scholarly journals ¿Es el Score SOFA un predictor adecuado para evaluar la mortalidad materna?

2021 ◽  
Vol 9 (4) ◽  
pp. 10-11
Author(s):  
Joseph Alburqueque Melgarejo ◽  
Juan Carlos Roque Quezada
Keyword(s):  
Apache Ii ◽  
Saps Ii

Estimado señor editor: Luego de haber leído con interés el artículo “Utilidad del score SOFA en la predicción de muerte materna en la UCI materna del INMP” por De la Peña Meniz Walter et al. publicado en el Volumen 9 número 3 de la Revista Peruana de Investigación Materno Perinatal, el cual consideramos un estudio de suma relevancia en el campo de la Gineco-Obstetricia y la Medicina Intensivista; y teniendo en cuenta la alta tasa de mortalidad materna en el Perú; quisiéramos mencionar algunos aspectos que deberían considerarse para posteriores estudios. Actualmente no existe un score específico para predecir la mortalidad materna en pacientes obstétricas en la UCI. Sin embargo, a pesar de que no hay muchos estudios al respecto, el score SOFA es el que ha presentado los mejores resultados en contraste con otros scores para valorar mortalidad. Esto puede verse ilustrado en el hecho de que otros scores como el APACHE II o el SAPS II sobreestiman la mortalidad materna, este no es el caso del score SOFA 1-3 . Por otro lado, es de relevancia señalar las características del score SOFA que hacen que sea un score confiable para la estimación de la variable mortalidad materna, en comparación con otros scores de mortalidad.  Una de ellas reside en el hecho de las variables que evalúa el score SOFA que, a diferencia de otros scores, no presentan modificaciones considerables en el estado fisiológico del embarazo. Sin embargo, el score SOFA también algunas variables que si podrían modificarse con este estado fisiológico, estas son las siguientes: presión arterial media, niveles de creatinina sérica y conteo de plaquetas. Además, el score SOFA considera variables que pueden ser evaluadas en estancias de escasos recursos, a diferencia de otros scores1,4 . Aunque existen varios subtipos de score SOFA, que tienen diferentes utilidades. En el presente estudio se valoró el score SOFA en la admisión y a las 48h del ingreso. Con la presencia de estas dos mediciones hubiera sido interesante el cálculo del delta SOFA, el cual se obtiene del cambio entre el score SOFA total en la admisión y en un punto definido en el tiempo. Esta sugerencia se sustenta en el hecho de que el delta SOFA tiene más confiabilidad para la evaluación de mortalidad en los ensayos clínicos 4,5 .Es importante también mencionar que la medida del score SOFA debe ser adecuada, puesto que errores al momento de su medición pueden conllevar a variabilidad en los resultados entre diferentes autores 4. Finalmente, mencionar que el score SOFA es un instrumento útil para evaluar la mortalidad materna, dada su superioridad en relación a otros scores previamente mencionados.

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

Membranes ◽  
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.

EVALUATION OF APACHE II, SAPS II, MPM II, AND MEDS FOR THE PROGNOSTICATION OF SEVERE SEPSIS OR SEPTIC SHOCK IN THE EMERGENCY DEPARTMENT.

2006 ◽  
Vol 34 ◽  
pp. A2 ◽  
Author(s):  
Thomas Cho ◽  
H Bryant Nguyen ◽  
Sean R Hayes ◽  
Laura Leistiko ◽  
Renee Schroetlin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Apache Ii ◽  
Saps Ii

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

scholarly journals Πρόγνωση ασθενών με κακοήθεια που εισάγονται στη μονάδα εντατικής θεραπείας

2013 ◽  
Author(s):  
Σουσάνα Ανίσογλου
Keyword(s):  
Standard Deviation ◽  
Performance Status ◽  
T Test ◽  
Apache Ii ◽  
Saps Ii ◽  
Student’S T ◽  
Student’S T Test

ΣΚΟΠΟΣ: Η συλλογή, ανάλυση και επεξεργασία στοιχείων ογκολογικών ασθενών που νοσηλεύθηκαν στη Μονάδα Εντατικής Θεραπείας (Μ.Ε.Θ.) και η συσχέτισή τους με συγκεκριμένους πιθανούς παράγοντες κινδύνου .ΥΛΙΚΟ: Πρόκειται για μία προοπτική μελέτη παρατήρησης (prospective observational) σε δείγμα 125 ογκολογικών ασθενών που νοσηλεύθηκαν στη Μ.Ε.Θ. κατά την τελευταία διετία.ΜΕΘΟΔΟΣ: Αξιολογήθηκαν επιδημιολογικοί, κλινικοί και λειτουργικοί παράγοντες. Ειδικότερα ελέγχθηκαν η πρωτοπαθής νεοπλασματική νόσος, η ηλικία, η παρουσία στεφανιαίας νόσου, χρόνιας αποφρακτικής πνευμονοπάθειας, σακχαρώδους διαβήτη, νεφρικής ανεπάρκειας, ο δείκτης μάζας σώματος, η εφαρμογή χημειοθεραπείας ή και ακτινοθεραπείας, η διάρκεια νοσηλείας, τα score βαρύτητας (APACHE II, SAPS II, SOFA) και η έκβαση (εξιτήριο ή θάνατος) και έγιναν συσχετίσεις με τα προηγούμενα στοιχεία. Χρησιμοποιήθηκε το στατιστικό λογισμικό πακέτο SPSS 17.0 (SPSS, Chicago, IL, USA) για Windows. Οι συνεχείς μεταβλητές παρουσιάζονται ως μέσοι όροι + τυπική απόκλιση (mean + standard deviation). Για τη σύγκριση των μέσων όρων μεταξύ δύο ομάδων έγινε χρήση του student’s t-test, εφόσον οι μεταβλητές ακολουθούσαν την κανονική κατανομή και του Mann-Whitney U test στην αντίθετη περίπτωση. Για την ανάδειξη συσχετίσεων μεταξύ ποιοτικών μεταβλητών έγινε χρήση του x2 test.ΑΠΟΤΕΛΕΣΜΑΤΑ: Η θνητότητα ανήλθε στο 48.8%. Στατιστικά σημαντικοί παράγοντες κακής έκβασης κατά την εισαγωγή του ασθενούς στη ΜΕΘ ήταν τα score βαρύτητας (APACHE II, SAPS II, SOFA), το πτωχό performance status και τα συνυπάρχοντα σοβαρά νοσήματα. Στατιστικά σημαντικοί παράγοντες κακής έκβασης κατά τη διάρκεια νοσηλείας του ασθενούς στη Μ.Ε.Θ. ήταν η διάρκεια του μηχανικού αερισμού, η χρήση αγγειοσυσπαστικών, η πολυοργανική ανεπάρκεια και η σηπτική κατάσταση. Από τις εργαστηριακές εξετάσεις στατιστικά σημαντικές ήταν ο χαμηλός αριθμός αιμοπεταλίων και η θετική αιμοκαλλιέργεια. Ο στατιστικός έλεγχος αξιολόγησης κατά Hosmer Lemeshow παρά τον σχετικά μικρό αριθμό του δείγματος επιβεβαίωσε τη χρησιμότητα των APACHE II, SAPS II, SOFA ως προγνωστικών μοντέλων.ΣΥΜΠΕΡΑΣΜΑΤΑ: Η πρόγνωση ογκολογικών ασθενών που εισάγονται στη ΜΕΘ είναι μέτρια. Υπάρχουν σαφείς προγνωστικοί παράγοντες κινδύνου που μπορούν να συνθέσουν ένα είδος προγνωστικού μοντέλου, ωστόσο απαιτούνται περαιτέρω πολυκεντρικές μελέτες με προοπτικό χαρακτήρα σε μεγαλύτερο αριθμό ασθενών.

scholarly journals The Pros and Cons of the Prediction Game: The Never-ending Debate of Mortality in the Intensive Care Unit

2019 ◽  
Vol 16 (18) ◽  
pp. 3394 ◽  
Author(s):  
Piotr A. Fuchs ◽  
Iwona J. Czech ◽  
Łukasz J. Krzych
Keyword(s):  
Intensive Care ◽  
Scoring Systems ◽  
Roc Curves ◽  
Simplified Acute Physiology Score ◽  
Apache Ii ◽  
Icu Mortality ◽  
Saps Ii ◽  
Icu Discharge ◽  
Pros And Cons ◽  
Long Term Prognosis

Background: The Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scales are scoring systems used in intensive care units (ICUs) worldwide. We aimed to investigate their usefulness in predicting short- and long-term prognosis in the local ICU. Methods: This single-center observational study covered 905 patients admitted from 1 January 2015 to 31 December 2017 to a tertiary mixed ICU. SAPS II, APACHE II, and SOFA scores were calculated based on the worst values from the first 24 h post-admission. Patients were divided into surgical (SP) and nonsurgical (NSP) subjects. Unadjusted ICU and post-ICU discharge mortality rates were considered the outcomes. Results: Baseline SAPS II, APACHE II, and SOFA scores were 41.1 ± 20.34, 14.07 ± 8.73, and 6.33 ± 4.12 points, respectively. All scores were significantly lower among SP compared to NSP (p < 0.05). ICU mortality reached 35.4% and was significantly lower for SP (25.3%) than NSP (57.9%) (p < 0.001). The areas under the receiver-operating characteristic (ROC) curves were 0.826, 0.836, and 0.788 for SAPS II, APACHE II, and SOFA scales, respectively, for predicting ICU prognosis, and 0.708, 0.709, and 0.661 for SAPS II, APACHE II, and SOFA, respectively, for post-ICU prognosis. Conclusions: Although APACHE II and SAPS II are good predictors of ICU mortality, they failed to predict survival after discharge. Surgical patients had a better prognosis than medical ICU patients.

scholarly journals Outcome of Patients With Necrotizing Vasculitis Admitted to the Intensive Care Unit (ICU) for Sepsis: Results of a Single-Centre Retrospective Analysis

2020 ◽  
pp. 088506662095376
Author(s):  
Marco Krasselt ◽  
Christoph Baerwald ◽  
Sirak Petros ◽  
Olga Seifert
Keyword(s):  
Intensive Care Unit ◽  
Logistic Regression ◽  
Intensive Care ◽  
Tertiary Hospital ◽  
Simplified Acute Physiology Score ◽  
Apache Ii ◽  
Necrotizing Vasculitis ◽  
Multivariate Logistic Regression ◽  
Sepsis Mortality ◽  
Saps Ii

Introduction/Background: Vasculitis patients have a high risk for infections that may require intensive care unit (ICU) treatment in case of resulting sepsis. Since data on sepsis mortality in this patient group is limited, the present study investigated the clinical characteristics and outcomes of vasculitis patients admitted to the ICU for sepsis. Methods: The medical records of all necrotizing vasculitis patients admitted to the ICU of a tertiary hospital for sepsis in a 13-year period have been reviewed. Mortality was calculated and multivariate logistic regression was used to determine independent risk factors for sepsis mortality. Moreover, the predictive power of common ICU scores was further evaluated. Results: The study included 34 patients with necrotizing vasculitis (mean age 69 ± 9.9 years, 35.3% females). 47.1% (n = 16) were treated with immunosuppressives (mostly cyclophosphamide, n = 35.3%) and 76.5% (n = 26) received glucocorticoids. Rituximab was used in 4 patients (11.8%).The in-hospital mortality of septic vasculitis patients was 41.2%. The Sequential Organ Failure Assessment (SOFA) score (p = 0.003) was independently associated with mortality in multivariate logistic regression. Acute Physiology And Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II) and SOFA scores were good predictors of sepsis mortality in the investigated vasculitis patients (APACHE II AUC 0.73, p = 0.02; SAPS II AUC 0.81, p < 0.01; SOFA AUC 0.898, p < 0.0001). Conclusions: Sepsis mortality was high in vasculitis patients. SOFA was independently associated with mortality in a logistic regression model. SOFA and other well-established ICU scores were good mortality predictors.

Validación de los Mortality Probability Models II comparados con las predicciones de mortalidad hospitalaria de APACHE II y SAPS II (réplica)

2000 ◽  
Vol 24 (8) ◽  
pp. 375-376
Author(s):  
A. García de Lorenzo ◽  
N. Serrano Hernández ◽  
Mateos ◽  
M.L. Mora Quintero ◽  
J. Fedriani Gorría
Keyword(s):  
Apache Ii ◽  
Probability Models ◽  
Saps Ii ◽  
Mortality Probability

scholarly journals An Evaluation of Serum Procalcitonin and C-Reactive Protein Levels as Diagnostic and Prognostic Biomarkers of Severe Sepsis

2015 ◽  
Vol 1 (4) ◽  
pp. 147-153 ◽  
Author(s):  
Janos Szederjesi ◽  
Emoke Almasy ◽  
Alexandra Lazar ◽  
Adina Huțanu ◽  
Iudita Badea ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
The Body ◽  
Apache Ii ◽  
Prognostic Biomarkers ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
Saps Ii ◽  
Severity Scores ◽  
Saps Ii Score

Abstract Background: Recommendations have been made, following the multicenter Surviving Sepsis Campaign study, to standardize the definition of severe sepsis with reference to several parameters such as haemodynamic stability, acid-base balance, bilirubin, creatinine, International Normalized Ratio (INR), urine output and pulmonary functional value of the ratio between arterial oxigen partial pressure and inspiratory oxigen concentration. Procalcitonin (PCT) is considered to be a gold standard biomarker for the inflammatory response, and recent studies have shown that it may help to discover whether a seriously ill person is developing sepsis. C-reactive protein (CRP) is also used as a marker of inflammation in the body, as its blood levels increase if there is any inflammation in the body. The aim of this study was to evaluate serum procalcitonin and C-reactive protein levels as diagnostic and prognostic biomarkers of severe sepsis. Material and method: Sixty patients, diagnosed as being “septic”, were admitted to the intensive care unit (ICU). Based on laboratory results and clinical findings a diagnosis of “severe sepsis“ was made, and correlated with PCT and CRP values. The APACHE II, SAPS II and SOFA severity scores were calculated, analyzed and correlated with PCT and CRP. Results: Fifty two patients (86.67%) presented with criteria for severe sepsis. Multivariate correlation analysis indicated a significant positive association between procalcitonin and all severity scores (APACHEII p<0.0001, SOFA p<0.0001, SAPS II p<0.0001). CRP proved to be significantly correlated only with the SAPS II score (p=0.0145). Mortality rate was high, with 48 patients (80%) dying. There was no significant correlation between the levels of the PCT and CRP biomarkers and severe sepsis (p=0.2059 for PCT, p=0.6059 for CRP). Conclusions: The procalcitonin levels are highly correlated with the severity scores (APACHE II, SAPS II, SOFA) regularly used in ICUs and therefore can be used for determining the severity of the septic process. Quantitive procalcitonin and C-reactive protein analysis was not shown to be useful in diagnosing severe sepsis. However, PCT and CRP can be used to predict the fatal progression of the septic patient.

Comparison of APACHE II and SAPS II between hemorrhagic and ischemic stroke patients

2015 ◽  
Vol 357 ◽  
pp. e136
Author(s):  
Y.S. Park ◽  
S.K. Park ◽  
B.H. Moon ◽  
K.S. Jang
Keyword(s):  
Ischemic Stroke ◽  
Apache Ii ◽  
Stroke Patients ◽  
Saps Ii
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