APACHE IV is an accurate measure of predicting in-hospital mortality of ICU patients, but there are covariates associated with its occasional failure - a multicentre analysis of intensive care units

2020 ◽  
Author(s):  
Shuo Feng ◽  
Joel A Dubin
Keyword(s):  
Hospital Mortality ◽  
Performance Metrics ◽  
Predictive Accuracy ◽  
Hospital Death ◽  
Type I ◽  
Type Ii ◽  
Hospital Survival ◽  
Icu Stay ◽  
Holdout Validation ◽  
Apache Iv

Abstract Background: APACHE IV provides typically useful and accurate predictions on in-hospital mortality and length of stay for patients in critical care. However, there are factors which may preclude APACHE IV from reaching its ceiling of predictive accuracy. Our primary aim was to determine which variables available within the first 24 hours of a patient’s ICU stay may be indicative of the APACHE IV scoring system making occasional but potentially illuminating errors in predicting in-hospital mortality. Methods: We utilized the publicly available multi-institutional ICU database, eICU, available since 2018, to identify a large observational cohort for our investigation. APACHE IV scores are provided by eICU for each patient’s ICU stay. We used Lasso logistic regression in an aim to build parsimonious final models, using cross-validation to select the penalization parameter, separately for each of our two responses, i.e., errors, of interest, which are APACHE falsely predicting in-hospital death (Type I error), and APACHE falsely predicting in-hospital survival (Type II error). We then assessed the performance of the models with a random holdout validation sample. Results: While the extremeness of the APACHE prediction led to dependable predictions for preventing either type of error, there were a small set of distinct variables identified as being strongly associated with the two different types of errors occurring. These included worst lactate and mean SpO2 for Type I, and mean non-invasive blood pressure and mean respiratory rate for Type II. The two models also differed in their performance metrics in identical holdout validation samples, in large part due to the lower prevalence of Type II errors compared to Type I. Conclusions: The eICU database was a good resource for evaluating our objective, and important recommendations to intensivists are provided, particularly identifying key variables that could lead to APACHE prediction errors when APACHE scores are sufficiently low to predict in-hospital survival.

scholarly journals Identifying early-measured variables associated with APACHE IVa providing incorrect in-hospital mortality predictions for critical care patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shuo Feng ◽  
Joel A. Dubin
Keyword(s):  
Critical Care ◽  
Hospital Mortality ◽  
Type I Error ◽  
Treatment Plan ◽  
Hospital Death ◽  
Type I ◽  
Type Ii ◽  
Hospital Survival ◽  
Icu Stay ◽  
Holdout Validation

AbstractAPACHE IVa provides typically useful and accurate predictions on in-hospital mortality and length of stay for patients in critical care. However, there are factors which may preclude APACHE IVa from reaching its ceiling of predictive accuracy. Our primary aim was to determine which variables available within the first 24 h of a patient’s ICU stay may be indicative of the APACHE IVa scoring system making occasional but potentially illuminating errors in predicting in-hospital mortality. We utilized the publicly available multi-institutional ICU database, eICU, available since 2018, to identify a large observational cohort for our investigation. APACHE IVa scores are provided by eICU for each patient’s ICU stay. We used Lasso logistic regression in an aim to build parsimonious final models, using cross-validation to select the penalization parameter, separately for each of our two responses, i.e., errors, of interest, which are APACHE falsely predicting in-hospital death (Type I error), and APACHE falsely predicting in-hospital survival (Type II error). We then assessed the performance of the models with a random holdout validation sample. While the extremeness of the APACHE prediction led to dependable predictions for preventing either type of error, distinct variables were identified as being strongly associated with the two different types of errors occurring. These included a primary set of predictors consisting of mean SpO2 and worst lactate for predicting Type I errors, and worst albumin and mean heart rate for Type II. In addition, a secondary set of predictors including changes recorded in care limitations for the patient’s treatment plan, worst pH, whether cardiac arrest occurred at admission, and whether vasopressor was provided for predicting Type I error; age, whether the patient was ventilated in day 1, mean respiratory rate, worst lactate, worst blood urea nitrogen test, and mean aperiodic vitals for Type II. The two models also differed in their performance metrics in their holdout validation samples, in large part due to the lower prevalence of Type II errors compared to Type I. The eICU database was a good resource for evaluating our objective, and important recommendations are provided, particularly identifying key variables that could lead to APACHE prediction errors when APACHE scores are sufficiently low to predict in-hospital survival.

scholarly journals Surgical outcomes of DeBakey type I and type II acute aortic dissection: a propensity score-matched analysis in 599 patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Chun-Yu Lin ◽  
Tao-Hsin Tung ◽  
Meng-Yu Wu ◽  
Chi-Nan Tseng ◽  
Feng-Chun Tsai
Keyword(s):  
Propensity Score ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Acute Aortic Dissection ◽  
Survival Rates ◽  
Type I ◽  
Acute Type ◽  
Type Ii ◽  
Matched Cohort ◽  
Reoperation Rates

Abstract Background The DeBakey classification divides Stanford acute type A aortic dissection (ATAAD) into DeBakey type I (D1) and type II (D2) according to the extent of acute aortic dissection (AAD). This retrospective study aimed to compare the early and late outcomes of D1-AAD and D2-AAD through a propensity score-matched analysis. Methods Between January 2009 and April 2020, 599 consecutive patients underwent ATAAD repair at our institution, and were dichotomized into D1 (n = 543; 90.7%) and D2 (n = 56; 9.3%) groups. Propensity scoring was performed with a 1:1 ratio, resulting in a matched cohort of 56 patients per group. The clinical features, postoperative complications, 5-year cumulative survival and freedom from reoperation rates were compared. Results In the overall cohort, the D1 group had a lower rate of preoperative shock and more aortic arch replacement with longer cardiopulmonary bypass time. The D1 group had a higher in-hospital mortality rate than the D2 group in overall (15.8% vs 5.4%; P = 0.036) and matched cohorts (19.6% vs 5.4%; P = 0.022). For patients that survived to discharge, the D1 and D2 groups demonstrated similar 5-year survival rates in overall (77.0% vs 85.2%; P = 0.378) and matched cohorts (79.1% vs 85.2%; P = 0.425). The 5-year freedom from reoperation rates for D1 and D2 groups were 80.0% and 97.1% in overall cohort (P = 0.011), and 93.6% and 97.1% in matched cohort (P = 0.474), respectively. Conclusions Patients with D1-AAD had a higher risk of in-hospital mortality than those with D2-AAD. However, for patients who survived to discharge, the 5-year survival rates were comparable between both groups.

scholarly journals Sequential Organ Failure Assessment Component Score Prediction of In-hospital Mortality From Sepsis

2018 ◽  
Vol 35 (8) ◽  
pp. 810-817 ◽  
Author(s):  
Tushar Gupta ◽  
Michael A. Puskarich ◽  
Elizabeth DeVos ◽  
Adnan Javed ◽  
Carmen Smotherman ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Statistical Significance ◽  
Predictive Ability ◽  
Hospital Death ◽  
Icu Stay ◽  
Relative Contribution ◽  
Failure Assessment

Objectives: Early organ dysfunction in sepsis confers a high risk of in-hospital mortality, but the relative contribution of specific types of organ failure to overall mortality is unclear. The objective of this study was to assess the predictive ability of individual types of organ failure to in-hospital mortality or prolonged intensive care. Methods: Retrospective cohort study of adult emergency department patients with sepsis from October 1, 2013, to November 10, 2015. Multivariable regression was used to assess the odds ratios of individual organ failure types for the outcomes of in-hospital death (primary) and in-hospital death or ICU stay ≥ 3 days (secondary). Results: Of 2796 patients, 283 (10%) experienced in-hospital mortality, and 748 (27%) experienced in-hospital mortality or an ICU stay ≥ 3 days. The following components of Sequential Organ Failure Assessment (SOFA) score were most predictive of in-hospital mortality (descending order): coagulation (odds ratio [OR]: 1.60, 95% confidence interval [CI]: 1.32-1.93), hepatic (1.58, 95% CI: 1.32-1.90), respiratory (OR: 1.33, 95% CI: 1.21-1.47), neurologic (OR: 1.20, 95% CI: 1.07-1.35), renal (OR: 1.14, 95% CI: 1.02-1.27), and cardiovascular (OR: 1.13, 95% CI: 1.01-1.25). For mortality or ICU stay ≥3 days, the most predictive SOFA components were respiratory (OR: 1.97, 95% CI: 1.79-2.16), neurologic (OR: 1.72, 95% CI: 1.54-1.92), cardiovascular (OR: 1.38, 95% CI: 1.23-1.54), coagulation (OR: 1.31, 95% CI: 1.10-1.55), and renal (OR: 1.19, 95% CI: 1.08-1.30) while hepatic SOFA (OR: 1.16, 95% CI: 0.98-1.37) did not reach statistical significance ( P = .092). Conclusion: In this retrospective study, SOFA score components demonstrated varying predictive abilities for mortality in sepsis. Elevated coagulation or hepatic SOFA scores were most predictive of in-hospital death, while an elevated respiratory SOFA was most predictive of death or ICU stay >3 days.

scholarly journals Ethnic Disparities in AL Amyloidosis Outcomes Among Hospitalized Patients in the United States

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4110-4110
Author(s):  
Samer Al Hadidi ◽  
Deepa Dongarwar ◽  
Hamisu Salihu ◽  
Carolina Schinke ◽  
Sharmilan Thanendrarajan ◽  
...  
Keyword(s):  
Palliative Care ◽  
Health Disparities ◽  
Hospital Mortality ◽  
Conflicts Of Interest ◽  
The United States ◽  
Hospital Death ◽  
Al Amyloidosis ◽  
Type I ◽  
Care Services ◽  
Palliative Care Services

Abstract INTRODUCTION Health disparities in immunoglobulin light chain (AL) amyloidosis have not been well described. We aimed to assess if health disparities between non-Hispanic (NH)-Whites, NH-Blacks and Hispanics exist and to describe differences between different ethnic/racial groups. METHODS We conducted a retrospective cross-sectional analysis of in-patient AL amyloidosis hospitalizations from 2016 to 2018 using the Nationwide Inpatient Sample (NIS), a database which provides nationally representative information on hospitalizations in the U.S. The studied period was chosen to capture data from the ICD-10-CM codes to avoid misclassification of AL amyloidosis which was grouped with other cases of ATTR amyloidosis in the ICD-9-CM coding system. All hospitalizations in adults (age ≥18 years) were included. The exposure for the study was the occurrence of AL amyloidosis in the discharge records. Outcomes were [1] in-hospital death [2] chemotherapy use; [3] intensive care unit (ICU) utilization; [4] palliative care consultation. The analysis for this study was performed using R program version 3.5.1; a 5% type I error rate for all hypothesis tests (two-sided) was assumed. RESULTS Admissions related to AL amyloidosis constituted 0.03% of all hospitalizations in the study period (25,470 of 90,869,381). The prevalence of AL amyloidosis related hospitalizations was higher in NH-Blacks when compared with NH-Whites (42.8 vs.28.1 per 100,000 hospitalizations). AL amyloidosis related in-hospital mortality rate was higher in NH-Whites and Hispanics when compared to NH-Blacks (6.6%% and 6.2% vs. 4.9%). In-hospital mortality with AL amyloidosis was higher in older patients, males and those who self-paid for their treatment. Utilization of ICU care was more common in NH-Blacks when compared to NH-Whites (6% vs. 4.8%). Hispanics had the lowest inpatient chemotherapy use (1.7% vs. 2.9%). Multivariable adjusted association between race/ethnicity and various outcomes showed a trend towards lower in-hospital mortality in NH-Blacks when compared to NH-Whites (OR: 0.76, 95% CI: 0.55-1.05, p=0.09) and lower utilization of palliative care services in NH-Blacks when compared with NH-Whites (OR: 0.61, 95% CI: 0.42-0.88, p=0.01). Despite very low numbers of transplant related admissions, such admissions occurred only in NH-Whites. CONCLUSIONS Our findings highlight disparities in AL amyloidosis care for NH-Blacks and Hispanics. NH-Blacks tend to have lower in-hospital mortality with higher utilization of ICU care, nevertheless, they receive the lowest palliative care services. Despite the higher utilization of ICU care, data suggest possible superior outcomes of AL amyloidosis in NH-Blacks when compared to NH-Whites. Disclosures No relevant conflicts of interest to declare.

scholarly journals Predicting financial distress of companies listed on the JSE: A comparison of techniques

2009 ◽  
Vol 40 (1) ◽  
pp. 21-32 ◽  
Author(s):  
G. H. Muller ◽  
B. W. Steyn-Bruwer ◽  
W. D. Hamman
Keyword(s):  
Financial Distress ◽  
Type I Error ◽  
Predictive Accuracy ◽  
Recursive Partitioning ◽  
Type I ◽  
Logit Analysis ◽  
Type Ii ◽  
Multiple Discriminant Analysis ◽  
Main Research ◽  
Modelling Techniques

In 2006, Steyn-Bruwer and Hamman highlighted several deficiencies in previous research which investigated the prediction of corporate failure (or financial distress) of companies. In their research, Steyn-Bruwer and Hamman made use of the population of companies for the period under review and not only a sample of bankrupt versus successful companies. Here the sample of bankrupt versus successful companies is considered as two extremes on the continuum of financial condition, while the population is considered as the entire continuum of financial condition.The main objective of this research, which was based on the above-mentioned authors’ work, was to test whether some modelling techniques would in fact provide better prediction accuracies than other modelling techniques. The different modelling techniques considered were: Multiple discriminant analysis (MDA), Recursive partitioning (RP), Logit analysis (LA) and Neural networks (NN).From the literature survey it was evident that existing literature did not readily consider the number of Type I and Type II errors made. As such, this study introduces a novel concept (not seen in other research) called the “Normalised Cost of Failure” (NCF) which takes cognisance of the fact that a Type I error typically costs 20 to 38 times that of a Type II error.In terms of the main research objective, the results show that different analysis techniques definitely produce different predictive accuracies. Here, the MDA and RP techniques correctly predict the most “failed” companies, and consequently have the lowest NCF; while the LA and NN techniques provide the best overall predictive accuracy.

scholarly journals Association Between Dexamethasone and Delirium in Critically ill Patients: A Retrospective Cohort Study of a Large Clinical Database

2020 ◽  
Author(s):  
Zehao Wu ◽  
Huili Li ◽  
Kaihua Liao ◽  
Yun Wang
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Hospital Death ◽  
Icu Stay ◽  
The Relationship

Abstract BackgroundDelirium is a common complication in ICU patients, and it can significantly increase the length of hospital stay and cost. Dexamethasone is widely used in various inflammatory diseases and is a glucocorticoid commonly used in critically ill patients. There are no studies on the effect of dexamethasone on the development of delirium in critically ill patients, therefore, this study aimed to confirm the effect of dexamethasone use and the dose on the incidence of delirium and patient prognosis in critically ill patients through a large cohort study.MethodsA retrospective cohort study was conducted using data extracted from the MIMIC III database, and the primary outcome was the development of delirium, using multivariate logistic regression analysis to reveal the relationship between dexamethasone and delirium. Secondary endpoints were in-hospital mortality, total length of stay and length of ICU stay, and the relationship between dexamethasone and prognosis was assessed with Cox proportional hazards models. The Lowess smoothing technique was used to investigate the dose correlation between dexamethasone and outcomes, subgroup analysis was used to account for heterogeneity, and different correction models and propensity matching analysis were used to eliminate potential confounders.ResultsFinally, 38,509 patients were included, and 2,204 (5.7%) used dexamethasone. A significantly higher incidence of delirium (5.0% vs. 3.4%, P < 0.001), increased in-hospital mortality (15.0% vs. 11.3%, P < 0.001), and longer length of stay and ICU stay were observed in patients taking dexamethasone compared with those not taking dexamethasone. Multivariate logistic and Cox regression analyses confirmed that dexamethasone was significantly associated with delirium (adjusted OR = 1.45, 95% CI = 1.08-1.95, P = 0.014) and in-hospital mortality (adjusted HR = 1.19, 95% CI = 1.02-1.40, P = 0.032). The risk of delirium and in-hospital death was lower with dexamethasone less than 10 mg, and subjects with 10-14 mg had the shortest length of hospital stay.ConclusionsThis study demonstrated that the use of dexamethasone in critically ill patients exacerbated the occurrence of delirium, while increasing the risk of in-hospital death and length of stay, and the use of low-dose dexamethasone had a lower risk of delirium and death, which appeared to be safer.

Heat-Etching with a Bullivant Type II Simple Freeze-Cleave Device

1970 ◽  
Vol 28 ◽  
pp. 106-107 ◽  
Author(s):  
Ronald S. Weinstein ◽  
N. Scott McNutt
Keyword(s):  
New Zealand ◽  
General Hospital ◽  
Massachusetts General Hospital ◽  
Type I ◽  
Type Ii ◽  
Collaborative Effort ◽  
Temperature And Pressure ◽  
The University

The Type I simple cold block device was described by Bullivant and Ames in 1966 and represented the product of the first successful effort to simplify the equipment required to do sophisticated freeze-cleave techniques. Bullivant, Weinstein and Someda described the Type II device which is a modification of the Type I device and was developed as a collaborative effort at the Massachusetts General Hospital and the University of Auckland, New Zealand. The modifications reduced specimen contamination and provided controlled specimen warming for heat-etching of fracture faces. We have now tested the Mass. General Hospital version of the Type II device (called the “Type II-MGH device”) on a wide variety of biological specimens and have established temperature and pressure curves for routine heat-etching with the device.

Labelling of non-A, non-B hepatitis infected chimpanzee hepatocytes with nuclease-gold conjugates

1984 ◽  
Vol 42 ◽  
pp. 250-251
Author(s):  
G. D. Gagne ◽  
M. F. Miller ◽  
D. A. Peterson
Keyword(s):  
Endoplasmic Reticulum ◽  
Experimental Infection ◽  
Uranyl Acetate ◽  
Type I ◽  
Cellular Injury ◽  
Type Ii ◽  
Tubular Structures ◽  
Type Iii ◽  
Type Iv ◽  
Infected Chimpanzee

Experimental infection of chimpanzees with non-A, non-B hepatitis (NANB) or with delta agent hepatitis results in the appearance of characteristic cytoplasmic alterations in the hepatocytes. These alterations include spongelike inclusions (Type I), attached convoluted membranes (Type II), tubular structures (Type III), and microtubular aggregates (Type IV) (Fig. 1). Type I, II and III structures are, by association, believed to be derived from endoplasmic reticulum and may be morphogenetically related. Type IV structures are generally observed free in the cytoplasm but sometimes in the vicinity of type III structures. It is not known whether these structures are somehow involved in the replication and/or assembly of the putative NANB virus or whether they are simply nonspecific responses to cellular injury. When treated with uranyl acetate, type I, II and III structures stain intensely as if they might contain nucleic acids. If these structures do correspond to intermediates in the replication of a virus, one might expect them to contain DNA or RNA and the present study was undertaken to explore this possibility.

Comparative surface and ultrastructural views of methylotrophic bacteria by TEM, STEM, SE, and freeze-etch electron microscopy.

1987 ◽  
Vol 45 ◽  
pp. 792-793
Author(s):  
T.A. Fassel ◽  
M.J. Schaller ◽  
M.E. Lidstrom ◽  
C.C. Remsen
Keyword(s):  
Cytoplasmic Membrane ◽  
Structural Features ◽  
Methylotrophic Bacteria ◽  
Type I ◽  
Type Ii ◽  
Membrane Complex ◽  
Oxidation Of Methane ◽  
Methane Oxidizing Bacteria ◽  
Wall Structures ◽  
Methylomonas Albus

Methylotrophic bacteria play an Important role in the environment in the oxidation of methane and methanol. Extensive intracytoplasmic membranes (ICM) have been associated with the oxidation processes in methylotrophs and chemolithotrophic bacteria. Classification on the basis of ICM arrangement distinguishes 2 types of methylotrophs. Bundles or vesicular stacks of ICM located away from the cytoplasmic membrane and extending into the cytoplasm are present in Type I methylotrophs. In Type II methylotrophs, the ICM form pairs of peripheral membranes located parallel to the cytoplasmic membrane. Complex cell wall structures of tightly packed cup-shaped subunits have been described in strains of marine and freshwater phototrophic sulfur bacteria and several strains of methane oxidizing bacteria. We examined the ultrastructure of the methylotrophs with particular view of the ICM and surface structural features, between representatives of the Type I Methylomonas albus (BG8), and Type II Methylosinus trichosporium (OB-36).

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