Predictive Values of Initial Severity Scores at Intensive Care Unit Admission for Patients With Overnight or Prolonged Stay

2021 ◽  
Author(s):  
Koji Hosokawa ◽  
Nobuaki Shime
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Apache Ii ◽  
Icu Patients ◽  
Prolonged Stay ◽  
Saps Ii ◽  
Icu Stay ◽  
Severity Scores

Abstract Background: The predictive value of disease severity scores for intensive care unit (ICU) patients is occasionally inaccurate because ICU patients with mild symptoms are also considered. We, thus, aimed to evaluate the accuracy of severity scores in predicting mortality of patients with complicated conditions admitted for > 24 hours. Methods: Overall, 35,353 adult patients using nationwide ICU data were divided into two groups: (1) overnight ICU stay after elective surgery and alive on discharge within 24 hours and (2) death within 24 hours or prolonged stay. The performance and accuracy of Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) II and III, and Simplified Acute Physiology Score (SAPS) II scores in predicting in-hospital mortality were evaluated. Results: In the overnight stay group, the correlation between SOFA and APACHE III scores or SAPS II was low because many had a SOFA score of 0. In the prolonged stay group, the predictive value of SAPS II and APACHE II and III showed high accuracy but that of SOFA was moderate. Conclusions: When overnight ICU stay patients were not included, the high predictive value for in-hospital mortality of SAPS II and APACHE II and III was evident.

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.

Comparison of Sensitivity, Specificity and Accuracy of APACHE II, SAPS II and SOFA Scoring Systems as Predictors

2021 ◽  
Vol 15 (12) ◽  
pp. 3364-3366
Author(s):  
Aamir Furqan ◽  
Mehwish Naseer ◽  
Rafia Tabassum
Keyword(s):  
Intensive Care ◽  
Scoring System ◽  
Scoring Systems ◽  
Mortality Prediction ◽  
Apache Ii ◽  
Icu Patients ◽  
Saps Ii ◽  
Icu Stay ◽  
Study Results ◽  
Sensitivity Specificity

Aim: To compare the APACHE II, SAPS II and SOFA scoring systems as predictors of mortality in ICU patients in terms of sensitivity, specificity and accuracy. Methodology: A prospective observational study. Intensive care unit from May 13, 2018 to September 15, 2021. For 1368 patients included in study, results for APACHE II, SAPS II and SOFA were calculated with the worst values recorded. At the end of ICU stay, patient outcome was labelled as survivors and non-survivors. The cut off value for APACHE II, SAPS II and SOFA was taken as 50% of the highest possible score, with <50% expected to survive and with ≥50% expected to die during their ICU stay. Cross tables were made against real outcome of the patients, and sensitivity, specificity and accuracy for APACHE II, SAPS II and SOFA were calculated. Results: Sensitivity, specificity and accuracy were 77.53%, 94.28% and 85.45% for APACHE II scoring system; 47.29%, 87.32%, and 66.23% for SAPS II scoring system; and 73.37%, 60.28%, and 67.18% for SOFA scoring system, respectively. Conclusion: Apache Ii scoring system has highest sensitivity, specificity and accuracy in mortality prediction in ICU patients as compared to SAPS II and SOFA scoring systems, with SAPS II being least sensitive and accurate. Keywords: Sensitivity, specificity, accuracy, Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II), Sequential Organ Failure Assessment (SOFA), Intensive care units (ICU), Mortality.

scholarly journals Validation of APACHE II, APACHE III and SAPS II scores in in-hospital and one year mortality prediction in a mixed intensive care unit in Poland: a cohort study

2020 ◽  
Author(s):  
Szymon Czajka ◽  
Katarzyna Ziębińska ◽  
Konstanty Marczenko ◽  
Barbara Posmyk ◽  
Anna Szczepańska ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Diagnostic Accuracy ◽  
Mortality Prediction ◽  
Apache Ii ◽  
Post Discharge ◽  
Saps Ii ◽  
Apache Iii

Abstract Background. There are several scores used for in-hospital mortality prediction in critical illness. Their application in a local scenario requires validation to ensure appropriate diagnostic accuracy. Moreover, their use in assessing post-discharge mortality in intensive care unit (ICU) survivors has not been extensively studied. We aimed to validate APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed adult ICU in Poland. APACHE II, APACHE III and SAPS II scores, with corresponding predicted mortality ratios, were calculated for 303 consecutive patients admitted to a 10-bed ICU in 2016. Short-term (in-hospital) and long-term (12-month post-discharge) mortality was assessed. Results. Median APACHE II, APACHE III and SAPS II scores were 19 (IQR 12-24), 67 (36.5-88) and 44 (27-56) points, with corresponding in-hospital mortality ratios of 25.8% (IQR 12.1-46.0), 18.5% (IQR 3.8-41.8) and 34.8% (IQR 7.9-59.8). Observed in-hospital mortality was 35.6%. Moreover, 12-month post-discharge mortality reached 17.4%. All the scores predicted in-hospital mortality (p<0.05): APACHE II (AUC=0.78; 95%CI 0.73-0.83), APACHE III (AUC=0.79; 95%CI 0.74-0.84) and SAPS II (AUC=0.79; 95%CI 0.74-0.84); as well as mortality after hospital discharge (p<0.05): APACHE II (AUC=0.71; 95%CI 0.64-0.78), APACHE III (AUC=0.72; 95%CI 0.65-0.78) and SAPS II (AUC=0.69; 95%CI 0.62-0.76), with no statistically significant difference between the scores (p>0.05). The calibration of the scores was good. Conclusions. All the scores are acceptable predictors of in-hospital mortality. In the case of post-discharge mortality, their diagnostic accuracy is lower and of borderline clinical relevance. Further studies are needed to create scores estimating the long-term prognosis of subjects successfully discharged from the ICU.

scholarly journals Validation of APACHE II, APACHE III and SAPS II scores in in-hospital and one year mortality prediction in a mixed intensive care unit in Poland: a cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Szymon Czajka ◽  
Katarzyna Ziębińska ◽  
Konstanty Marczenko ◽  
Barbara Posmyk ◽  
Anna J. Szczepańska ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Diagnostic Accuracy ◽  
Mortality Prediction ◽  
Apache Ii ◽  
Post Discharge ◽  
Saps Ii ◽  
Apache Iii

Abstract Background There are several scores used for in-hospital mortality prediction in critical illness. Their application in a local scenario requires validation to ensure appropriate diagnostic accuracy. Moreover, their use in assessing post-discharge mortality in intensive care unit (ICU) survivors has not been extensively studied. We aimed to validate APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed adult ICU in Poland. APACHE II, APACHE III and SAPS II scores, with corresponding predicted mortality ratios, were calculated for 303 consecutive patients admitted to a 10-bed ICU in 2016. Short-term (in-hospital) and long-term (12-month post-discharge) mortality was assessed. Results Median APACHE II, APACHE III and SAPS II scores were 19 (IQR 12–24), 67 (36.5–88) and 44 (27–56) points, with corresponding in-hospital mortality ratios of 25.8% (IQR 12.1–46.0), 18.5% (IQR 3.8–41.8) and 34.8% (IQR 7.9–59.8). Observed in-hospital mortality was 35.6%. Moreover, 12-month post-discharge mortality reached 17.4%. All the scores predicted in-hospital mortality (p < 0.05): APACHE II (AUC = 0.78; 95%CI 0.73–0.83), APACHE III (AUC = 0.79; 95%CI 0.74–0.84) and SAPS II (AUC = 0.79; 95%CI 0.74–0.84); as well as mortality after hospital discharge (p < 0.05): APACHE II (AUC = 0.71; 95%CI 0.64–0.78), APACHE III (AUC = 0.72; 95%CI 0.65–0.78) and SAPS II (AUC = 0.69; 95%CI 0.62–0.76), with no statistically significant difference between the scores (p > 0.05). The calibration of the scores was good. Conclusions All the scores are acceptable predictors of in-hospital mortality. In the case of post-discharge mortality, their diagnostic accuracy is lower and of borderline clinical relevance. Further studies are needed to create scores estimating the long-term prognosis of subjects successfully discharged from the ICU.

Incidence and Predictive Value of Thrombocytopenia in Patients with Severe Community Acquired Pneumonia

2015 ◽  
Vol 15 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Jelena Dunaiceva ◽  
Olegs Sabelnikovs
Keyword(s):  
Intensive Care ◽  
Platelet Count ◽  
Hospital Mortality ◽  
Sofa Score ◽  
Predictive Value ◽  
Community Acquired Pneumonia ◽  
Icu Patients ◽  
Icu Stay ◽  
Severe Community Acquired Pneumonia ◽  
Clinical Records

SummaryIntroduction. Thrombocytopenia is frequently encountered in intensive care unit (ICU) patients. The cause of thrombocytopenia is multifactorial, it develops as a result of infection, inflammation and depletion of coagulation factors. Therefore, thrombocytopenia could potentially serve as an indicator of severity of the illness and an outcome predictor in patients with severe community-acquired pneumonia (CAP).Aim of the study. To determine incidence and predictive value of thrombocytopenia in ICU patients with severe CAP.Material and methods. We carried out a retrospective study based on clinical records from patients admitted to the Pauls Stradins Clinical University Hospital Intensive Care and Reanimation Unit from 2011 to 2014. Thrombocytopenia was defined as platelet count ≤150×109/L.Results. A total of 98 patients were included in this study, 58 (59%) men and 40 (41%) women. The mean (±SD) age of patients was 61±17.9 years, 54% died and 46% survived. 57 patients (58%) developed thrombocytopenia, in 58% it was present at the admission to ICU, and 42% developed thrombocytopenia during their stay in ICU. The lowest platelet count, in survivors was on fifth day in ICU, while in non-survivors on fourth day in ICU. Platelet count on admission to ICU (ROC AUC: 0.610, p=0.095) had lower discriminative power for ICU mortality than SOFA score (ROC AUC: 0.729, p=0.001) and CURB-65 score (ROC AUC: 0.680, p=0.006). Patients with thrombocytopenia at any point of ICU stay had higher hospital mortality in comparison to patients without thrombocytopenia. (36 (63.1%) vs 17 (41.1%), p=0.041). In thrombocytopenic patients non-resolution of thrombocytopenia during the ICU stay was associated with higher mortality (OR 5.5; 95% CI, 1.6-18.7, p=0.006). After adjusting for age, gender and SOFA score, non-resolution of thrombocytopenia remained to be an independent mortality predictor (OR 8, 95% CI 1.7-37, p=0.008)Conclusions. Thrombocytopenia is frequently encountered in patients with severe CAP. Thrombocytopenia at any point of ICU stay is associated with higher hospital mortality. Resolution of thrombocytopenia is associated with better clinical outcome.

scholarly journals Prognostic value of plasma pentraxin 3 levels in patients with septic shock admitted to intensive care

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243849
Author(s):  
S. Perez-San Martin ◽  
B. Suberviola ◽  
M. T. Garcia-Unzueta ◽  
B. A. Lavin ◽  
S. Campos ◽  
...  
Keyword(s):  
Septic Shock ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Prognostic Value ◽  
Positive Association ◽  
Serum Levels ◽  
Apache Ii ◽  
Predictive Capacity ◽  
Saps Ii ◽  
Severity Scores

Objective To evaluate the usefulness of a new marker, pentraxin, as a prognostic marker in septic shock patients. Materials and methods Single-centre prospective observational study that included all consecutive patients 18 years or older who were admitted to the intensive care unit (ICU) with septic shock. Serum levels of procalcitonin (PCT), C-reactive protein (CRP) and pentraxin (PTX3) were measured on ICU admission. Results Seventy-five septic shock patients were included in the study. The best predictors of in-hospital mortality were the severity scores: SAPS II (AUC = 0.81), SOFA (AUC = 0.79) and APACHE II (AUC = 0.73). The ROC curve for PTX3 (ng/mL) yielded an AUC of 0.70, higher than the AUC for PCT (0.43) and CRP (0.48), but lower than lactate (0.79). Adding PTX3 to the logistic model increased the predictive capacity in relation to SAPS II, SOFA and APACHE II for in-hospital mortality (AUC 0.814, 0.795, and 0.741, respectively). In crude regression models, significant associations were found between in-hospital mortality and PTX3. This positive association increased after adjusting for age, sex and immunosuppression: adjusted OR T3 for PTX3 = 7.83, 95% CI 1.35–45.49, linear P trend = 0.024. Conclusion Our results support the prognostic value of a single determination of plasma PTX3 as a predictor of hospital mortality in septic shock patients.

Evaluation of single intensive care unit performance in Croatia using APACHE II and SAPS II systems

2005 ◽  
Vol 22 (Supplement 34) ◽  
pp. 169
Author(s):  
K. Desa ◽  
Z. Zupan ◽  
B. Krstulovic ◽  
V. Golubovic ◽  
A. Sustic
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Apache Ii ◽  
Saps Ii ◽  
Unit Performance
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