scholarly journals Predictive accuracy of Apache-II for mortality in Poly Trauma patients.

2020 ◽  
Vol 27 (11) ◽  
pp. 2314-2319
Author(s):  
Manzoor Qadir Joyia ◽  
Mudassar Murtaza ◽  
Mohammad Ansar Aslam ◽  
Fakhar Irfan ◽  
Hira Liaqat ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Diagnostic Accuracy ◽  
General Hospital ◽  
Predictive Accuracy ◽  
Treatment Plan ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Trauma Patients ◽  
Cross Sectional ◽  
Efficient Treatment

Objectives: The objective of our study was to find diagnostic accuracy of APACHE-II score to predict mortality in poly trauma patients within first 24 hours of hospitalization. Study Design: Cross Sectional study. Setting: Department of Emergency Lahore General Hospital. Period: 25 March, 2016 to 25 September, 2016. Material & Methods: A total of 230 patients who fulfilled inclusion criteria were enrolled in the study from emergency department of Lahore General Hospital, informed consent was taken from all patients or their attendants to take their demographic profile (name, age, gender and contact no) and other necessary clinical data. To calculate APACHE-II score, vital signs, blood / serum profile, GCS, age and prolong health problems were measured on patients’ arrival. Patients were classified as per their APACHE-II score. After calculating APACHE-II score patients were managed according to trauma severity and followed up till 24 hours to note the in- hospital mortality. All the data was recorded on a Performa. Statistical analysis was carried out using SPSS 20. Results: Out of 230 patients, 147 (63.91%) were male and 83(36.09%) were female; mean age was 38.53 ± 11.67 years. Out of 230 cases, in hospital mortality occurred in 84(36.5%) while other 146(63.5%) were alive within 24 hours of admission. According to APACHE-II score, 84(36.5%) cases had > 11.5 score and rests of 146(63.5%) had APACHE-II ≤ 11.5. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of APACHE-II was 89.16%, 93.2%, 88.1%, 93.84% and 91.74% respectively. Conclusion: According to the findings of this study, we found APACHE-II highly accurate for indicating in-hospital mortality. Using APACHE-II in future we can devise an efficient treatment plan for poly trauma patients to reduce the probability of hospital mortality.

scholarly journals Predictive accuracy of APACHE II score in predicting mortality in poly Trauma patients.

2021 ◽  
Vol 28 (12) ◽  
pp. 1752-1757
Author(s):  
Ibtisam Ahmed Khan ◽  
Muhammad Kareem Ullah ◽  
Saeed Mahmood ◽  
Adnan Sadiq Butt ◽  
Naeem Sarwar ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Diagnostic Accuracy ◽  
Predictive Accuracy ◽  
Treatment Plan ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Mortality Data ◽  
Trauma Patients ◽  
Efficient Treatment ◽  
Sensitivity Specificity

Objective: To find diagnostic precision of APACHE II score in predicting mortality in poly Trauma patients within first 24 hours of hospitalization. Study Design: Cross Sectional study. Setting: Emergency Department of Lahore General Hospital. Period: 2018-2019. Materials & Methods: A total of 270 patients who fulfilled selection criteria were enrolled in the study. To calculate APACHE II score, age, vitals, CBC level, Glasgow coma scale score and chronic health points were measured. Patients were classified as per their APACHE II score. After calculating APACHE II score patients were managed according to trauma severity and followed up till 24 hours to note the mortality. Data was analyzed in SPSS v. 20. Results: The mean age of patients was 38.53 ± 11.67 years with 173(63.91%) male and 97(36.09%) were female patients. Out of 270 cases, in hospital mortality occurred in 99(36.5%) while other 171(63.5%) were alive within 24 hours of admission. According to APACHE II score, 99(36.5%) cases had > 11.5 score and rests of 171(63.5%) had APACHE II ≤ 11.5. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of APACHE II was 89.16%, 93.2%, 88.1%, 93.84% and 91.74%. Conclusion: According to this study, high accuracy of APACHE II for prediction of in-hospital mortality with high sensitivity, specificity, PPV, NPV and diagnostic accuracy as 89.16%, 93.2%, 88.1%, 93.84% and 91.74%. Using APACHE II in future we can devise an efficient treatment plan for poly trauma patients to reduce the probability of hospital mortality.

scholarly journals Comparison of APACHE II and three abbreviated APACHE II scores for predicting outcome among emergency trauma patients

2014 ◽  
Vol 60 (4) ◽  
pp. 381-386 ◽  
Author(s):  
Jorge Roberto Polita ◽  
Jussara Gomez ◽  
Gilberto Friedman ◽  
Sérgio Pinto Ribeiro
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Operating Characteristic ◽  
Laboratory Data ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Trauma Patients ◽  
Individual Data ◽  
Predicting Outcome ◽  
Similar Accuracy

Objective: to compare the ability of the APACHE II score and three different abbreviated APACHE II scores: simplified APACHE II (s-APACHE II), Rapid Acute Physiology score (RAPS) and Rapid Emergency Medicine score to evaluate in-hospital mortality of trauma patients at the emergency department (ED). Methods: retrospective analysis of a prospective cohort study. All patients' victims of trauma admitted to the ED, during a 5 months period. For all entries to the ED, APACHE II score was calculated. APACHE II system was abbreviated by excluding the laboratory data to calculate s-APACHE II score for each patient. Individual data were reanalyzed to calculate RAPS and REMS. APACHE II score and its subcomponents were collected, and in-hospital mortality was assessed. The area under the receiver operating characteristic (AUROC) curve was used to determine the predictive value of each score. Results: 163 patients were analyzed. In-hospital mortality rate was 10.4%. s-APACHE II, RAPS and REMS scores were correlated with APACHE II score (r2= 0.96, r2= 0.82, r2= 0.92; p < 0.0001). Scores had similar accuracy in predicting mortality ([AUROC 0.777 [95% CI 0.705 to 0.838] for APACHE II, AUROC 0.788 [95% CI 0.717 to 0.848] for s-APACHE II, AUROC 0.806 [95% CI 0.737 to 0.864] for RAPS, AUROC 0.761 [95% CI 0.688 to 0.824] for REMS. Conclusion: abbreviated APACHE II scores have similar ability to evaluate in-hospital mortality of emergency trauma patients in comparison to APACHE II score.

The Relationship of the ACCP/SCCM Consensus Conference Classification of Sepsis to Mortality and Multiorgan Dysfunction among Medical ICU Patients

1996 ◽  
Vol 11 (6) ◽  
pp. 326-334 ◽  
Author(s):  
Marin H. Kollef ◽  
Paul R. Eisenberg
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Consensus Conference ◽  
Organ System ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Patients ◽  
Multiorgan Dysfunction

To determine the relation between the proposed ACCP/SCCM Consensus Conference classification of sepsis and hospital outcomes, we conducted a single-center, prospective observational study at Barnes Hospital, St. Louis, MO, an academic tertiary care hospital. A total of 324 consecutive patients admitted to the medical intensive care unit (ICU) were studied for prospective patient surveillance and data collection. The main outcome measures were the number of acquired organ system derangements and hospital mortality. Fifty-seven (17.6%) patients died during the study period. The proposed classifications of sepsis (e.g., systemic inflammatory response syndrome [SIRS], sepsis, severe sepsis, septic shock) correlated with hospital mortality ( r = 0.330; p < 0.001) and development of an Organ System Failure Index (OSFI) of 3 or greater ( r = 0.426; p < 0.001). Independent determinants of hospital mortality for this patient cohort ( p < 0.05) were development of an OSFI of 3 or greater (adjusted odds ratio [AOR], 13.9; 95% confidence interval [CI], 6.4–30.2; p < 0.001); presence of severe sepsis or septic shock (AOR, 2.6; 95% CI, 1.2–5.6; p = 0.002), and an APACHE II score ≥ of 18 or greater (AOR, 2.4; 95% CI, 1.0–5.8; p = 0.045). Intra-abdominal infection (AOR, 19.1; 95% CI, 1.6–230.1; p = 0.011), an APACHE II score ≥ of 18 or greater (AOR, 8.9; 95% CI, 4.2–18.6; p < 0.001), and presence of severe sepsis or septic shock (AOR, 2.9; 95% CI, 1.5–5.4; p = 0.001) were independently associated with development of an OSFI of 3 or greater. These data confirm that acquired multiorgan dysfunction is the most important predictor of mortality among medical ICU patients. In addition, they identify the proposed ACCP/SCCM Consensus Conference classification of sepsis as an additional independent determinant of both hospital mortality and multiorgan dysfunction.

scholarly journals Changes in muscle ultrasound for the diagnosis of intensive care unit acquired weakness in critically ill patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Weiqing Zhang ◽  
Jun Wu ◽  
Qiuying Gu ◽  
Yanting Gu ◽  
Yujin Zhao ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Diagnostic Accuracy ◽  
Biceps Brachii ◽  
Rectus Femoris ◽  
Apache Ii ◽  
Cross Sectional ◽  
Icu Admission ◽  
The Right ◽  
Muscle Ultrasound

AbstractTo test diagnostic accuracy of changes in thickness (TH) and cross-sectional area (CSA) of muscle ultrasound for diagnosis of intensive care unit acquired weakness (ICU-AW). Fully conscious patients were subjected to muscle ultrasonography including measuring the changes in TH and CSA of biceps brachii (BB) muscle, vastus intermedius (VI) muscle, and rectus femoris (RF) muscles over time. 37 patients underwent muscle ultrasonography on admission day, day 4, day 7, and day 10 after ICU admission, Among them, 24 were found to have ICW-AW. Changes in muscle TH and CSA of RF muscle on the right side showed remarkably higher ROC-AUC and the range was from 0.734 to 0.888. Changes in the TH of VI muscle had fair ROC-AUC values which were 0.785 on the left side and 0.779 on the right side on the 10th day after ICU admission. Additionally, Sequential Organ Failure Assessment (SOFA), Acute Physiology, and Chronic Health Evaluation II (APACHE II) scores also showed good discriminative power on the day of admission (ROC-AUC 0.886 and 0.767, respectively). Ultrasonography of changes in muscles, especially in the TH of VI muscle on both sides and CSA of RF muscle on the right side, presented good diagnostic accuracy. However, SOFA and APACHE II scores are better options for early ICU-AW prediction due to their simplicity and time efficiency.

scholarly journals Improvement of APACHE II score system for disease severity based on XGBoost algorithm

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yan Luo ◽  
Zhiyu Wang ◽  
Cong Wang
Keyword(s):  
Intensive Care ◽  
Hospital Mortality ◽  
Patient Outcomes ◽  
External Validation ◽  
Apache Ii ◽  
Validation Dataset ◽  
Apache Ii Score ◽  
Severity Scores ◽  
The Impact ◽  
Improve Patient

Abstract Background Prognostication is an essential tool for risk adjustment and decision making in the intensive care units (ICUs). In order to improve patient outcomes, we have been trying to develop a more effective model than Acute Physiology and Chronic Health Evaluation (APACHE) II to measure the severity of the patients in ICUs. The aim of the present study was to provide a mortality prediction model for ICUs patients, and to assess its performance relative to prediction based on the APACHE II scoring system. Methods We used the Medical Information Mart for Intensive Care version III (MIMIC-III) database to build our model. After comparing the APACHE II with 6 typical machine learning (ML) methods, the best performing model was screened for external validation on anther independent dataset. Performance measures were calculated using cross-validation to avoid making biased assessments. The primary outcome was hospital mortality. Finally, we used TreeSHAP algorithm to explain the variable relationships in the extreme gradient boosting algorithm (XGBoost) model. Results We picked out 14 variables with 24,777 cases to form our basic data set. When the variables were the same as those contained in the APACHE II, the accuracy of XGBoost (accuracy: 0.858) was higher than that of APACHE II (accuracy: 0.742) and other algorithms. In addition, it exhibited better calibration properties than other methods, the result in the area under the ROC curve (AUC: 0.76). we then expand the variable set by adding five new variables to improve the performance of our model. The accuracy, precision, recall, F1, and AUC of the XGBoost model increased, and were still higher than other models (0.866, 0.853, 0.870, 0.845, and 0.81, respectively). On the external validation dataset, the AUC was 0.79 and calibration properties were good. Conclusions As compared to conventional severity scores APACHE II, our XGBoost proposal offers improved performance for predicting hospital mortality in ICUs patients. Furthermore, the TreeSHAP can help to enhance the understanding of our model by providing detailed insights into the impact of different features on the disease risk. In sum, our model could help clinicians determine prognosis and improve patient outcomes.

scholarly journals The Characteristics of Mortality Predictor Scoring for Sepsis Patients in Haji Adam Malik Hospital

2021 ◽  
Vol 8 (10) ◽  
pp. 339-344
Author(s):  
Abdul Halim Harahap ◽  
Franciscus Ginting ◽  
Lenni Evalena Sihotang
Keyword(s):  
Sofa Score ◽  
Scoring System ◽  
Scoring Systems ◽  
Developed Countries ◽  
Apache Ii ◽  
Apache Ii Score ◽  
P Value ◽  
Cross Sectional ◽  
Cross Sectional Design ◽  
Score Apache

Introduction: Sepsis is a leading cause of death in the Intensive Care Unit (ICU) in developed countries and its incidence is increasing. Many scoring systems are used to assess the severity of disease in patients admitted to the ICU. SOFA score to assess the degree of organ dysfunction in septic patients. The Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system is most often used for patients admitted to the ICU. CCI scoring system to assess the effect of comorbid disease in critically ill patients on mortality. The study aimed to describe the characteristics of the use of scoring to predict patients’ mortality admitted to Haji Adam Malik Hospital. Methods: This is an observational study with a cross-sectional design. A total of 299 study subjects met the inclusion criteria and exclusion criteria, three types of scoring, namely SOFA score, APACHE II score, and CCI score were used to assess the prognosis of septic patients. Data analysis was performed using SPSS. P-value <0.05 was considered statistically significant. Results: A total of 252 people (84.3%) of sepsis patients died. The mean age of the septic patients who died was 54.25 years. The SOFA score ranged from 0-24, the median SOFA score in deceased sepsis patients was 5.0. The APACHE II score ranged from 0-71, the median APACHE II score in deceased sepsis patients was 23.0. The CCI score ranged from 0-37, the median CCI score in deceased sepsis patients was 5.0. Conclusion: Higher scores are associated with an increased probability of death in septic patients. Keywords: Sepsis; mortality predictor; SOFA score; APACHE II score, CCI score.

scholarly journals Influencing Factors and Prevention of Sepsis or Acute Kidney Injury in 85 Patients with Severe Trauma

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Hong Zhang ◽  
Dan Chen ◽  
Lihua Wang ◽  
Bing Li
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Influencing Factors ◽  
Severe Trauma ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Trauma Patients ◽  
Risk Of Death ◽  
Disturbance Of Consciousness ◽  
Prevention And Treatment

Severe trauma can cause systemic reactions, leading to massive bleeding, shock, asphyxia, and disturbance of consciousness. At the same time, patients with severe trauma are at high risk of sepsis and acute renal injury. The occurrence of complications will increase the difficulty of clinical treatment, improve the mortality rate, and bring heavy physical and mental burdens and economic pressure to patients and their families. It is of great clinical significance to understand the high risk factors of sepsis and AKI and actively formulate prevention and treatment measures. In this study, the clinical data of 85 patients with severe trauma were analyzed by univariate and multivariate logistic regression to identify the risk factors leading to sepsis or AKI and analyze the prevention and treatment strategies. The results showed that multiple injuries, APACHE II score on admission, SOFA score on admission, and mechanical ventilation were independent influencing factors of sepsis in patients with severe trauma, while hemorrhagic shock, APACHE II score on admission, CRRT, and sepsis were independent influencing factors of AKI in patients with severe trauma. Severe trauma patients complicated with sepsis or AKI will increase the risk of death. In the course of treatment, prevention and intervention should be given as far as possible to reduce the incidence of complications.

scholarly journals CORRELATION BETWEEN LEVEL OF SOLUBLE FAS AND DEGREE OF SEPSIS SEVERITY BASED ON APACHE II SCORE

2018 ◽  
Vol 24 (3) ◽  
pp. 231
Author(s):  
Pauline Hadisiswoyo ◽  
Endang Retnowati ◽  
Erwin Astha Triyono
Keyword(s):  
Prediction Model ◽  
Scoring System ◽  
Linear Regression Analysis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Sepsis Severity ◽  
Cross Sectional ◽  
Chronic Health ◽  
Soluble Fas ◽  
Positive Correlations

A widely used scoring system to assess the severity of sepsis is Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II scoring system, however there are some disadvantages in using this. Other parameters are needed to predict severity and outcome of sepsis. Proinflammatory cytokines and Fas receptors are increased in sepsis and their concentration elevations are correlated with disease severity. An increase of soluble Fas level will follow increasing Fas receptors. This study aimed to prove any correlation between the level of soluble Fas and degree of sepsis severity based on APACHE II score. A cross-sectional observational study was conducted in January-June 2015 on 30 septic patients. APACHE II scores were calculated from the patients’physiological data, age, and chronic health problem status. Levels of soluble Fas were measured using the ELISA method (Human FAS/ CD95 (Factor-Related Apoptosis) ELISA Kit, Elabscience Biotechnology). Levels of soluble Fas ranged between 1,049-2,783 pg/mL (1,855.7 ± 477.27 pg/mL). APACHE II scores varied between 4-29 (17.2 ± 5.82). Significant positive correlations between levels of soluble Fas and APACHE II score (r=0.347, p=0.03) were found. A prediction model of soluble Fas levels based on APACHE II score was made. Linear regression analysis produced a prediction model of soluble Fas levels based on APACHE II score, in which soluble Fas level= 1,365.8 + 28.485 x APACHE II score.  

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.

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.

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