scholarly journals Epidemiological Study of Patients Admitted in Intensive Care Unit with Severe Acute Respiratory Illness with a Possible Diagnosis of COVID19 (EPIC19), a Multicentre Study.

2021 ◽  
Author(s):  
Amarja Ashok Havaldar ◽  
Vinay Kumar ◽  
Balaji Vijayan ◽  
John Michael Raj ◽  
Tinku Thomas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Proportional Hazard ◽  
Icu Mortality ◽  
Ventilator Support ◽  
Arterial Blood ◽  
Cox Proportional Hazard ◽  
History Of

Abstract BackgroundGlobal pandemic of COVID 19 has affected many countries. The initial epicenter was in China with gradual spread to various countries including India.For a developing country like India with limited resources and high population, it is worthwhile to know how these patients requiring intensive care admission were managed and the outcome of these patients. To address these issues, a prospective observational study was planned.Methods A multicenter study was conducted from June 2020 to December 2020 including 4 centers across India. Patients > 18 years of age admitted in the intensive care unit (ICU), with the diagnosis of COVID 19 pneumonia confirmed by reverse transcriptase –polymerase chain reaction (RT-PCR) or rapid antigen test (RAT) as applicable were included. Factors associated with ICU mortality were examined using multivariable logistic regression analysis and Cox proportional hazard model. ResultsOf 667 patients were included in the study. ICU mortality was 60 %. In multivariable analysis, history of cerebral vascular accident (CVA), day 1 acute physiology and chronic health evaluation (APACHE II) score, need for invasive ventilator support, minimum PO2, fluid balance and complications such as pneumothorax and arrhythmia during ICU admission were associated with mortality. Among these parameters, day 1 need for invasive ventilator support (odds ratio OR: 3.01(1.81, 5.00) and development of arrhythmia (OR 3.85 [1.56, 8.06]) had higher odds of mortality. Cox proportional hazard analysis showed, history of ischemic heart disease (IHD) (Hazard Ratio, HR 1.64, 95% CI:1.13, 2.38), day1 APACHE II (HR 1.03, 95% CI:1.00, 1.07), arterial blood gas (ABG) pH (HR 0.14, 95% CI:0.03, 0.56) and use of therapeutic anticoagulation (HR 0.42,95% CI:0.29, 0.61) as a predictor of 7 days ICU mortality. Daywise trend of ventilator parameters showed dynamic compliance was higher on day3 and 4 in survivors.ConclusionIn this cohort of ICU patients, ICU mortality was 60%. The reason for higher mortality could be the severity of illness as suggested by the day 1 PF ratio (109.31 [77.79-187.26]).Trial Registration-(IEC131/2020, CTRI/2020/06/025858).

scholarly journals Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit

2018 ◽  
Vol 46 (3) ◽  
pp. 1254-1262 ◽  
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.

scholarly journals Prognostic Factors to Predict ICU Mortality in Patients with ARDS Who Received Early and Prolonged Prone Positioning Therapy

2021 ◽  
Author(s):  
Po-Hsin Lee ◽  
Pin-Kuei Fu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Mortality Risk ◽  
Risk Group ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Prone Positioning ◽  
Icu Mortality ◽  
Factors Associated

Abstract Background: Early and prolonged prone positioning (PP) could reduce the mortality in patients with moderate to severe ARDS, however, factors associated with mortality in the intensive care unit (ICU) remain unclear. The aim of this study is to identified factors associated with mortality and create the prognostic score in patients with ARDS who underwent early and prolonged PP. Methods: This retrospective study included patients with moderate to severe ARDS admitted to the intensive care unit (ICU) from January 2015 to June 2018 in a tertiary referral center in Taiwan and who received early and prolonged PP. Demographic data, disease severity score, comorbidities, and clinical outcomes were recorded. Univariate and multivariate regression models were used to estimate the odds ratio (OR) of ICU mortality. Receiver operating characteristic (ROC) curve analysis were performed to identify the cutoff value of parameters. Results: A total of 116 patients were enrolled. In the multivariate analysis, three factors were significantly associated with mortality: renal replacement therapy (RRT; OR: 3.38, 1.55–7.36), malignant comorbidity (OR: 7.42, 2.06–26.70), and noninfluenza-related ARDS (OR: 3.78, 1.07–13.29). Age, RRT, noninfluenza-related ARDS, malignant comorbidity, and APACHE II score were included in a composite prone score, which demonstrated an area under the curve of 0.816 for predicting mortality risk. The mortality risk in ICU was 27.1% in the low-risk group (prone score: 0–2) and 84.2% in the high-risk group (prone score: 3–5). Conclusions: For patients with moderate to severe ARDS even receiving early and prolonged PP in ICU, poor prognostic factors were age, RRT, malignant comorbidity, noninfluenza-related ARDS, and higher APACHE II score. High mortality should be informed to the family of patient if their prone score was more than 3 points.

scholarly journals Colistin-induced nephrotoxicity and risk factors in intensive care unit: estimating from the routine laboratory findings

2019 ◽  
Vol 6 (9) ◽  
pp. 210-220 ◽  
Author(s):  
Ahmet Ziya Şahin ◽  
Betül Kocamer Şimşek
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Tracheal Aspirate ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Urine Ph ◽  
Laboratory Findings ◽  
Arterial Blood Gas ◽  
Arterial Blood

Objective: In this study we aimed to evaluate the patients treated with colistin in an intensive care unit (ICU) and risk factors emergence of acute renal failure (ARF) after colistine treatment. Materials and Methods: Patients treated with colistine in the ICU between June 2016 and September 2018 were reviewed in this retrospective study. The 37 patients who were received colistine more than 3 days due to detection of Acinetobacter baumannii in culture of tracheal aspirate specimen were included in this study. Sociodemographic and clinical data and also biochemical parameters, glomerular filtration rates (GFR), APACHE-II, RIFLE and AKIN scores were examined. Patients were divided into two groups as ARF-developing and non-ARF-developing. Follow - up parameters were compared between these two groups. Results: The patient group consisted of 26 males and 11 females. The mean age of the patients was 61.0 ± 19.33 years and %45 of the patients developed ARF. Mean APACHE-II score was 20.7±5.6. Mean age was significantly older in ARF patients. Onset day of colistine was significantly lower in patients with ARF. Significant relationships were found with the creatinine, albumin, AST, ALT and BUN parameters between ARF. Conclusion: Older age and early initiation of colistin treatment in the ICU should be considered to be risky for ARF development. Before colistin treatment BUN, creatinine, CRP, albumin and AST levels should be considered to be risky for ARF development. After colistin treatment ALT, BUN, creatinine, urine output, platelet, AST, arterial blood gas base excess levels, urine pH, and protein amount in urine should be followed carefully.

scholarly journals Evaluation of acute physiology and chronic health evaluation (APACHE) II in predicting ICU mortality among critically ill

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.

APACHE II Score and Evaluation of Intensive Care Unit Patients

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

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

2019 ◽  
Vol 9 (1) ◽  
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.

scholarly journals Plasma Glutamine Levels in Relation to Intensive Care Unit Patient Outcome

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 402
Author(s):  
Renée Blaauw ◽  
Daan G. Nel ◽  
Gunter K. Schleicher
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Area Under The Curve ◽  
Threshold Value ◽  
High Plasma ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Roc Curve Analysis ◽  
Reactive Protein ◽  
Proxy Indicators

Low and high plasma glutamine levels are associated with increased mortality. This study aimed to measure glutamine levels in critically ill patients admitted to the intensive care unit (ICU), correlate the glutamine values with clinical outcomes, and identify proxy indicators of abnormal glutamine levels. Patients were enrolled from three ICUs in South Africa, provided they met the inclusion criteria. Clinical and biochemical data were collected. Plasma glutamine was categorized as low (<420 µmol/L), normal (420–700 µmol/L), or high (>700 µmol/L). Three hundred and thirty patients (median age 46.8 years, 56.4% male) were enrolled (median APACHE II score) 18.0 and SOFA) score 7.0). On admission, 58.5% had low (median 299.5 µmol/L) and 14.2% high (median 898.9 µmol/L) plasma glutamine levels. Patients with a diagnosis of polytrauma and sepsis on ICU admission presented with the lowest, and those with liver failure had the highest glutamine levels. Admission low plasma glutamine was associated with higher APACHE II scores (p = 0.003), SOFA scores (p = 0.003), C-reactive protein (CRP) values (p < 0.001), serum urea (p = 0.008), and serum creatinine (p = 0.023) and lower serum albumin (p < 0.001). Low plasma glutamine was also associated with requiring mechanical ventilation and receiving nutritional support. However, it was not significantly associated with length of stay or mortality. ROC curve analysis revealed a CRP threshold value of 87.9 mg/L to be indicative of low plasma glutamine levels (area under the curve (AUC) 0.7, p < 0.001). Fifty-nine percent of ICU patients had low plasma glutamine on admission, with significant differences found between diagnostic groupings. Markers of infection and disease severity were significant indicators of low plasma glutamine.

Outcomes of Critically Ill Gynecological Cancer Patients Admitted to Intensive Care Unit

2012 ◽  
Vol 30 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Silvio A. Ñamendys-Silva ◽  
María O. González-Herrera ◽  
Julia Texcocano-Becerra ◽  
Angel Herrera-Gómez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Gynecological Cancer ◽  
Apache Ii ◽  
Apache Ii Score

Purpose: To assess the characteristics of critically ill patients with gynecological cancer, and to evaluate their prognosis. Methods: Fifty-two critically ill patients with gynecological cancer admitted to intensive care unit (ICU) were included. Univariate and multivariate logistic regressions were used to identify factors associated with hospital mortality. Results: Thirty-five patients (67.3%) had carcinoma of the cervix uteri and 11 (21.2%) had ovarian cancer. The mortality rate in the ICU was 17.3% (9 of 52) and hospital mortality rate were 23%(12 of 52). In the multivariate analysis, independent prognostic factors for hospital mortality were vasopressor use (odds ratio [OR] = 8.60, 95% confidence interval [CI] 2.05-36; P = .03) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 1.43, 95% CI 1.01-2.09; P = .048). Conclusions: The independent prognostic factors for hospital mortality were the need for vasopressors and the APACHE II score.

The Utility of Acute Physiology and Chronic Health Evaluation II Scores for Prediction of Mortality among Intensive Care Unit (ICU) and Non-ICU Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia

2012 ◽  
Vol 33 (6) ◽  
pp. 558-564 ◽  
Author(s):  
Vanessa Stevens ◽  
Thomas P. Lodise ◽  
Brian Tsuji ◽  
Meagan Stringham ◽  
Jill Butterfield ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Chronic Health Evaluation ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Icu Patients ◽  
Time Points

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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