Correlations of inflammatory factors, CCCK-18, MMP-9 and D-Dimer with APACHE II score and prognosis of patients with acute cerebral hemorrhage

Objective To investigate Changweishu’s clinical effect on gastrointestinal dysfunction in patients with sepsis. Methods Fifty patients with gastrointestinal dysfunction and sepsis were randomly divided into treatment and control groups. The control group patients received routine Western medicine treatments (meropenem, noradrenaline, glutamine glue, Bifidobacterium lactis triple-strain tablet), and the treatment group patients received routine Western medicine treatment combined with Changweishu. Treatments in both groups lasted 7 days. Changes in APACHE II score, gastrointestinal dysfunction score, serum levels of diamine oxidase (DAO), D-lactic acid, inflammatory factors (tumor necrosis factor (TNF)-α, interleukin (IL)-6, and high-mobility group box 1 (HMGB-1)), and the incidence of multiple organ dysfunction syndrome (MODS) and mortality were observed. Results After treatment, APACHE II score, gastrointestinal dysfunction score, and DAO, D-lactic acid, TNF-α, IL-6, and HMGB-1 levels decreased significantly in both groups, but the decrease was more significant in the treatment group than in the control group. The incidence of MODS and mortality were significantly lower in the treatment group than in the control group. Conclusion The addition of Changweishu to routine Western treatments can improve gastrointestinal function in patients with sepsis and gastrointestinal dysfunction, as well as decreasing the incidence of MODS and mortality and improving patient prognosis.

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D-dimer levels in predicting the severity of acute pancreatitis

International Surgery Journal ◽

10.18203/2349-2902.isj20175398 ◽

2017 ◽

Vol 4 (12) ◽

pp. 3993

Author(s):

Anil Kumar ◽

Ranjith Kothagattu

Keyword(s):

Acute Pancreatitis ◽

Prognostic Marker ◽

Clinical Parameter ◽

Multiple Organ ◽

Apache Ii ◽

Apache Ii Score ◽

Reactive Protein ◽

Failure Assessment ◽

The Mean ◽

D Dimer

Background:Coagulative disorder is known to occur in the early phase of acute pancreatitis. (AP) and D-dimer is a commonly used clinical parameter of haemostasis. The aim of this study was to assess the value of the plasma D-dimer level as a marker of severity in the 1.3.5 days after admission in patients with Acute pancreatitis.Methods: From September 2015 to September 2017, 60 patients admitted for AP were included in this observational study. The D-dimer level was measured during days 1,3,5 after admission and the acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, and other clinical parameters were recorded at the same time. The maximum and the mean D-dimer values were used for analysis and compared with other prognostic factors of AP.Results:Both the maximum and mean levels of D-dimer were signiﬁcantly different between patients with and without clinical variables such as multiple-organ dysfunction syndrome (MODS), need for surgical intervention, and the mortality. Additionally, the D-dimer level correlated well with two usual markers of AP severity-the APACHE II score and the C-reactive protein level. Conclusion D-dimer measurement is a useful, easy, and inexpensive early prognostic marker of the evolution and complications of AP.Conclusions:D-dimer measurement is a useful, easy, and inexpensive early prognostic marker of the evolution and complications of SAP.

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Plasma Levels of IL-8 and Microparticle Tissue Factor Activity Are Associated with Mortality in Patients with Primary Influenza A/H1N1 Infection

Blood ◽

10.1182/blood.v126.23.3544.3544 ◽

2015 ◽

Vol 126 (23) ◽

pp. 3544-3544

Author(s):

Matthew T. Rondina ◽

Kohei Tatsumi ◽

Julie A. Bastarache ◽

Nigel Mackman

Keyword(s):

Plasma Levels ◽

Influenza A ◽

H1n1 Influenza ◽

Apache Ii ◽

Apache Ii Score ◽

H1n1 Infection ◽

C Reactive Protein ◽

Reactive Protein ◽

Influenza A H1n1 ◽

D Dimer

Abstract Background and Objective: Treatment and triage decisions during influenza remain difficult due to lack of reliable severity of illness predictive score. Influenza A/H1N1 induces the expression and release of tissue-factor bearing microparticles (MP-TF), contributing to a prothrombic milieu. However, there are no studies reporting levels of circulating TF-expressing MPs during the course of human influenza. We sought to determine if MP-TF are an early predictor of mortality in critically ill patients with influenza A/H1N1. Methods: This was a prospective, multicenter, case-cohort pilot study of three academic intensive care units. We prospectively studied 15 patients with primary influenza A/H1N1 that included 7 survivors and 8 non-survivors. For comparison, 27 healthy, medication-free, age- and gender-matched control subjects were also prospectively studied. Plasma was prepared from blood drawn upon ICU admission in influenza patients. MP-TF activity, thrombin-antithrombin complexes (TATc), and D-dimers were measured as markers of activation of coagulation. Plasma cytokine levels were measured on the same blood samples. Patients were followed for the primary outcome of 28-day mortality. Results: The average admission APACHE II score of the influenza patients was 25.5±9.3, 60% of patients had shock, and the 28-day mortality rate was 53.3% (n=8/15). Compared to healthy controls, influenza patients had significantly higher plasma fibrinogen, C-reactive protein (CRP) MP-TF activity, TATc, D-dimer and a prolonged prothrombin time. However, of these procoagulant markers, only MP-TF activity predicted influenza related mortality (5.6±1.2 pg/ml in non-survivors vs. 1.8±0.8 pg/mL in survivors, p < 0.05; Table 1 and Fig. 1A). MP-TF activity, TATc levels, and D-dimer did not correlate with APACHE II score, platelet count, fibrinogen levels, CRP, or age or between patients with severe sepsis versus septic shock. Influenza non-survivors also had significantly higher plasma IL-8 levels compared with survivors (71.8±29.1 pg/ml vs. 17.3±3.7 pg/mL, p < 0.05; Figure 1B). MP-TF activity and IL-8 levels were significantly and positively correlated (r2 = 0.60, P =0.003; Figure 1C). Other cytokines, TATc, and D-dimer were not different between non-survivors and survivors. Conclusions: This study demonstrates that plasma IL-8 and MP-TF activity measured upon admission in patients with severe, primary influenza A/H1N1 infection is associated with subsequent mortality. Thus, these biomarkers may serve as very early prognostic markers for patients with influenza A/H1N1. Table 1. Characteristics of the influenza patients. Laboratory values, coagulation markers, and plasma cytokines were measured within 24 hours of ICU admission. All Influenza A/H1N1 Patients(n=15) Influenza Non-Survivors(n=8) Influenza Survivors(n=7) P value Admission Characteristic Age, years 43.3±11.0 45.8±4.6 40.4±15.5 0.37 Male Gender, n (%) 7 (47%) 3 (38%) 4 (57%) 0.45 Weight, kg 95.5±25.2 86.6±20.9 105.7±27.4 0.15 BMI, kg/m2 33.3±7.2 31.5±5.0 35.4±9.1 0.31 Obesity (BMI³30 kg/m2) 10 (67%) 5 (63%) 5 (71%) 0.71 Tobacco Use, n (%) 4 (27%) 3 (38%) 1 (14%) 0.31 APACHE II Score 25.5±9.3 27.9±9.1 22.9±9.4 0.31 Mechanically Ventilated, n (%) 15 (100%) 8 (100%) 7 (100%) -- Shock, n (%) 9 (60%) 6 (75%) 3 (43%) 0.21 P/F Ratio 83±28 84±34 82±22 0.89 Clinical Outcomes ICU Length of Stay, days 21.9±7.7 23.0±7.9 20.7±7.8 0.58 Duration of Ventilation, days 8.2±1.0 8.5±0.9 7.6±0.9 0.11 Secondary Bacterial Infection, n (%) 5 (33%) 4 (50%) 1 (14%) 0.28 Overt DIC, n (%) 15 (100%) 8 (100%) 7 (100%) -- Laboratory Values Platelets, 103/µL 213±138 154±104 280±150 0.08 White Blood Cells, K/µL 7.3±4.4 8.5±4.9 5.9±3.5 0.28 Hemoglobin, g/dL 11.7±1.9 11.5±2.0 12.0±1.8 0.66 Serum Creatinine, mg/dL 1.1±0.7 1.14±0.74 1.07±0.59 0.84 Coagulation Markers Fibrinogen, mg/dL 571±240 461±253 700±157 0.07 C-reactive Protein, mg/L 11.0±7.6 11.8±7.4 10.2±8.2 0.70 PT, sec 20±7.0 19.2±4.7 20.9±9.3 0.67 aPTT, sec 53.0±22.9 55.1±29.0 50.7±15.0 0.72 MP-TF, pg/mL 3.8±0.9 5.6±1.2 1.8±0.8 < 0.05 TATc, ng/mL 11.8±2.7 14.3±3.5 9.1±4.1 0.35 D-dimer, ng/mL 2439±86 2568±98 2292±134 0.11 Figure 1. MP-TF activity and IL-8 predict mortality in patients with influenza A/H1N1. (A) Plasma levels of MP-TF activity and (B) IL-8 levels in survivors and non-survivors. (C) Correlation between MP TF activity and IL-8 levelsin H1N1 influenza-infected patients (*P <0.05). Figure 1. MP-TF activity and IL-8 predict mortality in patients with influenza A/H1N1. / (A) Plasma levels of MP-TF activity and (B) IL-8 levels in survivors and non-survivors. (C) Correlation between MP TF activity and IL-8 levelsin H1N1 influenza-infected patients (*P <0.05). Disclosures No relevant conflicts of interest to declare.

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Das rupturierte infrarenale Aortenaneurysma – eine kritische Analyse

VASA ◽

10.1024/0301-1526.28.1.30 ◽

1999 ◽

Vol 28 (1) ◽

pp. 30-33 ◽

Cited By ~ 9

Author(s):

Bürger ◽

Meyer ◽

Tautenhahn ◽

Halloul

Keyword(s):

Aortic Aneurysm ◽

Aortic Rupture ◽

Anesthetic Management ◽

Objective Evaluation ◽

Left Ventricular ◽

Apache Ii ◽

Apache Ii Score ◽

Infrarenal Aortic Aneurysm ◽

Emergency Situations ◽

Probability Of Death

Background: Objective evaluation of the management of patients with ruptured infrarenal aortic aneurysm in emergency situations has been described rarely. Patients and methods: Fifty-two consecutive patients with ruptured infrarenal aortic aneurysm (mean age, 70.3 years; range, 56–89 years; SD 7.8) were admitted between January 1993 and March 1998. Emergency protocols, final reports, and follow-up data were analyzed retrospectively. APACHE II scores at admission and fifth postoperative day were assessed. Results: The time between the appearance of first symptoms and the referral of patients to the hospital was more than 5 hours in 37 patients (71%). Thirty-eight patients (71%) had signs of shock at time of admission. Ultrasound was performed in 81% of patients as the first diagnostic procedure. The most frequent site of aortic rupture was the left retroperitoneum (87%). Intraoperatively, acute left ventricular failure occurred in four patients, and cardiac arrest in two others. The postoperative course was complicated significantly in 34 patients. The overall mortality rate was 36.5% (n = 19). In 35 patients, APACHE II score was assessed, showing a probability of death of more than 40% in five patients and lower than 30% in 17 others. No patient showing probability of death of above 75% at the fifth postoperative day survived (n = 7). Conclusions: Ruptured aortic aneurysm demands surgical intervention. Clinical outcome is also influenced by preclinical and anesthetic management. The severity of disease as well as the patient’s prognosis can be approximated using APACHE II score. Treatment results of heterogenous patient groups can be compared.

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Outcome Prediction in Patients with Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation—A Retrospective International Multicenter Study

Membranes ◽

10.3390/membranes11030170 ◽

2021 ◽

Vol 11 (3) ◽

pp. 170

Author(s):

Alexander Supady ◽

Jeff DellaVolpe ◽

Fabio Silvio Taccone ◽

Dominik Scharpf ◽

Matthias Ulmer ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

The United States ◽

Apache Ii ◽

Apache Ii Score ◽

Survival Prediction ◽

Study Cohort ◽

Additional Tool ◽

Saps Ii ◽

Membrane Oxygenation ◽

International Multicenter

The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19 acute respiratory distress syndrome (ARDS) is still under debate and conclusive data from large cohorts are scarce. Furthermore, criteria for the selection of patients that benefit most from this highly invasive and resource-demanding therapy are yet to be defined. In this study, we assess survival in an international multicenter cohort of COVID-19 patients treated with V-V ECMO and evaluate the performance of several clinical scores to predict 30-day survival. Methods: This is an investigator-initiated retrospective non-interventional international multicenter registry study (NCT04405973, first registered 28 May 2020). In 127 patients treated with V-V ECMO at 15 centers in Germany, Switzerland, Italy, Belgium, and the United States, we calculated the Sequential Organ Failure Assessment (SOFA) Score, Simplified Acute Physiology Score II (SAPS II), Acute Physiology And Chronic Health Evaluation II (APACHE II) Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score, Predicting Death for Severe ARDS on V‑V ECMO (PRESERVE) Score, and 30-day survival. Results: In our study cohort which enrolled 127 patients, overall 30-day survival was 54%. Median SOFA, SAPS II, APACHE II, RESP, and PRESERVE were 9, 36, 17, 1, and 4, respectively. The prognostic accuracy for all these scores (area under the receiver operating characteristic—AUROC) ranged between 0.548 and 0.605. Conclusions: The use of scores for the prediction of mortality cannot be recommended for treatment decisions in severe COVID-19 ARDS undergoing V-V ECMO; nevertheless, scoring results below or above a specific cut-off value may be considered as an additional tool in the evaluation of prognosis. Survival rates in this cohort of COVID-19 patients treated with V‑V ECMO were slightly lower than those reported in non-COVID-19 ARDS patients treated with V-V ECMO.

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Comparison of outcomes of high-flow nasal cannula and noninvasive positive-pressure ventilation in patients with hypoxemia and various APACHE II scores after extubation

Therapeutic Advances in Respiratory Disease ◽

10.1177/17534666211004235 ◽

2021 ◽

Vol 15 ◽

pp. 175346662110042

Author(s):

Xiaoke Shang ◽

Yanggan Wang

Keyword(s):

Positive Pressure Ventilation ◽

Noninvasive Positive Pressure Ventilation ◽

Abdominal Distension ◽

Apache Ii ◽

Positive Pressure ◽

Apache Ii Score ◽

Subgroup Ii ◽

Significant Difference ◽

Group A ◽

Group B

Aims: The study aimed to compare and analyze the outcomes of high-flow nasal cannula (HFNC) and noninvasive positive-pressure ventilation (NPPV) in the treatment of patients with acute hypoxemic respiratory failure (AHRF) who had extubation after weaning from mechanical ventilation. Methods: A total 120 patients with AHRF were enrolled into this study. These patients underwent tracheal intubation and mechanical ventilation. They were organized into two groups according to the score of Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II); group A: APACHE II score <12; group B: 12⩽ APACHE II score <24. Group A had 72 patients and patients given HFNC were randomly assigned to subgroup I while patients given NPPV were assigned to subgroup II (36 patients in each subgroup). Group B had 48 patients and patients given HFNC were randomly assigned to subgroup I while patients given NPPV were assigned to subgroup II (24 patients in each subgroup). General information, respiratory parameters, endpoint event, and comorbidities of adverse effect were compared and analyzed between the two subgroups. Results: The incidence of abdominal distension was significantly higher in patients treated with NPPV than in those treated with HFNC in group A (19.44% versus 0, p = 0.005) and group B (25% versus 0, p = 0.009). There was no significant difference between the HFNC- and NPPV-treated patients in blood pH, oxygenation index, partial pressure of carbon dioxide, respiratory rate, and blood lactic acid concentration in either group ( p > 0.05). Occurrence rate of re-intubation within 72 h of extubation was slightly, but not significantly, higher in NPPV-treated patients ( p > 0.05). Conclusion: There was no significant difference between HFNC and NPPV in preventing respiratory failure in patients with AHRF with an APACHE II score <24 after extubation. However, HFNC was superior to NPPV with less incidence of abdominal distension. The reviews of this paper are available via the supplemental material section.

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Augmented renal clearance: a retrospective, cohort study of urinary creatinine clearance in critically ill patients in the United Kingdom

Journal of International Medical Research ◽

10.1177/03000605211015573 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110155

Author(s):

Brian W Johnston ◽

David Perry ◽

Martyn Habgood ◽

Miland Joshi ◽

Anton Krige

Keyword(s):

Risk Factors ◽

United Kingdom ◽

Creatinine Clearance ◽

Renal Clearance ◽

Repeated Measures ◽

Apache Ii ◽

Apache Ii Score ◽

Augmented Renal Clearance ◽

Urinary Creatinine ◽

The United Kingdom

Objective Augmented renal clearance (ARC) is associated with sub-therapeutic antibiotic, anti-epileptic, and anticoagulant serum concentrations leading to adverse patient outcomes. We aimed to describe the prevalence and associated risk factors for ARC development in a large, single-centre cohort in the United Kingdom. Methods We conducted a retrospective observational study of critically unwell patients admitted to intensive care between 2014 and 2016. Urinary creatinine clearance was used to determine the ARC prevalence during the first 7 days of admission. Repeated measures logistic regression was used to determine risk factors for ARC development. Results The ARC prevalence was 47.0% (95% confidence interval [95%CI]: 44.3%–49.7%). Age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and sepsis diagnosis were significantly associated with ARC. ARC was more prevalent in younger vs. older (odds ratio [OR] 0.95 [95%CI: 0.94–0.96]), male vs. female (OR 0.32 [95%CI: 0.26–0.40]) patients with lower vs. higher APACHE II scores (OR 0.94 [95%CI: 0.92–0.96]). Conclusions This patient group probably remains unknown to many clinicians because measuring urinary creatinine clearance is not usually indicated in this group. Clinicians should be aware of the ARC risk in this group and consider measurement of urinary creatinine clearance.

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Predicting Burn Mortality Using a Simple Novel Prediction Model

Indian Journal of Plastic Surgery ◽

10.1055/s-0040-1721867 ◽

2021 ◽

Author(s):

Sneha Sharma ◽

Raman Tandon

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Prediction Model ◽

Receiver Operating Characteristic ◽

Logistic Regression Analysis ◽

Operating Characteristic ◽

Binary Logistic Regression ◽

Apache Ii ◽

Apache Ii Score ◽

Binary Logistic Regression Analysis

Abstract Background Prediction of outcome for burn patients allows appropriate allocation of resources and prognostication. There is a paucity of simple to use burn-specific mortality prediction models which consider both endogenous and exogenous factors. Our objective was to create such a model. Methods A prospective observational study was performed on consecutive eligible consenting burns patients. Demographic data, total burn surface area (TBSA), results of complete blood count, kidney function test, and arterial blood gas analysis were collected. The quantitative variables were compared using the unpaired student t-test/nonparametric Mann Whitney U-test. Qualitative variables were compared using the ⊠2-test/Fischer exact test. Binary logistic regression analysis was done and a logit score was derived and simplified. The discrimination of these models was tested using the receiver operating characteristic curve; calibration was checked using the Hosmer—Lemeshow goodness of fit statistic, and the probability of death calculated. Validation was done using the bootstrapping technique in 5,000 samples. A p-value of <0.05 was considered significant. Results On univariate analysis TBSA (p <0.001) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score (p = 0.004) were found to be independent predictors of mortality. TBSA (odds ratio [OR] 1.094, 95% confidence interval [CI] 1.037–1.155, p = 0.001) and APACHE II (OR 1.166, 95% CI 1.034–1.313, p = 0.012) retained significance on binary logistic regression analysis. The prediction model devised performed well (area under the receiver operating characteristic 0.778, 95% CI 0.681–0.875). Conclusion The prediction of mortality can be done accurately at the bedside using TBSA and APACHE II score.

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

Gastroenterology ◽

10.1016/s0016-5085(21)01467-0 ◽

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

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Successful de-escalation antibiotic therapy using cephamycins for sepsis caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae bacteremia: A sequential 25-case series

Open Medicine ◽

10.1515/med-2020-0103 ◽

2020 ◽

Vol 15 (1) ◽

pp. 782-786

Author(s):

Tsukasa Kuwana ◽

Junko Yamaguchi ◽

Kosaku Kinoshita ◽

Satoshi Hori ◽

Shingo Ihara ◽

...

Keyword(s):

Septic Shock ◽

Antibiotic Therapy ◽

Vital Signs ◽

Apache Ii ◽

Empiric Antibiotic Therapy ◽

Apache Ii Score ◽

Beta Lactamase ◽

Extended Spectrum Beta Lactamase ◽

Escalation Therapy ◽

Extended Spectrum

AbstractCarbapenems are frequently used to treat infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E), but carbapenem-resistant Enterobacteriaceae bacteria are a clinical concern. Although cephamycins (cefmetazole; CMZ) have been shown to be effective against mild cases of ESBL-E infection, data on their use for severe ESBL-E infections with sepsis or septic shock remain scarce. Herein, we discuss a de-escalation therapy to CMZ that could be used after empiric antibiotic therapy in ICU patients with sepsis or septic shock caused by ESBL-E bacteremia. A sequence of 25 cases diagnosed with sepsis or septic shock caused by ESBL-E bacteria was evaluated. The attending infectious disease specialist physicians selected the antibiotics and decided the de-escalation timing. The median SOFA (Sequential Organ Failure Assessment) and APACHE II (Acute Physiology and Chronic Health Evaluation II) severity scores were 8 and 30; the rate of septic shock was 60%. Infections originated most frequently with urinary tract infection (UTI) (56%) and Escherichia coli (85%). Eleven patients were de-escalated to CMZ after vital signs were stable, and all survived. No patients died of UTI regardless of with or without de-escalation. The median timing of de-escalation antibiotic therapy after admission was 4 days (range, 3–6 days). At the time of de-escalation, the median SOFA score fell from 8 to 5, the median APACHE II score from 28 to 22, and the rate of septic shock from 55% to 0%. We conclude that for sepsis in UTI caused by ESBL-E bacteremia, de-escalation therapy from broad-spectrum antibiotics to CMZ is a potential treatment option when vital signs are stable.

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