Use of APACHE II Classification to Evaluate Outcome and Response to Therapy in Acute Renal Failure Patients in a Surgical Intensive Care Unit

Renal Failure ◽  
1995 ◽  
Vol 17 (6) ◽  
pp. 731-742 ◽  
Author(s):  
E. F. H. van Bommel ◽  
N. D. Bouvy ◽  
W. C. J. Hop ◽  
H. A. Bruining ◽  
W. Weimar
2007 ◽  
Vol 73 (8) ◽  
pp. 743-747
Author(s):  
Mary-Margaret Brandt ◽  
Anthony Falvo ◽  
H. Mathilda Horst

The negative impact of mild to moderate renal dysfunction on patient outcome is often underestimated. Any amount of renal dysfunction is deleterious in the surgical intensive care unit (SICU). We evaluated all surgery patients admitted to our SICU. We identified two groups of patients: no renal failure and acute renal failure. A total of 5152 patients were included in this study. There were 1259 patients in the acute renal failure group. The average number of ventilator days increased by 2.2 for every increase of creatinine by 1.0. Patients who required dialysis stayed an average of 11 days longer than patients who did not have any renal failure. For every increase of creatinine by 1.0, average cost increased by $23,048. Only 7 per cent of the patients with acute renal failure required dialysis (n = 85). The odds ratio for mortality compared with those patients without renal failure was 7.06 (confidence interval, 3.91–12.76) regardless of the definition of renal failure. This study demonstrates that even mild to moderate renal failure increases mortality. Moreover, we demonstrated that even a mild decline in renal function increases length of stay, ventilator days, and cost in patients in the SICU. Aggressive vigilance in the prevention of any loss of renal function is warranted in the SICU.


1981 ◽  
Vol 141 (4) ◽  
pp. 492-496 ◽  
Author(s):  
Stephen J. Sweet ◽  
Christopher U. Glenney ◽  
John P. Fitzgibbons ◽  
Paul Friedmann ◽  
Daniel Teres

2019 ◽  
Vol 8 (10) ◽  
pp. 1709 ◽  
Author(s):  
Tsung-Lun Tsai ◽  
Min-Hsin Huang ◽  
Chia-Yen Lee ◽  
Wu-Wei Lai

Besides the traditional indices such as biochemistry, arterial blood gas, rapid shallow breathing index (RSBI), acute physiology and chronic health evaluation (APACHE) II score, this study suggests a data science framework for extubation prediction in the surgical intensive care unit (SICU) and investigates the value of the information our prediction model provides. A data science framework including variable selection (e.g., multivariate adaptive regression splines, stepwise logistic regression and random forest), prediction models (e.g., support vector machine, boosting logistic regression and backpropagation neural network (BPN)) and decision analysis (e.g., Bayesian method) is proposed to identify the important variables and support the extubation decision. An empirical study of a leading hospital in Taiwan in 2015–2016 is conducted to validate the proposed framework. The results show that APACHE II and white blood cells (WBC) are the two most critical variables, and then the priority sequence is eye opening, heart rate, glucose, sodium and hematocrit. BPN with selected variables shows better prediction performance (sensitivity: 0.830; specificity: 0.890; accuracy 0.860) than that with APACHE II or RSBI. The value of information is further investigated and shows that the expected value of experimentation (EVE), 0.652 days (patient staying in the ICU), is saved when comparing with current clinical experience. Furthermore, the maximal value of information occurs in a failure rate around 7.1% and it reveals the “best applicable condition” of the proposed prediction model. The results validate the decision quality and useful information provided by our predicted model.


2006 ◽  
Vol 72 (10) ◽  
pp. 966-969 ◽  
Author(s):  
Rodrigo F. Alban ◽  
Sergey Lyass ◽  
Daniel R. Margulies ◽  
M. Michael Shabot

Although obesity has been proposed as a risk factor for adverse outcomes after trauma, numerous studies report conflicting results. The objective of this study was to compare outcomes of obese and nonobese patients after trauma. The study population consisted of all trauma patients admitted to a surgical intensive care unit in a Level I trauma center from January 1999 to December 2002. Admission data, demographics, injury severity score (ISS), severity of illness, hospital course, complications, and outcomes were compared between obese (OB; body mass index [BMI] ≥ 30), and nonobese patients (NOB; BMI ≤ 29). A total of 918 patients was included in the study, 135 OB (14.7%) and 783 NOB (85.3%). There was no significant difference in demographic data, ISS, APACHE II score, and hospital stay. Intensive care unit stay was longer for OB patients (6.8 vs 4.8 days, P = 0.04). Overall mortality was 5.9 per cent for OB and 8.0 per cent for NOB patients (P = 0.48). Mortality by mechanism of injury was 3.4 per cent OB versus 7.4 per cent NOB (P = 0.26) for blunt and 10.6 per cent OB versus 10.2 per cent NOB (P = 0.9) for penetrating injury. The three most common complications associated with death were pulmonary, cardiovascular, and neurological deterioration. Using logistic regression analysis, age and ISS and APACHE II scores were associated with mortality, but BMI was not. We conclude that obesity does not appear to be a risk factor for adverse outcomes after blunt or penetrating trauma. Further research is warranted to uncover the reason for discrepant findings between centers.


2009 ◽  
Vol 18 (1) ◽  
pp. 58-64 ◽  
Author(s):  
L. Donahoe ◽  
E. McDonald ◽  
M. E. Kho ◽  
M. Maclennan ◽  
P. W. Stratford ◽  
...  

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