SOFA Score prognostic performance among patients admitted to High-Dependency Units

2019 ◽  
Vol 85 (10) ◽  
Author(s):  
Francesca Innocenti ◽  
Francesca Caldi ◽  
Irene Tassinari ◽  
Federico Meo ◽  
Arianna Gandini ◽  
...  
Keyword(s):  
Sofa Score ◽  
Prognostic Performance ◽  
High Dependency

scholarly journals Complementary Use of Presepsin with the Sepsis-3 Criteria Improved Identification of High-Risk Patients with Suspected Sepsis

Biomedicines ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1076
Author(s):  
Jong Eun Park ◽  
Beomki Lee ◽  
Sun Joo Yoon ◽  
Chi-Min Park ◽  
Chul Won Jung ◽  
...  
Keyword(s):  
High Risk ◽  
Sofa Score ◽  
Lactate Level ◽  
Characteristic Curve ◽  
Prognostic Information ◽  
Suspected Sepsis ◽  
Prognostic Performance ◽  
High Risk Patients ◽  
Prognostic Accuracy ◽  
Risk Patients

Presepsin has been proposed as an early indicator for diagnosis and prognosis in sepsis. We aimed to evaluate the prognostic accuracy of presepsin levels and additional value for identifying high-risk patients when taken together with the current sepsis criteria. This was a single-center, prospective, observational study of patients with suspected sepsis. The primary outcome was 28-day mortality. The prognostic performance of presepsin was evaluated by the area under the receiver operating characteristic curve (AUC), according to the sepsis definition using the Sequential Organ Failure Assessment (SOFA) score change (delta SOFA ≥ 2) and lactate level ≥ 2 mmol/L. A total of 755 patients were included. The AUC of presepsin for predicting 28-day mortality was 0.747. Presepsin showed adequate prognostic accuracy regardless of the delta SOFA score or lactate level. High presepsin levels (>755 pg/mL) showed an independent association with 28-day mortality (adjusted odds ratio: 5.17), and significant differences in mortality were observed, even in patients with non-sepsis low lactate level. Compared with a single criterion of the delta SOFA score or lactate, the addition of the high presepsin criterion significantly increased discrimination. Presepsin showed fair prognostic performance regardless of the clinical sepsis criteria. Complementary use of presepsin with the Sepsis-3 criteria may identify more high-risk septic patients and provide useful prognostic information.

scholarly journals Complementary use of Presepsin with the Sepsis-3 Criteria Improved Identification of High-Risk Patients with Suspected Sepsis

2021 ◽  
Author(s):  
Jong Eun Park ◽  
Beomki Lee ◽  
Sun Joo Yoon ◽  
Chi-Min Park ◽  
Chul Won Jung ◽  
...  
Keyword(s):  
High Risk ◽  
Sofa Score ◽  
Lactate Level ◽  
Characteristic Curve ◽  
Prognostic Information ◽  
Suspected Sepsis ◽  
Prognostic Performance ◽  
High Risk Patients ◽  
Prognostic Accuracy ◽  
Risk Patients

Abstract Background: We aimed to evaluate the prognostic accuracy of presepsin levels and additional value for identifying high-risk patients when taken together with the current sepsis criteria. Methods: This was a single-center, prospective, observational study of patients with suspected sepsis. The primary outcome was 28-day mortality. The prognostic performance of presepsin was evaluated by the area under the receiver operating characteristic curve (AUC), according to the sepsis definition using the Sequential Organ Failure Assessment (SOFA) score change (delta SOFA ≥ 2) and lactate level ≥ 2 mmol/L. Results: A total of 775 patients were included. The AUC of presepsin for predicting 28-day mortality was 0.747 (95% confidence interval [CI]: 0.701-0.792). Presepsin showed adequate prognostic accuracy regardless of the delta SOFA score or lactate level. High presepsin levels (>755 pg/ml) showed an independent association with 28-day mortality (adjusted odds ratio: 5.17, 95% CI: 2.92–9.16), and significant differences in mortality were observed, even in patients with non-sepsis (13.3% in the high presepsin group vs. 3.6% in the low presepsin group) or low lactate level (14.4% vs. 2.7%). Compared with a single criterion of the delta SOFA score (AUC: 0.670) or lactate (AUC: 0.682), addition of the high presepsin criterion significantly increased discrimination (presepsin + delta SOFA score, AUC: 0.750; presepsin + lactate, AUC: 0.772; presepsin + delta SOFA score+ lactate, AUC: 0.795).Conclusion: Presepsin showed fair prognostic performance regardless of the clinical sepsis criteria. Complementary use of presepsin with the Sepsis-3 criteria may identify more high-risk septic patients and provide useful prognostic information.

Carotid endarterectomy following thrombolysis for acute ischaemic stroke

VASA ◽  
2017 ◽  
Vol 46 (2) ◽  
pp. 116-120 ◽  
Author(s):  
Naz Ahmed ◽  
Damian Kelleher ◽  
Manmohan Madan ◽  
Sarita Sochart ◽  
George A. Antoniou
Keyword(s):  
Ischaemic Stroke ◽  
Carotid Endarterectomy ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Wound Complications ◽  
Cardiac Complications ◽  
High Dependency ◽  
Low Incidence

Abstract. Background: Insufficient evidence exists to support the safety of carotid endarterectomy (CEA) following intravenous thrombolysis (IVT) for acute ischaemic stroke. Our study aimed to report a single-centre experience of patients treated over a five-year period. Patients and methods: Departmental computerised databases were interrogated to identify patients who suffered an ischaemic stroke and subsequently underwent thrombolysis followed by CEA. Mortality and stroke within 30 days of surgery were defined as the primary outcome end points. Results: Over a five-year period, 177 out of a total of 679 carotid endarterectomies (26 %) were performed in patients presenting with acute ischaemic stroke. Twenty-five patients (14 %) received IVT prior to CEA in the form of alteplase. Sixty percent of patients were male with a mean age of 68 years. Sixteen patients (64 %) underwent CEA within 14 days of IVT and the median interval between thrombolysis and CEA was 7.5 days (range, 3–50 days). One female patient died of a further intraoperative stroke within 30 days of surgery, yielding a mortality rate of 4 %. Two patients (8 %) suffered from cardiac complications postoperatively resulting in a short high dependency unit stay. Another two patients (8 %) developed local wound complications, which were managed conservatively without the need for re-operation. The median hospital length of stay was 4.5 days (range, 1–33 days). Conclusions: Our experience indicates that CEA post-thrombolysis has a low incidence of mortality. Further high quality evidence is required before CEA can be routinely recommended following IVT for acute ischaemic stroke.

IMPACT probability of poor outcome and plasma cytokine concentrations are associated with multiple organ dysfunction syndrome following traumatic brain injury

2019 ◽  
Vol 131 (6) ◽  
pp. 1931-1937 ◽  
Author(s):  
Sungho Lee ◽  
Hyunsoo Hwang ◽  
Jose-Miguel Yamal ◽  
J. Clay Goodman ◽  
Imoigele P. Aisiku ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Sofa Score ◽  
Plasma Concentrations ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Poor Outcome ◽  
Initial Plasma

OBJECTIVETraumatic brain injury (TBI) is a major cause of morbidity and mortality. Multiple organ dysfunction syndrome (MODS) occurs frequently after TBI and independently worsens outcome. The present study aimed to identify potential admission characteristics associated with post-TBI MODS.METHODSThe authors performed a secondary analysis of a recent randomized clinical trial studying the effects of erythropoietin and blood transfusion threshold on neurological recovery after TBI. Admission clinical, demographic, laboratory, and imaging parameters were used in a multivariable Cox regression analysis to identify independent risk factors for MODS following TBI, defined as maximum total Sequential Organ Failure Assessment (SOFA) score > 7 within 10 days of TBI.RESULTSTwo hundred patients were initially recruited and 166 were included in the final analysis. Respiratory dysfunction was the most common nonneurological organ system dysfunction, occurring in 62% of the patients. International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) probability of poor outcome at admission was significantly associated with MODS following TBI (odds ratio [OR] 8.88, 95% confidence interval [CI] 1.94–42.68, p < 0.05). However, more commonly used measures of TBI severity, such as the Glasgow Coma Scale, Injury Severity Scale, and Marshall classification, were not associated with post-TBI MODS. In addition, initial plasma concentrations of interleukin (IL)–6, IL-8, and IL-10 were significantly associated with the development of MODS (OR 1.47, 95% CI 1.20–1.80, p < 0.001 for IL-6; OR 1.26, 95% CI 1.01–1.58, p = 0.042 for IL-8; OR 1.77, 95% CI 1.24–2.53, p = 0.002 for IL-10) as well as individual organ dysfunction (SOFA component score ≥ 1). Finally, MODS following TBI was significantly associated with mortality (OR 5.95, 95% CI 2.18–19.14, p = 0.001), and SOFA score was significantly associated with poor outcome at 6 months (Glasgow Outcome Scale score < 4) when analyzed as a continuous variable (OR 1.21, 95% CI 1.06–1.40, p = 0.006).CONCLUSIONSAdmission IMPACT probability of poor outcome and initial plasma concentrations of IL-6, IL-8, and IL-10 were associated with MODS following TBI.

Clinical effectiveness of high dose versus standard dose of meropenem in ventilator-associated pneumonia caused by multidrug-resistant bacteria: a randomized single-blind clinical trial

2020 ◽  
Vol 20 ◽  
Author(s):  
Mahila Monajati ◽  
Shahram Ala ◽  
Masoud Aliyali ◽  
Roya Ghasemian ◽  
Fatemeh Heidari ◽  
...  
Keyword(s):  
Success Rate ◽  
Sofa Score ◽  
Dose Group ◽  
Clinical Success ◽  
Standard Dose ◽  
Clinical Success Rate ◽  
High Dose Group ◽  
Resistant Bacteria ◽  
High Dose ◽  
Ventilator Associated Pneumonia

Background: Meropenem standard doses are based on the minimum inhibitory concentration of sensitive pathogens and the pharmacokinetic parameter of not critically ill patients. We compared the efficacy of high versus standard dose of meropenem in ventilator-associated pneumonia (VAP). Methods: 24 out of 34 eligible patients were randomized to receive meropenem 3 g q8h (high dose group, 11 patients) or 2 g q8h (standard dose group, 13 patients) as a 3h infusion. Primary outcome was considered as clinical success that was defined as stable hemodynamic, improved sequential organ failure assessment (SOFA) score, stable or improved PaO2/FiO2 after 7 days. A sputum culture was taken before intervention. Results: Clinical success rate was not significantly different between the high and standard dose group (54.5% vs. 38.5%, P= 0.431). There was a significant difference in reduction of clinical pulmonary infection score (CPIS) compared to high dose with standard group (P=0.038). SOFA score declined significantly in high dose group through the study (P=0.006). A shorter duration of VAP treatment was recorded in high dose group (P=0.061). We did not observe any significant adverse event related to meropenem. Acinetobacter spp. (34.8%), Klebsiella spp. (32.6%) and, Pseudomonas aeruginosa (19.5%) isolated more frequently from sputum cultures. Conclusion: Treatment with high dose of meropenem seems to be safe. However, it did not provide significantly higher clinical success rate in comparison with the standard dose, but could be considered as an appropriate empirical treatment in patients with severe infection due to reducing in SOFA and CPIS.

Shared Care for High-Dependency Patients: Mental Illness, Neurological Disorders and Terminal Care—A Review

1999 ◽  
Vol 12 (4) ◽  
pp. 205-211 ◽  
Author(s):  
Z. Walker ◽  
M. McKinnon ◽  
J. Townsend
Keyword(s):  
Mental Illness ◽  
Neurological Disorders ◽  
Terminal Care ◽  
Shared Care ◽  
High Dependency

scholarly journals P044 Can an electronic prescribing system ensure clear anticoagulation discharge communication?

2019 ◽  
Vol 104 (7) ◽  
pp. e2.49-e2
Author(s):  
Susie Gage
Keyword(s):  
Patient Safety ◽  
Discharge Summary ◽  
Electronic Prescribing ◽  
List Type ◽  
Heparin Infusion ◽  
National Patient Safety Agency ◽  
High Dependency ◽  
National Patient ◽  
Discharge Summaries

AimThe National Patient Safety Agency (NPSA)1 identified heparin as a major cause of adverse events associated with adverse incidents, including some fatalities. By ensuring good communication, this should be associated with risk reduction.1 The aim of this study was to ensure there is clear anticoagulation communication on discharge, from the paediatric intensive care unit (PICU) electronic prescribing system (Philips), to the paediatric cardiac high dependency unit and paediatric cardiac ward. To investigate whether the heparin regimen complies with the hospital’s anticoagulant guidelines and if there is any deviation; that this is clearly documented. To find out if there is an indication documented for the heparin regimen chosen and if there is a clear long term plan documented for the patient, after heparin cessation.MethodsA report was generated for all patients who were prescribed a heparin infusion on PICU, between 1st January 2018 and 30th June 2018, from the Philips system. All discharge summaries from the PICU Philips system were reviewed. Only paediatric cardiac patients were included that had a heparin infusion prescribed on discharge, all other discharge summaries were excluded from the study. Each discharge summary was reviewed in the anticoagulant section; for the heparin regimen chosen, whether it complies with the hospital’s anticoagulant guidelines and if there was any deviation whether this was documented. The indication documented of which heparin regimen was chosen and whether a clear long term plan was documented after heparin cessation; for example if the patient is to be transferred onto aspirin, clopidogrel, warfarin or enoxaparin.Results82 discharge summaries were reviewed over the 6 month period between 1st January 2018 and 30th June 2018; 16 were excluded as were not paediatric cardiac, leaving 66 paediatric cardiac discharge summaries that were reviewed. 45 out of 66 (68%) complied with the hospital’s heparin anticoagulation guidelines. Of the 32% that deviated from the protocol; only 33% (7 out of 21) had a reason documented. Only 50% (33) of the summaries reviewed had an indication for anticoagulation noted on the discharge summary and 91% of discharge summaries had a long term anticoagulant plan documented.ConclusionThe electronic prescribing system can help to ensure a clear anticoagulation communication as shown by 91% of the anticoagulation long term plan being clearly documented; making it a more seamless patient transfer. On the Philips PICU electronic prescribing system there is an anticoagulant section on the discharge summary that has 3 boxes that need to be completed; heparin regimen, indication and anticoagulation long term plan. However, despite these boxes; deviations from the anticoagulant protocol were poorly documented as highlighted by only 33% having the reason highlighted in the discharge summary, only 50% of the indications were documented. Despite having prompts for this information on the discharge summary, the medical staffs needs to be aware to complete this information, in order to reduce potential medication errors and risk.ReferenceThe National Patient Safety Agency (NPSA). Actions that make anticoagulant therapy safer. NPSA; March 2007.

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