scholarly journals Performance of Sequential Organ Failure Assessment and Simplified Acute Physiology Score II for Post-Cardiac Surgery Patients in Intensive Care Unit

2021 ◽  
Vol 8 ◽  
Author(s):  
Fei Xu ◽  
Weina Li ◽  
Cheng Zhang ◽  
Rong Cao
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Scoring System ◽  
Simplified Acute Physiology Score ◽  
Saps Ii ◽  
Icu Stay ◽  
Cutoff Values ◽  
Adjusted Model

Background: The aim of this study is to assess the performance of Sequential Organ Failure Assessment (SOFA) score and Simplified Acute Physiology Score (SAPS II) on outcomes of patients with cardiac surgery and identify the cutoff values to provide a reference for early intervention.Methods: All data were extracted from MIMIC-III (Medical Information Mart for Intensive Care-III) database. Cutoff values were calculated by the receiver-operating characteristic curve and Youden indexes. Patients were grouped, respectively, according to the cutoff values of SOFA and SAPS II. A non-adjusted model and adjusted model were established to evaluate the prediction of risk. Comparison of clinical efficacy between two scoring systems was made by decision curve analysis (DCA). The primary outcomes of this study were in-hospital mortality, 28-day mortality, 90-day mortality, and 1-year mortality after cardiac surgery. The secondary outcomes included length of hospital stay and intensive care unit (ICU) stay and the incidence of acute kidney injury (AKI) within 7 days after ICU admission.Results: A total of 6,122 patients were collected and divided into the H-SOFA group (SOFA ≥ 7) and L-SOFA group (SOFA < 7) or H-SAPS II group (SAPS II ≥ 43) and L-SAPS II group (SAPS II < 43). In-hospital mortality, 28-day mortality, 90-day mortality, and 1-year mortality were higher, the length of hospital and ICU stay were longer in the H-SOFA group than in the L-SOFA group (p < 0.05), while the incidence of AKI was not significantly different. In-hospital mortality, 28-day mortality, 90-day mortality, 1-year mortality, and the incidence of AKI were all significantly higher in the H-SAPS II group than in the L-SAPS II group (p < 0.05). Hospital stay and ICU stay were longer in the H-SAPS II group than in the L-SAPS II group (p < 0.05). According to DCA, the SAPS II scoring system had more net benefits on assessing the long-term mortality compared with the SOFA scoring system.Conclusion: Exceeding the cutoff values of SOFA and SAPS II scores could lead to increased mortality and extended length of ICU and hospital stay. The SAPS II scoring system had a better discriminative performance of 90-day mortality and 1-year mortality in post-cardiac surgery patients than the SOFA scoring system. Emphasizing the critical value of the scoring system is of significance for timely treatment.

Lack of Association between Preoperative Statin Use and Respiratory and Neurologic Complications after Cardiac Surgery

2017 ◽  
Vol 126 (5) ◽  
pp. 799-809 ◽  
Author(s):  
Ryu Komatsu ◽  
Huseyin Oguz Yilmaz ◽  
Jing You ◽  
C. Allen Bashour ◽  
Shobana Rajan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Odds Ratio ◽  
Hospital Length Of Stay ◽  
Neurologic Complications ◽  
Prolonged Ventilation ◽  
Statin Use

Abstract Background Statins may reduce the risk of pulmonary and neurologic complications after cardiac surgery. Methods The authors acquired data for adults who had coronary artery bypass graft, valve surgery, or combined procedures. The authors matched patients who took statins preoperatively to patients who did not. First, the authors assessed the association between preoperative statin use and the primary outcomes of prolonged ventilation (more than 24 h), pneumonia (positive cultures of sputum, transtracheal fluid, bronchial washings, and/or clinical findings consistent with the diagnosis of pneumonia), and in-hospital all-cause mortality, using logistic regressions. Second, the authors analyzed the collapsed composite of neurologic complications using logistic regression. Intensive care unit and hospital length of stay were evaluated with Cox proportional hazard models. Results Among 14,129 eligible patients, 6,642 patients were successfully matched. There was no significant association between preoperative statin use and prolonged ventilation (statin: 408/3,321 [12.3%] vs. nonstatin: 389/3,321 [11.7%]), pneumonia (44/3,321 [1.3%] vs. 54/3,321 [1.6%]), and in-hospital mortality (52/3,321 [1.6%] vs. 43/3,321 [1.3%]). The estimated odds ratio was 1.06 (98.3% CI, 0.88 to 1.27) for prolonged ventilation, 0.81 (0.50 to 1.32) for pneumonia, and 1.21 (0.74 to 1.99) for in-hospital mortality. Neurologic outcomes were not associated with preoperative statin use (53/3,321 [1.6%] vs. 56/3,321 [1.7%]), with an odds ratio of 0.95 (0.60 to 1.50). The length of intensive care unit and hospital stay was also not associated with preoperative statin use, with a hazard ratio of 1.04 (0.98 to 1.10) for length of hospital stay and 1.00 (0.94 to 1.06) for length of intensive care unit stay. Conclusions Preoperative statin use did not reduce pulmonary or neurologic complications after cardiac surgery.

Comparison of Sensitivity, Specificity and Accuracy of APACHE II, SAPS II and SOFA Scoring Systems as Predictors

2021 ◽  
Vol 15 (12) ◽  
pp. 3364-3366
Author(s):  
Aamir Furqan ◽  
Mehwish Naseer ◽  
Rafia Tabassum
Keyword(s):  
Intensive Care ◽  
Scoring System ◽  
Scoring Systems ◽  
Mortality Prediction ◽  
Apache Ii ◽  
Icu Patients ◽  
Saps Ii ◽  
Icu Stay ◽  
Study Results ◽  
Sensitivity Specificity

Aim: To compare the APACHE II, SAPS II and SOFA scoring systems as predictors of mortality in ICU patients in terms of sensitivity, specificity and accuracy. Methodology: A prospective observational study. Intensive care unit from May 13, 2018 to September 15, 2021. For 1368 patients included in study, results for APACHE II, SAPS II and SOFA were calculated with the worst values recorded. At the end of ICU stay, patient outcome was labelled as survivors and non-survivors. The cut off value for APACHE II, SAPS II and SOFA was taken as 50% of the highest possible score, with <50% expected to survive and with ≥50% expected to die during their ICU stay. Cross tables were made against real outcome of the patients, and sensitivity, specificity and accuracy for APACHE II, SAPS II and SOFA were calculated. Results: Sensitivity, specificity and accuracy were 77.53%, 94.28% and 85.45% for APACHE II scoring system; 47.29%, 87.32%, and 66.23% for SAPS II scoring system; and 73.37%, 60.28%, and 67.18% for SOFA scoring system, respectively. Conclusion: Apache Ii scoring system has highest sensitivity, specificity and accuracy in mortality prediction in ICU patients as compared to SAPS II and SOFA scoring systems, with SAPS II being least sensitive and accurate. Keywords: Sensitivity, specificity, accuracy, Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II), Sequential Organ Failure Assessment (SOFA), Intensive care units (ICU), Mortality.

Predictive Values of Initial Severity Scores at Intensive Care Unit Admission for Patients With Overnight or Prolonged Stay

2021 ◽  
Author(s):  
Koji Hosokawa ◽  
Nobuaki Shime
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Apache Ii ◽  
Icu Patients ◽  
Prolonged Stay ◽  
Saps Ii ◽  
Icu Stay ◽  
Severity Scores

Abstract Background: The predictive value of disease severity scores for intensive care unit (ICU) patients is occasionally inaccurate because ICU patients with mild symptoms are also considered. We, thus, aimed to evaluate the accuracy of severity scores in predicting mortality of patients with complicated conditions admitted for > 24 hours. Methods: Overall, 35,353 adult patients using nationwide ICU data were divided into two groups: (1) overnight ICU stay after elective surgery and alive on discharge within 24 hours and (2) death within 24 hours or prolonged stay. The performance and accuracy of Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) II and III, and Simplified Acute Physiology Score (SAPS) II scores in predicting in-hospital mortality were evaluated. Results: In the overnight stay group, the correlation between SOFA and APACHE III scores or SAPS II was low because many had a SOFA score of 0. In the prolonged stay group, the predictive value of SAPS II and APACHE II and III showed high accuracy but that of SOFA was moderate. Conclusions: When overnight ICU stay patients were not included, the high predictive value for in-hospital mortality of SAPS II and APACHE II and III was evident.

scholarly journals Objective Quantification of In-Hospital Patient Mobilization after Cardiac Surgery Using Accelerometers: Selection, Use, and Analysis

Sensors ◽  
2021 ◽  
Vol 21 (6) ◽  
pp. 1979
Author(s):  
Frank R. Halfwerk ◽  
Jeroen H. L. van Haaren ◽  
Randy Klaassen ◽  
Robby W. van Delden ◽  
Peter H. Veltink ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Hospital Stay ◽  
Intensive Care Unit Stay ◽  
Heart Surgery ◽  
Mixed Model ◽  
Postoperative Recovery ◽  
Time In Bed ◽  
Surgical Ward

Cardiac surgery patients infrequently mobilize during their hospital stay. It is unclear for patients why mobilization is important, and exact progress of mobilization activities is not available. The aim of this study was to select and evaluate accelerometers for objective qualification of in-hospital mobilization after cardiac surgery. Six static and dynamic patient activities were defined to measure patient mobilization during the postoperative hospital stay. Device requirements were formulated, and the available devices reviewed. A triaxial accelerometer (AX3, Axivity) was selected for a clinical pilot in a heart surgery ward and placed on both the upper arm and upper leg. An artificial neural network algorithm was applied to classify lying in bed, sitting in a chair, standing, walking, cycling on an exercise bike, and walking the stairs. The primary endpoint was the daily amount of each activity performed between 7 a.m. and 11 p.m. The secondary endpoints were length of intensive care unit stay and surgical ward stay. A subgroup analysis for male and female patients was planned. In total, 29 patients were classified after cardiac surgery with an intensive care unit stay of 1 (1 to 2) night and surgical ward stay of 5 (3 to 6) nights. Patients spent 41 (20 to 62) min less time in bed for each consecutive hospital day, as determined by a mixed-model analysis (p < 0.001). Standing, walking, and walking the stairs increased during the hospital stay. No differences between men (n = 22) and women (n = 7) were observed for all endpoints in this study. The approach presented in this study is applicable for measuring all six activities and for monitoring postoperative recovery of cardiac surgery patients. A next step is to provide feedback to patients and healthcare professionals, to speed up recovery.

scholarly journals Validation of the Simplified Acute Physiology Score 3 Scoring System in a Korean Intensive Care Unit

2011 ◽  
Vol 52 (1) ◽  
pp. 59 ◽  
Author(s):  
So Yeon Lim ◽  
Cho Rom Ham ◽  
So Young Park ◽  
Suhyun Kim ◽  
Maeng Real Park ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Scoring System ◽  
Simplified Acute Physiology Score ◽  
Acute Physiology Score

Esmolol before cardioplegia and as cardioplegia adjuvant reduces cardiac troponin release after cardiac surgery. A randomized trial

Perfusion ◽  
2016 ◽  
Vol 32 (4) ◽  
pp. 313-320 ◽  
Author(s):  
Elena Bignami ◽  
Marcello Guarnieri ◽  
Annalisa Franco ◽  
Chiara Gerli ◽  
Monica De Luca ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Placebo Group ◽  
Cardiopulmonary Bypass ◽  
Hospital Stay ◽  
Troponin T ◽  
Mechanical Activity ◽  
Double Blind ◽  
Elective Cardiac Surgery

Background: Cardioplegic solutions are the standard in myocardial protection during cardiac surgery, since they interrupt the electro-mechanical activity of the heart and protect it from ischemia during aortic cross-clamping. Nevertheless, myocardial damage has a strong clinical impact. We tested the hypothesis that the short-acting beta-blocker esmolol, given immediately before cardiopulmonary bypass and as a cardioplegia additive, would provide an extra protection to myocardial tissue during cardiopulmonary bypass by virtually reducing myocardial activity and, therefore, oxygen consumption to zero. Materials and methods: This was a single-centre, double-blind, placebo-controlled, parallel-group phase IV trial. Adult patients undergoing elective valvular and non-valvular cardiac surgery with end diastolic diameter >60 mm and ejection fraction <50% were enrolled. Patients were randomly assigned to receive either esmolol, 1 mg/kg before aortic cross-clamping and 2 mg/kg with Custodiol® crystalloid cardioplegia or equivolume placebo. The primary end-point was peak postoperative troponin T concentration. Troponin was measured at Intensive Care Unit arrival and at 4, 24 and 48 hours. Secondary endpoints included ventricular fibrillation after cardioplegic arrest, need for inotropic support and intensive care unit and hospital stay. Results: We found a reduction in peak postoperative troponin T, from 1195 ng/l (690–2730) in the placebo group to 640 ng/l (544–1174) in the esmolol group (p=0.029) with no differences in Intensive Care Unit stay [3 days (1-6) in the placebo group and 3 days (2-5) in the esmolol group] and hospital stay [7 days (6–10) in the placebo group and 7 days (6–12) in the esmolol group]. Troponin peak occurred at 24 hours for 12 patients (26%) and at 4 hours for the others (74%). There were no differences in other secondary end-points. Conclusions: Adding esmolol to the cardioplegia in high-risk patients undergoing elective cardiac surgery reduces peak postoperative troponin levels. Further investigation is necessary to assess esmolol effects on major clinical outcomes.

Prognostic Value of GDF-15 in Predicting Prolonged Intensive Care Stay following Cardiac Surgery: A Retrospective Case-Control Study

2021 ◽  
Author(s):  
Henry Barton ◽  
Elisabeth Zechendorf ◽  
Dirk Ostareck ◽  
Antje Ostareck-Lederer ◽  
Christian Stoppe ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Confidence Interval ◽  
Prediction Models ◽  
Unit Length ◽  
Icu Stay ◽  
Intensive Care Stay ◽  
Cardio Pulmonary Bypass ◽  
Prolonged Icu Stay ◽  
Pulmonary Bypass

Abstract Background: Predicting intensive care unit length of stay and outcome following cardiac surgery is currently based on clinical parameters. Novel biomarkers could be employed to improve the prediction models. Methods: We performed a qualitative cytokine screening array to identify highly expressed biomarkers in preoperative blood samples of cardiac surgery patients. After identification of one highly expressed biomarker, growth differentiation factor 15 (GDF-15), a quantitative ELISA was undertaken. Preoperative levels of GDF-15 were compared in regard to duration of intensive care stay, cardio-pulmonary bypass time and indicators of organ dysfunction.Results: Preoperatively, GDF-15 was highly expressed in addition to several less highly expressed other biomarkers. After qualitative analysis we could show that preoperatively raised levels of GDF-15 was positively associated with prolonged ICU stay exceeding 48 h (median 713 versus 1041 pg/ml, p = 0.003). It was also associated with prolonged mechanical ventilation and rates of severe sepsis but not with dialysis rates or cardio-pulmonary bypass time. In univariate regression, raised GDF-15 levels were predictive of a prolonged ICU stay (OR 1.01, 95% Confidence Interval 1 – 1.02, p= 0.029). On ROC curves, GDF-15 was found to predict prolonged ICU stay (AUC= 0.86, 95% Confidence Interval 0.71 – 0.99, p= 0.003).Conclusion: GDF-15 showed potential as predictor of prolonged intensive care stay following cardiac surgery, which might be valuable for risk stratification models.

Neutrophil-to-lymphocyte Ratio as a Predictor of Mortality in ICU Patients: An Analysis of MIMIC-III Database

2020 ◽  
Author(s):  
Xie Wu ◽  
Zhanhao Su ◽  
Qipeng Luo ◽  
Yinan Li ◽  
Hongbai Wang ◽  
...  
Keyword(s):  
Intensive Care ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Predictive Power ◽  
Inflammatory Marker ◽  
Survival Group ◽  
Icu Patients ◽  
Lymphocyte Ratio ◽  
Saps Ii ◽  
Death Group

Abstract Background: Identifying high-risk patients in intensive care unit (ICU) is very important because of the high mortality rate. Existing scoring systems are numerous but lack effective inflammatory markers. Our objective was to identify and evaluate a low-cost, easily accessible and effective inflammatory marker that can predict mortality in ICU patients.Methods: We conducted a retrospective study using data from the Medical Information Mart for Intensive Care III database. We first divided the patients into the survival group and the death group based on in-hospital mortality. Receiver operating characteristic analyses were performed to find the best inflammatory marker (i.e. neutrophil-to-lymphocyte ratio, NLR). We then re-divided the patients into three groups based on NLR levels. Univariate and multivariate logistic regression were performed to evaluate the association between NLR and mortality. The area under the curve (AUC), Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) were used to assess whether the incorporate of NLR can improve the predictive power of existing predictive model. Results: A total of 21,822 patients were included in this study, with an in-hospital mortality rate of 14.43%. Among all inflammatory marker in routine blood test results, NLR had the best predictive ability, with a median (interquartile range) NLR of 5.40 (2.95, 10.46) in the survival group and 8.32 (4.25, 14.75) in the death group. We then re-divided the patients into low (≤1), medium (1-6) and high (≥6) groups based on NLR levels. Compared with the median NLR group, the in-hospital mortality rates were significantly higher in the low (odds ratio [OR] = 2.09; 95% confidence interval [CI], 1.64 to 2.66) and high (OR=1.64; 95%CI, 1.50-1.80) NLR groups. The addition of NLR to Simplified Acute Physiology Score II (SAPS II) improved the AUC from 0.789 to 0.798 (P<0.001), with NRI of 16.64% (P<0.001) and IDI of 0.27% (P<0.001).Conclusion: NLR is a good predictor of mortality in ICU patients, both low and high levels of NLR are associated with elevated mortality rate. The inclusion of NLR might improve the predictive power of SAPS II.

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