-glucose group (>9 mmol/L). The lactate level was associated with in-hospital mortality in the low- and high- glucose groups, but not in the medium-glucose group, whereas the SOFA score and APACHE II score were associated with in-hospital mortality in all three glucose groups. The AUROC of lactate in the medium-glucose group was also the lowest among the three glucose groups, indicating a decrease in its predictive ability. Conclusions. Our findings demonstrated that the predictive ability of lactate to assess in-hospital mortality could be influenced by glucose levels. In the medium glucose level (i.e., 7-9 mmol/L), lactate was inadequate to predict in-hospital mortality and the SOFA score; the APACHE II score should be utilized as a complementation in order to obtain a more accurate prediction.

scholarly journals Impact of Extended Duration of Polymyxin B-immobilized Fiber Column Direct Hemoperfusion on Hemodynamics, Vasoactive Substance Requirement, and Pulmonary Oxygenation in Patients With Sepsis: An Observational Study

2020 ◽  
Author(s):  
Chieko Mitaka ◽  
Makio Kusaoi ◽  
Izumi Kawagoe ◽  
Daizoh Satoh ◽  
Toshiaki Iba ◽  
...  
Keyword(s):  
Septic Shock ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Sofa Score ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Standard Group ◽  
Direct Hemoperfusion ◽  
Extended Group

Abstract BackgroundPolymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) is used for patients with septic shock, and the recommended hemoperfusion period is 2 h. However, it remains unclear whether the optimal duration is 2 h or longer. The purpose of this study was to compare the effects of PMX-DHP between conventional and longer duration of PMX-DHP.MethodsWe retrospectively investigated 103 patients with sepsis who underwent PMX-DHP between April 2015 and March 2020. The demographic data, routine biochemistry, microbiological data, primary infection site were reviewed in the medical chart. The acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, heart rate, mean arterial pressure (MAP), vasoactive-inotropic score (VIS), respiratory rate, PaO2/FIO2, at baseline and day 3 were compared between the standard group (patients received 2 h of PMX-DHP) and extended group (patients received more than 2 h of PMX-DHP). Ventilator-free days, incidence of continuous renal replacement therapy, and 28-day mortality were also compared between the groups. ResultsMedian MAP was significantly lower and median VIS was significantly higher in the extended group at baseline (p < 0.05, 0.01, respectively) There were no significant differences in APACHE II score, SOFA score, and PaO2/FIO2 at baseline between the two groups. The increase of MAP and the decrease in VIS from baseline to day 3 were significantly greater in the extended group (p < 0.01, respectively). In the extended group, increase in PaO2/FIO2 was significantly larger in the patients who underwent ≥ 8 h duration than that in patients who underwent < 8 h duration (p < 0.01). The ventilator-free days, the incidence of continuous renal replacement therapy, and the 28-day mortality were not different between the groups.ConclusionsLonger duration of PMX-DHP effectively improved MAP and decreased the volume of vasoactive-inotropic agents compared with the conventional duration. Eight and longer hours duration of PMX-DHP improved the pulmonary oxygenation. Further studies are needed to confirm the efficacy of longer duration of PMX-DHP in patients with septic shock. (329/350 limits)

scholarly journals Nutritional Assessment in the Critically Ill Patients

2020 ◽  
Author(s):  
Elham Bagheri ◽  
Farzaneh Hematian ◽  
Mandana Izadpanah ◽  
Mahbobeh Rashidi
Keyword(s):  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Nutritional Assessment ◽  
Apache Ii ◽  
Nutritional Risk ◽  
Apache Ii Score ◽  
Number Of Patients ◽  
Study Results ◽  
The Impact

Background: Malnutrition is a prevalent complication among critically ill patients. It has very detrimental effects on the patients' clinical course. This study aimed to investigate the impact of nutrition in the intensive care unit (ICU) patients. Methods: In this epidemiologic-analytic study conducted in the surgical ICU of Imam Khomeini hospital, Ahvaz, Iran, 34 patients were selected and divided into two groups. The first group of patients received the appropriate nutrition. The second group received an inappropriate diet, and the nutritional risk was evaluated according to the modified- Nutrition Risk in Critically ill (m-NUTRIC) score. The energy was calculated by using 25 Kcal/kg, also the two groups were compared in terms of ICU mortality, ICU stays, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II Scoring, and the Sequential Organ Failure Assessment (SOFA) Score. Results: Baseline data, such as APACHE II score and mean age, except sex, were not significantly different between the two groups. In this study, results were toward shorter ICU stay, less mortality, and better SOFA score in the group receiving appropriate nutrition compared to the other group. However, due to the low number of patients, no significant differences were observed in the two groups. Conclusion: Our data suggest that nutritional support should be considered as an essential part of the medication during critical illness.

scholarly journals Development and Validation of a Risk Score to Predict Low Birthweight Using Characteristics of the Mother: A Prospective Cohort Study

2020 ◽  
Author(s):  
Hamid Y. Hassen ◽  
Bilal S. Endris ◽  
Meselech A. Roro ◽  
Seifu H. Gebreyesus ◽  
Jean-Pierre Van Geertruyden
Keyword(s):  
Cohort Study ◽  
Prediction Model ◽  
Risk Score ◽  
Low Birthweight ◽  
Curve Analysis ◽  
Receiver Operating Characteristics ◽  
Operating Characteristics ◽  
Decision Curve Analysis ◽  
Maternal Characteristics ◽  
Receiver Operating Characteristics Curve

At least one ultrasound is recommended to predict fetal growth restriction and low birthweight earlier in pregnancy. However, in low-income countries imaging equipment and trained manpower are scarce. Hence, we developed and validated a model and risk score to predict low birthweight using maternal characteristics during pregnancy, for use in resource limited settings. We conducted a prospective cohort study among 379 pregnant women in South Ethiopia. A step-wise multivariable analysis was done to develop the prediction model. To improve clinical utility, we developed a simplified risk score to classify pregnant women at high- or low-risk of low birthweight. The accuracy of the model was evaluated using the area under the receiver operating characteristics curve (AUC) and calibration plot. We evaluated the clinical impact of the model using a decision curve analysis across various threshold probabilities. Age at pregnancy, underweight, anemia, height, gravidity, and presence of comorbidity remained in the final multivariable prediction model. The area under the receiver operating characteristics curve (AUC) of the model was 0.83 (95% confidence interval: 0.78 to 0.88). The decision curve analysis shows the model provides a higher net benefit across ranges of threshold probabilities. In general, this study showed the possibility of predicting low birthweight using maternal characteristics during pregnancy. The model could help to identify those at higher risk of having a low birthweight baby. This feasible prediction model would offer an opportunity to reduce obstetric-related complications and thus improving the overall maternal and child healthcare in low- and middle-income countries.

scholarly journals Relationships between serum procalcitonin level, severity and different stresses of non-septic critically ill patients

2020 ◽  
Vol 28 (1) ◽  
pp. 49-56
Author(s):  
Juncheng Shi ◽  
Qiankun Shi ◽  
Shoutao Yuan ◽  
Wenhao Zhang
Keyword(s):  
Mortality Rate ◽  
Critically Ill ◽  
Traumatic Stress ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Stress Group ◽  
Inflammatory Stress ◽  
Induced Stress

AbstractBackground: To explore the relationships between serum procalcitonin (PCT) level, severity and different stresses of non-septic critically ill patients.Materials and Methods: Patients were divided into traumatic stress, stroke-induced stress and non-infectious inflammatory stress groups. According to 28-day prognosis, they were divided into survival and death groups. The factors affecting prognosis were studied by multivariate logistic regression analysis.Results: PCT level was significantly positively correlated with Acute Physiology and Chronic Health Evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores (P=0.001). The PCT level and abnormality rate of the traumatic stress group significantly exceeded those of other groups (P---lt---0.05). The APACHE II score, SOFA score and 28-day mortality rate of traumatic stress and stroke-induced stress groups significantly exceeded those of the non-infectious inflammatory stress group (P---lt---0.05). The PCT level, APACHE II score and SOFA score of the death group significantly surpassed those of the survival group (P---lt---0.05). With rising PCT level, APACHE II score, SOFA score and 28-day mortality rate all increased, with significant intergroup differences (P---lt---0.01). Multivariate logistic analysis showed that serum PCT level, APACHE II score and SOFA score were independent risk factors for prognosis. The area under ROC curve for prognosis evaluated by PCT level was 0.797 (95%CI = 0.710~0.878, P=0.000). At a 4.3 μg/L cut-off, the sensitivity and specificity for predicting 28-day mortality were 87.4% and 78.1%, respectively.Conclusion: The serum PCT level of non-septic critically ill patient was positively correlated with severity, which was more likely elevated by traumatic stress than other stresses.

scholarly journals Fr402 MELD-NA SCORE VERSUS SOFA SCORE AND APACHE II SCORE AS EARLY PREDICTORS OF MORTALITY IN COVID-19 PATIENTS WITH LIVER INVOLVEMENT

2021 ◽  
Vol 160 (6) ◽  
pp. S-312-S-313
Author(s):  
Sandra R. Gomez ◽  
Eric Lam ◽  
Luis Gonzalez Mosquera ◽  
Joshua Fogel ◽  
Paul Mustacchia
Keyword(s):  
Sofa Score ◽  
Apache Ii ◽  
Liver Involvement ◽  
Apache Ii Score ◽  
Predictors Of Mortality ◽  
Early Predictors

scholarly journals Serum Soluble Triggering Receptor Expressed on Myeloid Cells-1 and Procalcitonin Can Reflect Sepsis Severity and Predict Prognosis: A Prospective Cohort Study

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Zhenyu Li ◽  
Hongxia Wang ◽  
Jian Liu ◽  
Bing Chen ◽  
Guangping Li
Keyword(s):  
Sofa Score ◽  
Prognostic Significance ◽  
Elevated Serum ◽  
Myeloid Cells ◽  
Serum Levels ◽  
Clinical Severity ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Survival Group ◽  
Severity Scores

Objective. To investigate the prognostic significance of serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), procalcitonin (PCT), N-terminal probrain natriuretic peptide (NT-pro-BNP), C-reactive protein (CRP), cytokines, and clinical severity scores in patients with sepsis.Methods. A total of 102 patients with sepsis were divided into survival group (n=60) and nonsurvival group (n=42) based on 28-day mortality. Serum levels of biomarkers and cytokines were measured on days 1, 3, and 5 after admission to an ICU, meanwhile the acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores were calculated.Results. Serum sTREM-1, PCT, and IL-6 levels of patients in the nonsurvival group were significantly higher than those in the survival group on day 1 (P<0.01). The area under a ROC curve for the prediction of 28 day mortality was 0.792 for PCT, 0.856 for sTREM-1, 0.953 for SOFA score, and 0.923 for APACHE II score. Multivariate logistic analysis showed that serum baseline sTREM-1 PCT levels and SOFA score were the independent predictors of 28-day mortality. Serum PCT, sTREM-1, and IL-6 levels showed a decrease trend over time in the survival group (P<0.05). Serum NT-pro-BNP levels showed the predictive utility from days 3 and 5 (P<0.05).Conclusion. In summary, elevated serum sTREM-1 and PCT levels provide superior prognostic accuracy to other biomarkers. Combination of serum sTREM-1 and PCT levels and SOFA score can offer the best powerful prognostic utility for sepsis mortality.

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