scholarly journals Impact of Body Mass Index on the Mortality of Critically Ill Patients Admitted to the Intensive Care Unit: An Observational Study

2020 ◽  
Author(s):  
Ata Mahmoodpoor ◽  
Fahimeh Karrubi ◽  
Mohammad-Salar Hosseini ◽  
Afshin Iranpour ◽  
Sarvin Sanaie
Keyword(s):  
Body Mass Index ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Waist Circumference ◽  
Mortality Rate ◽  
Body Mass ◽  
Apache Ii ◽  
Apache Ii Score ◽  
P Value ◽  
Surgical Trauma

Abstract Background: Obesity, a wide-ranging disorder all around the world, is associated with significant morbidity and mortality in the general population. Regarding the present controversies, this study aims to evaluate the possible association of body mass index (BMI) and mortality in patients admitted to intensive care units.Methods: During this cross-sectional study, all patients admitted to the intensive care unit of two university affiliated hospitals in northwest of Iran from November 2017 to March 2019 were enrolled. The demographic characteristics of patients, length of stay in the intensive care unit and hospital, organ failure, mortality, duration of mechanical ventilation and vasopressor-therapy, type of nutrition, the occurrence of nosocomial infection, type of admission (medical, surgical, trauma) were recorded for all patients. According to the WHO classification of BMI, patients were divided into the six groups, and the data were analyzed accordingly.Results: Of the 502 patients studied, 267 were male (53.2%) and 235 were female (46.8%). The highest mortality rate was observed among the obesity class II patients (35 < BMI < 40) with 28.6%, while the lowest rate was observed in the normal-weight patients (18.5 < BMI < 25) with 3.9%. The highest length of hospital stay was seen in patients with BMI > 30 with 12 days of hospitalizations. APACHE II and waist circumference had a statistically significant relationship with the mortality rate of patients (P-value < 0.001).Conclusion: The current study showed that BMI could be related to mortality, regardless of waist circumference and APACHE II score. However, considering waist circumference and APACHE II score as confounding factors, BMI does not have a significant effect on mortality and only affect the morbidity of patients.

scholarly journals Impact of Body Mass Index on the Mortality of Critically Ill Patients Admitted to the Intensive Care Unit: An Observational Study

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Sarvin Sanaie ◽  
Mohammad-Salar Hosseini ◽  
Fahimeh Karrubi ◽  
Afshin Iranpour ◽  
Ata Mahmoodpoor
Keyword(s):  
Body Mass Index ◽  
Intensive Care ◽  
Waist Circumference ◽  
Mortality Rate ◽  
Body Mass ◽  
Apache Ii ◽  
Apache Ii Score ◽  
P Value ◽  
Age And Gender ◽  
And Gender

Background: Obesity is a severe multifactorial disorder that carries high morbidity and mortality. Objectives: This study aimed to evaluate the possible association between body mass index (BMI) and mortality in patients admitted to intensive care units (ICU). Methods: In this cross-sectional study, all patients admitted to the ICU were studied. The demographic characteristics, ICU, and hospital length of stay, organ failure, mortality, duration of mechanical ventilation, the occurrence of nosocomial infection, and type of admission were recorded for all patients. Patients were categorized based on their BMI. Results: In total, 502 patients were studied who 53.2% of them were male. Most of the death (28.6%) were recorded in the obesity class II patients, while the lowest rate (3.9%) was for the normal-weight patients (P value < 0.001). The APACHE II and waist circumference had a statistically significant association with the mortality rate (P value < 0.001). After adjusting for age and gender, a significant association was found between waist circumference and mortality rate (OR = 1.15, 95% CI = 1.03 - 1.29; P value = 0.014), APACHE II score, and mortality rate (OR = 2.79, 95% CI = 1.91 - 4.07, P value < 0.001); but there was no significant association between BMI and mortality rate. Conclusions: This study demonstrated that BMI is associated with an increased risk of mortality, regardless of age and gender. However, after adjusting for age and gender as confounding factors, BMI didn’t have a significant effect on mortality, while the APACHE II score and waist circumference affected the mortality rate.

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.

scholarly journals Influence of time elapsed from end of emergency surgery until admission to intensive care unit, on Acute Physiology and Chronic Health Evaluation II (APACHE II) prediction and patient mortality rate

2005 ◽  
Vol 123 (4) ◽  
pp. 167-174 ◽  
Author(s):  
Paulo Antonio Chiavone ◽  
Samir Rasslan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Emergency Surgery ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Death Risk ◽  
Expected Mortality

CONTEXT AND OBJECTIVE: Patients are often admitted to intensive care units with delay in relation to when this service was indicated. The objective was to verify whether this delay influences hospital mortality, length of stay in the unit and hospital, and APACHE II prediction. DESIGN AND SETTING: Prospective and accuracy study, in intensive care unit of Santa Casa de São Paulo, a tertiary university hospital. METHODS: We evaluated all 94 patients admitted following emergency surgery, from August 2002 to July 2003. The variables studied were APACHE II, death risk, length of stay in the unit and hospital, and hospital mortality rate. The patients were divided into two groups according to the time elapsed between end of surgery and admission to the unit: up to 12 hours and over 12 hours. RESULTS: The groups were similar regarding gender, age, diagnosis, APACHE II score and hospital stay. The death risk factors were age, APACHE II and elapsed time (p < 0.02). The mortality rate for the over 12-hour group was higher (54% versus 26.1%; p = 0.018). For the over 12-hour group, observed mortality was higher than expected mortality (p = 0.015). For the up to 12-hour group, observed and expected mortality were similar (p = 0.288). CONCLUSION: APACHE II foresaw the mortality rate among patients that arrived faster to the intensive care unit, while the mortality rate was higher among those patients whose admission to the intensive care unit took longer.

scholarly journals 481. SARS-CoV-2 Infection in Hospitalized Children: An Elevated Body Mass Index is a Marker of Increased Risk of Acute Respiratory Failure

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S341-S342
Author(s):  
Catherine Foster ◽  
Shelley Kumar ◽  
Elizabeth Tocco ◽  
Galit Holzmann-Pazgal ◽  
Judith R Campbell ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Body Mass ◽  
Polymerase Chain Reaction Test ◽  
P Value ◽  
Hospitalized Children ◽  
Chi Square ◽  
Increased Risk ◽  
Length Of Hospitalization

Abstract Background Several risk factors are known to increase the severity of coronavirus disease 2019 (COVID-19) illness in adults, including age and obesity. Specific comorbidities affecting COVID-19 outcomes in children are less well defined. Methods We performed a retrospective cohort study of overweight and obese (OW) children compared to underweight and normal weight (NW) children with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Children between 2 and 18 years of age who were admitted to Texas Children’s Hospital from April through December of 2020 with a positive SARS-CoV-2 polymerase chain reaction test were included. Asymptomatic patients undergoing surveillance testing for SARS-CoV-2 were excluded. Body mass index (BMI) was calculated using the Centers for Disease Control definition. Demographic and clinical information was obtained from the electronic medical record. Statistical analyses were performed using SAS 9.0. Results We identified 145 total children who met inclusion criteria. Fifty-five (38%) children were NW and 90 (62%) children were OW. Demographics and characteristics are shown (Figure 1). Underlying asthma or chronic lung disease was present in 13 (24%) vs 31 (34%) in the NW and OW groups respectively (P=0.17). OW children were more likely to have pneumonia than NW children [relative risk1.6 (CI 1.40-2.45)]. An elevated BMI was also associated with an increased risk of requiring oxygen [relative risk 1.4 (CI 1.03-1.96)]. The median length of hospitalization was 4 days for NW versus 5 days for OW children (P=0.6). Admission to the Intensive Care Unit (ICU) was similar between the groups (P=0.7). There was no significant difference in treatments administered to children in the two groups, although there was a trend towards increased steroid (29 (53%) vs 59 (67%), P=0.13) and remdesivir (12 (22%) vs 30 (33%), P=0.14) use in the OW children. Four children in each group died. Characteristics of Hospitalized Children with SARS-CoV-2 Infection by Weight Category Abbreviations: ECMO, extracorporeal membrane oxygenation; ICU, intensive care unit; MIS-C, multisystem inflammatory syndrome in children; MV, mechanical ventilation; NC, nasal cannula *Denotes statistically significant P-value a. Calculated using chi-square or fisher exact unless otherwise noted. a. Calculated using chi-square or fisher exact unless otherwise noted. A P-value &lt;0.05 was considered significant. b. Calculated using Wilcoxon rank sum test. c. Includes patients with home noninvasive MV (2) or tracheostomy and home MV(4). Conclusion For children admitted with symptomatic COVID-19, being overweight or obese was significantly associated with having pneumonia and with requiring oxygen. A difference in ICU admission, length of hospitalization, and mortality was not observed. Obesity prevention along with vaccination efforts may prevent COVID-19 related morbidity in this group. Disclosures All Authors: No reported disclosures

scholarly journals Predictive Performance of two Measures of Prognostic Mortality of Cancer Patients in Intensive Care Unit in Jordan: A Comparative Single-Centre Study

2020 ◽  
Vol 14 (1) ◽  
pp. 168-173
Author(s):  
Issa M. Almansour ◽  
Mohammad K. Aldalaykeh ◽  
Zyad T. Saleh ◽  
Khalil M. Yousef ◽  
Mohammad M. Alnaeem
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Cancer Patients ◽  
Predictive Performance ◽  
Mortality Rates ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Actual Mortality ◽  
Apache Iv

Background: Information is presently insufficient about using Acute Physiology and Chronic Health Evaluation (APACHE) mortality predicting models for cancer patients in intensive care unit (ICU). Objective: To evaluates the performance of APACHE II and IV in predicting mortality for cancer patients in ICU. Interventions/Methods: This was a retrospective study including adult patients admitted to an ICU in a medical center in Jordan. Actual mortality rate was determined and compared with mortality rates predicted by APACHE II and IV models. Receiver operating characteristic (ROC) analysis was used to assess the sensitivity, specificity and predictive performance of both scores. Binary logistic regression analysis was used to determine the effect that APACHE II, APACHE IV and other sample characteristics have on predicting mortality. Results: 251 patients (survived=80; none-survived=171) were included in the study with an actual mortality rate of 68.1%. APACHE II and APACHE IV scores demonstrated similar predicted mortality rates (43.3% vs. 43.0%), sensitivity (52.6% vs. 52.0%), and specificity (76.3%, 76.2%), respectively. The area under (AUC), the ROC curve for APACHE II score was 0.714 (95% confidence interval [CI] 0.645–0.783), and AUC for APACHE IV score was 0.665 (95% CI 0.595–0.734). Conclusions: As APACHE ӀӀ and ӀV mortality models demonstrate insufficient predicting performance, there is no need to consider APACHE IV in our ICU instead of using APACHE ӀӀ as it has more variables and need longer data extraction time. Implications for Practice: We suggest that other approaches in addition to the available models should be attempted to improve the accuracy of cancer prognosis in ICU. Further, it is also required to adjust the available models.

scholarly journals Better COVID-19 Intensive Care Unit survival in females, independent of age, disease severity, comorbidities, and treatment

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Daniek A. M. Meijs ◽  
Bas C. T. van Bussel ◽  
Björn Stessel ◽  
Jannet Mehagnoul-Schipper ◽  
Anisa Hana ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Disease Severity ◽  
Apache Ii ◽  
Survival Models ◽  
Organ Support ◽  
Apache Ii Score ◽  
P Value ◽  
Admission Rates ◽  
Interaction Terms

AbstractAlthough male Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) patients have higher Intensive Care Unit (ICU) admission rates and a worse disease course, a comprehensive analysis of female and male ICU survival and underlying factors such as comorbidities, risk factors, and/or anti-infection/inflammatory therapy administration is currently lacking. Therefore, we investigated the association between sex and ICU survival, adjusting for these and other variables. In this multicenter observational cohort study, all patients with SARS-CoV-2 pneumonia admitted to seven ICUs in one region across Belgium, The Netherlands, and Germany, and requiring vital organ support during the first pandemic wave were included. With a random intercept for a center, mixed-effects logistic regression was used to investigate the association between sex and ICU survival. Models were adjusted for age, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, comorbidities, and anti-infection/inflammatory therapy. Interaction terms were added to investigate effect modifications by sex with country and sex with obesity. A total of 551 patients (29% were females) were included. Mean age was 65.4 ± 11.2 years. Females were more often obese and smoked less frequently than males (p-value 0.001 and 0.042, respectively). APACHE II scores of females and males were comparable. Overall, ICU mortality was 12% lower in females than males (27% vs 39% respectively, p-value < 0.01) with an odds ratio (OR) of 0.62 (95%CI 0.39–0.96, p-value 0.032) after adjustment for age and APACHE II score, 0.63 (95%CI 0.40–0.99, p-value 0.044) after additional adjustment for comorbidities, and 0.63 (95%CI 0.39–0.99, p-value 0.047) after adjustment for anti-infection/inflammatory therapy. No effect modifications by sex with country and sex with obesity were found (p-values for interaction > 0.23 and 0.84, respectively). ICU survival in female SARS-CoV-2 patients was higher than in male patients, independent of age, disease severity, smoking, obesity, comorbidities, anti-infection/inflammatory therapy, and country. Sex-specific biological mechanisms may play a role, emphasizing the need to address diversity, such as more sex-specific prediction, prognostic, and therapeutic approach strategies.

scholarly journals Analysis of Association between CT-assessed Body Composition and Survival Composition of Patients with Sepsis in EICU

2021 ◽  
Author(s):  
Tian Yun Xu ◽  
He Zhang ◽  
Jie Zhi Li ◽  
Nan Wang
Keyword(s):  
Skeletal Muscle ◽  
Intensive Care Unit ◽  
Body Composition ◽  
Intensive Care ◽  
Mortality Rate ◽  
Ct Scan ◽  
Cox Regression ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Survival Group

Abstract Background: The prevalence of sepsis among patients in the intensive care unit is high. Thus, the evaluation of prognosis in these patients is paramount. This study aimed to appraise the role of the abdominal composition quantified from computed tomography (CT) scan in predicting a 90-day mortality rate among patients with sepsis in the emergency intensive care unit (EICU).Method: Through Cox regression analysis, the skeletal muscle density (SMD, skeletal muscle area (SMA), and subcutaneous adipose tissue area (SAT) assessed by the CT abdomen were associated with the 90-day mortality rate, with adjustment to the acute physiology and chronic health assessment (APACHE II) score, sequential organ failure assessment (SOFA) score, and BMI. Linear regression was performed to analyze other clinical factors.Result: The Cox regression analyses showed that compared with the non-survival group at 90-day, patients with a higher SMD (HR per 10 HU = 0.619; 95% CI = 0.450 - 0.853; p = 0.003), SMA (HR per 10 cm2 = 0.870; 95% CI = 0.781 - 0.969; p = 0.011), and SAT (HR per 10 cm2 = 0.954; 95% CI = 0.912 - 0.999; P = 0.047) were significantly associated with a lower 90-day mortality rate. These significant correlations persisted after adjusting for the BMI, APACHE II, and SOFA scores. Further analysis revealed gender differences in the SMD and skeletal muscle index (SMI) between the survival and the non-survival group.Conclusion: The content of body composition assessed by an abdominal CT scan is highly associated with the 90-day mortality of patients with sepsis in the EICU, of which the SMD, SMA, and SAT represent valuable prognostic factors.

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.

scholarly journals Relationships between APACHE II and APACHE III Scores and Mortality Rate in Intensive Care Unit Patients

1999 ◽  
Vol 37 (5) ◽  
pp. 814
Author(s):  
Shin Ok Koh ◽  
Ki Jun Kim ◽  
Eun Chi Bang ◽  
Sung Won Na ◽  
Yong Taek Nam
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Apache Ii ◽  
Apache Iii

scholarly journals The Effects of Adjuvant Immunoglobulin M-Enriched Immunoglobulin Therapy on Mortality Rate and Renal Function in Sepsis-Induced Multiple Organ Dysfunction Syndrome: Retrospective Analysis of Intensive Care Unit Patients

2012 ◽  
Vol 40 (3) ◽  
pp. 1166-1174 ◽  
Author(s):  
L Yavuz ◽  
G Aynali ◽  
A Aynali ◽  
A Alaca ◽  
S Kutuk ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Renal Function ◽  
Intensive Care ◽  
Mortality Rate ◽  
Organ Dysfunction ◽  
Multiple Organ ◽  
Apache Ii ◽  
Control Group ◽  
Multiple Organ Dysfunction ◽  
Overall Mortality

OBJECTIVE: To determine the effect of immunoglobulin (Ig)M-enriched Ig therapy on mortality rate and renal function in sepsis-induced multiple organ dysfunction syndrome (MODS), using the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. METHODS: Retrospective study of patients with sepsis-induced MODS treated with standard antibiotic plus supportive therapy (control group) or IgM-enriched Ig therapy adjuvant to control group therapy (IVIg group). Total length of stay in the intensive care unit (ICU), overall mortality rate and 28-day case fatality rate (CFR), as well as APACHE II scores and renal function parameters at day 1 and day 4 of therapy, were recorded. RESULTS: A total of 118 patients were included (control group, n = 62; IVIg group, n = 56). In both groups, day 4 APACHE II scores decreased significantly compared with day 1 scores; the effect of treatment on renal function was minimal. Length of ICU stay, overall mortality rate and 28-day CFR were significantly lower in the IVIg group compared with the control group. CONCLUSIONS: Adding IgM-enriched Ig therapy to standard therapy for MODS improved general clinical conditions and significantly reduced APACHE II scores, overall mortality rate and 28-day CFR, although effects on renal function were minimal.

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