scholarly journals Haemogram-Derived Indices for Screening and Prognostication in Critically Ill Septic Shock Patients: A Case-Control Study

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 638
Author(s):  
Piotr S. Liberski ◽  
Michał Szewczyk ◽  
Łukasz J. Krzych
Keyword(s):  
Septic Shock ◽  
Organ Failure ◽  
Simplified Acute Physiology Score ◽  
Mortality Prediction ◽  
Apache Ii ◽  
Icu Mortality ◽  
Reactive Protein ◽  
Saps Ii ◽  
Multi Organ Failure ◽  
Failure Assessment

This study aimed (1) to assess the diagnostic accuracy of neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), monocyte-to-lymphocyte (MLR) and platelet count-to-mean platelet volume (PLT/MPV) ratios in predicting septic shock in patients on admission to the intensive care unit (ICU) and (2) to compare it with the role of C-reactive protein (CRP), procalcitonin (PCT) and lactate level. We also sought (3) to verify whether the indices could be useful in ICU mortality prediction and (4) to compare them with Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment (SOFA) scores. This retrospective study covered 138 patients, including 61 subjects with multi-organ failure due to septic shock (study group) and 77 sex- and age-matched controls. Septic patients had significantly higher NLR (p < 0.01) and NLR predicted septic shock occurrence (area under the ROC curve, AUROC = 0.66; 95% CI 0.58–0.74). PLR, MLR and PLT/MPV were impractical in sepsis prediction. Combination of CRP with NLR improved septic shock prediction (AUROC = 0.88; 95% CI 0.81–0.93). All indices failed to predict ICU mortality. APACHE II and SAPS II predicted mortality with AUROC = 0.68; 95% CI 0.54–0.78 and AUROC = 0.7; 95% CI 0.57–0.81, respectively. High NLR may be useful to identify patients with multi-organ failure due to septic shock but should be interpreted along with CRP or PCT. The investigated indices are not related with mortality in this specific clinical setting.

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 Critérios de admissão do paciente oncológico em Unidades de Terapia Intensiva de hospitais gerais

2019 ◽  
Vol 27 (2) ◽  
pp. 73
Author(s):  
Thaína Dalla Valle ◽  
Paulo Carlos Garcia
Keyword(s):  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Simplified Acute Physiology Score ◽  
Acute Physiology Score ◽  
Apache Ii ◽  
Electronic Library ◽  
Failure Assessment ◽  
Terapia Intensiva

A função da Unidade de Terapia Intensiva é de suporte terapêutico ao paciente. O paciente com câncer muitas vezes necessita de suporte intensivo. Nesse contexto, a gravidade das disfunções orgânicas, o comprometimento da capacidade funcional, o estadiamento do câncer e a aplicação de índices prognósticos são considerados na discussão para admissão na Unidade de Terapia Intensiva. Este artigo tem como objetivo identificar os critérios para admissão do paciente oncológico nas Unidade de Terapia Intensiva de hospitais gerais, através de uma revisão integrativa, com estudos de 2007 a 2017 disponíveis em versão completa e gratuita nas bases de dados digitais: Biblioteca Virtual em Saúde, Scientific Electronic Library Online e no portal PubMed. Foram encontradas 58 publicações potenciais. Após análise preliminar dos títulos e resumos e aplicação dos critérios de inclusão e exclusão, 23 artigos seguiram para leitura na íntegra, sendo que 10 compuseram a amostra final. Sete estudos (70%) citaram o escore prognóstico APACHE II, quatro (40%) utilizaram Simplified Acute Physiology Score, dois (20%) o Sequential Organ Failure Assessment e seis (60%) utilizaram mais de um instrumento. O câncer é uma doença grave, entretanto a decisão de indicação para tratamento intensivo não deve ser baseada em apenas uma morbidade. Pacientes oncológicos podem ter benefícios ao receberem suporte intensivo. Estudos que determinam critérios objetivos para admissão e avaliam o benefício da admissão do paciente oncológico nas Unidade de Terapia Intensiva de hospitais gerais devem ser incentivados a fim de melhor definir a utilização adequada dos recursos.

scholarly journals Παράγοντες κινδύνου πρώτου 24ώρου νοσηλείας που επηρεάζουν την τελική έκβαση ασθενών ΜΕΘ

2018 ◽  
Author(s):  
Σοφία Φίκα
Keyword(s):  
Organ Failure ◽  
Sofa Score ◽  
Therapeutic Intervention ◽  
Glasgow Coma Score ◽  
Scoring System ◽  
Simplified Acute Physiology Score ◽  
Apache Ii ◽  
Therapeutic Intervention Scoring System ◽  
Failure Assessment ◽  
Nursing Activity

Εισαγωγή: Στις Μονάδες Εντατικής Θεραπείας (ΜΕΘ), η ικανότητα πρόβλεψης της έκβασης μέσω των ειδικών συστημάτων με ακρίβεια και εγκυρότητα είναι πολύ χρήσιμη, καθώς έχει πολλές εφαρμογές στην κλινική πράξη. Στην βιβλιογραφία συστήνονται πολυάριθμες νέες μεταβλητές που φαίνεται να επηρεάζουν την τελική έκβαση των ασθενών και θα μπορούσαν δυνητικά να συμπεριληφθούν στα νέα προγνωστικά συστήματα που θα δημιουργηθούν στο μέλλον, με σκοπό να έχουν καλύτερη προγνωστική ικανότητα. Σκοπός: Ο κύριος σκοπός της παρούσας μελέτης ήταν η δημιουργία και αξιολόγηση τριών νέων προγνωστικών συστημάτων πρόβλεψης της θνησιμότητας των ασθενών της ΜΕΘ, χρησιμοποιώντας δεδομένα από το πρώτο 24ωρο της παραμονής τους σε αυτή. Τα τρία προγνωστικά συστήματα αφορούν στα τρία διαφορετικά είδη εκβάσεων: 1) θάνατος στη ΜΕΘ, 2) θάνατος στο νοσοκομείο και 3) θάνατος στο νοσοκομείο μόνο για τους ασθενείς που έχουν ήδη πάρει εξιτήριο από τη ΜΕΘ. Οι επιμέρους στόχοι ήταν: α) η σύγκριση της απόδοσης των νέων συστημάτων με τα ευρέως χρησιμοποιούμενα συμβατικά υπολογιστικά συστήματα πρόγνωσης και β) να αναδειχθούν οι παράγοντες κινδύνου που επηρεάζουν την τελική έκβαση των ασθενών στη ΜΕΘ. Υλικό και Μέθοδος: Πρόκειται για προοπτική, μη πειραματική μελέτη παρατήρησης σε μία παθολογική/χειρουργική, πολυδύναμη, πανεπιστημιακή ΜΕΘ ενός γενικού νοσοκομείου της Αττικής. Συνολικά μελετήθηκαν 436 ασθενείς που εισήχθησαν διαδοχικά στη ΜΕΘ, για το χρονικό διάστημα: Ιανουάριος 2012 - Ιούλιος 2013. Για τη συλλογή των δεδομένων αναπτύχθηκε ειδική φόρμα καταγραφής των δημογραφικών και κλινικών χαρακτηριστικών των ασθενών καθώς και ο κλινικοεργαστηριακός έλεγχος του πρώτου 24ώρου στη ΜΕΘ και η εκτίμηση της βαρύτητας της νόσου και του φόρτου νοσηλευτικής εργασίας, με βάση τα συστήματα: APACHE II (acute, physiology, age, chronic), SAPS III (Simplified Acute Physiology Score), SOFA score (Sepsis-Related Organ Failure Assessment), Κλίμακα Γλασκώβης (Glasgow Coma Score, GCS), TISS-28 (Therapeutic Intervention Scoring System) και NAS (Nursing Activity Score). Μόνο για τις δύο πρώτες εκβάσεις, το αρχικό δείγμα χωρίστηκε σε δύο υποσύνολα: στο δείγμα ανάπτυξης (Ν=400 ασθενείς) και στο δείγμα αξιολόγησης (Ν=36 ασθενείς). Από το δείγμα ανάπτυξης δημιουργήθηκαν τα νέα τελικά μοντέλα, ενώ από το δείγμα αξιολόγησης αξιολογήθηκε η απόδοση των μοντέλων αυτών για την ακριβή πρόβλεψη του θανάτου. Για τη δημιουργία των νέων συστημάτων και στις τρεις περιπτώσεις χρησιμοποιήθηκαν μέθοδοι πολλαπλής λογιστικής παλινδρόμησης. Αποτελέσματα: Δημιουργήθηκαν τρία τελικά μοντέλα πρόβλεψης του θανάτου σε ασθενείς ΜΕΘ, για τα τρία είδη των εκβάσεων: 1) Το νέο τελικό μοντέλο πρόβλεψης του θανάτου στη ΜΕΘ, είναι ένα πρωτότυπο, απλό και εύχρηστο εργαλείο, που αποτελείται από 12 μεταβλητές. Φαίνεται να έχει καλύτερη απόδοση (ROC AUC=0,85, SMR=1,25), σε σχέση τα συμβατικά προγνωστικά συστήματα (APACHE II: AUC=0,76, SMR=2,50, SAPS III: AUC=0,76, SMR=1,50) καθώς και καλύτερη προγνωστική ικανότητα (προβλεπόμενη θνησιμότητα: 41,63±31,61, παρατηρούμενη θνησιμότητα: 41,67%). 2) Το νέο τελικό μοντέλο πρόβλεψης του συνολικού θανάτου στο νοσοκομείο αποτελείται από 11 μεταβλητές. Φαίνεται να έχει καλύτερη διακριτική ικανότητα (ROC AUC=0,80, SMR=0,85) σε σχέση με συμβατικά προγνωστικά συστήματα (APACHE II: AUC=0,78, SMR=1,13, SAPS III: AUC=0,77, SMR=0,94) και επιτυγχάνει ικανοποιητική προγνωστική ικανότητα (προβλεπόμενη θνησιμότητα: 55,25±32,24, παρατηρούμενη θνησιμότητα: 47,22%). Όσον αφορά στο SOFA (ROC AUC=0,81, SMR=0,85), παρόλο που αυτό παρουσιάζει ελαφρώς καλύτερη απόδοση από το νέο σύστημα, δεν είναι τόσο ειδικό στην εκτίμηση της βαρύτητας της νόσου και στην πρόβλεψη της έκβασης, αλλά στην εκτίμηση της οργανικής δυσλειτουργίας. 3) Το νέο τελικό μοντέλο πρόβλεψης της νοσοκομειακής θνησιμότητας για τους ασθενείς που έχουν εξέλθει της ΜΕΘ είναι ένα πολύ απλό και εύχρηστο εργαλείο και αποτελείται από 7 μεταβλητές. Φαίνεται να έχει καλύτερη προσαρμογή (ROC AUC=0,85, SMR=1,62) σε σχέση τα συμβατικά προγνωστικά συστήματα (APACHE II: AUC=0,75, SMR=3,52, SAPS III: AUC=0,80, SMR=4,00) καθώς και καλύτερη προγνωστική ικανότητα (προβλεπόμενη θνησιμότητα: 20,67±22,14, παρατηρούμενη θνησιμότητα: 20,69%). Ωστόσο, αυτά τα αποτελέσματα δεν είναι τόσο αξιόπιστα, καθώς το μοντέλο αυτό δεν αξιολογήθηκε με ξεχωριστό δείγμα αξιολόγησης, λόγω του μικρού μεγέθους δείγματος και χρήζει περαιτέρω αξιολόγησης. Συμπεράσματα: Τα νέα μοντέλα που αναπτύχθηκαν είναι αρκετά απλά, εύχρηστα και πρωτότυπα εργαλεία, καθώς στα δύο από αυτά περιλαμβάνεται για πρώτη φορά ο ρυθμός μεταβολής της συγκέντρωσης του γαλακτικού οξέος στον ορό του ασθενούς κατά την πρώτη ημέρα παραμονής του στη ΜΕΘ. Φαίνεται ότι τα νέα αυτά μοντέλα ταιριάζουν καλύτερα στον τοπικό πληθυσμό των ασθενών που νοσηλεύονται στη δική μας ΜΕΘ, καθώς έχουν καλύτερη απόδοση και προγνωστική ικανότητα από τα συστήματα APACHE II, SAPS III και SOFA. Προς το παρόν, τα νέα μοντέλα φαίνονται να είναι καλύτερα από τα συμβατικά και αρκετά αξιόπιστοι δείκτες της θνησιμότητας, παρά τους διάφορους περιορισμούς της μελέτης. Προτείνεται επιπλέον μελλοντική έρευνα με σκοπό την αξιολόγηση τους με μεγαλύτερο μέγεθος δείγματος αξιολόγησης προκειμένου να επικυρωθούν και να χρησιμοποιηθούν και σε άλλες ΜΕΘ.

Effectiveness of the sequential organ failure assessment, acute physiology and chronic health evaluation II, and simplified acute physiology score II prognostic scoring systems in paraquat-poisoned patients in the intensive care unit

2016 ◽  
Vol 36 (5) ◽  
pp. 431-437 ◽  
Author(s):  
Jun Ho Lee ◽  
Seong Youn Hwang ◽  
Hye Ran Kim ◽  
Yang Won Kim ◽  
Mun Ju Kang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Sofa Score ◽  
Scoring Systems ◽  
Simplified Acute Physiology Score ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Saps Ii ◽  
Failure Assessment ◽  
Score Apache

Objective: This study was conducted to assess the ability of the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II scoring systems, as well as the simplified acute physiology score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with paraquat. This will assist physicians with risk stratification. Material and methods: The medical records of 244 paraquat-poisoned patients admitted to the ICU from January 2010 to April 2015 were examined retrospectively. The SOFA, APACHE II, and SAPS II scores were calculated based on initial laboratory data in the emergency department and during the first 24 h of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II. The ability of the SOFA score, APACHE II score, and SAPS II method to predict group mortality was assessed using a receiver operating characteristic (ROC) curve and calibration analyses. Results: A total of 219 patients (mean age, 63 years) were enrolled. Sensitivities, specificities, and accuracies were 58.5%, 86.1%, and 64.0% for the SOFA, respectively; 75.1%, 86.1%, and 77.6% for the APACHE II scoring systems, respectively; and 76.1%, 79.1%, and 76.7% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.716, 0.850, and 0.835, respectively. Conclusion: The SOFA, APACHE II, and SAPS II had different capabilities to discriminate and estimate early in-hospital mortality of paraquat-poisoned patients. Our results show that although the SOFA and SAPS II are easier and more quickly calculated than APACHE II, the APACHE II is superior for predicting mortality. We recommend use of the APACHE II for outcome predictions and risk stratification in paraquat-poisoned patients in the ICU.

scholarly journals oXiris® Use in Septic Shock: Experience of Two French Centres

2019 ◽  
Vol 47 (Suppl. 3) ◽  
pp. 29-35 ◽  
Author(s):  
Victor Schwindenhammer ◽  
Thibaut Girardot ◽  
Kevin Chaulier ◽  
Arnaud Grégoire ◽  
Céline Monard ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Sofa Score ◽  
Abdominal Sepsis ◽  
Simplified Acute Physiology Score ◽  
Saps Ii ◽  
Extracorporeal Blood Purification ◽  
Norepinephrine Infusion ◽  
Failure Assessment ◽  
Over Time

Background: Sepsis is a dysregulated host response to an infection and can result in organ dysfunctions and death. Extracorporeal blood purification techniques aim to improve the prognosis of these patients by modulating the unbalanced immune response. This study reports our experience with the use of the oXiris® membrane for septic shock patients requiring continuous renal replacement therapy (CRRT). Summary: Thirty-one patients were diagnosed with septic shock and underwent CRRT with the oXiris® membrane between 2014 and 2019. We compared the observed hospital mortality with that predicted by the Simplified Acute Physiology Score II (SAPS II). Change in the Sequential Organ Failure Assessment (SOFA) score and of the main clinical and biological parameters over time were analyzed. Hospital mortality was lower than predicted for the most severe patients (60 vs. 91% for the [74–87] SAPS II quartile and 70 vs. 98% for the [87–163] SAPS II quartile, p < 0.02). There was no significant improvement in the SOFA score from 0h to 48 h. An 88% relative decrease in norepinephrine infusion was observed (median at 0 h was 1.69 [0.52–2.45] µg/kg/min; at 48 h it was 0.20 [0.09–1.14] µg/kg/min, p = 0.002). Lactataemia and pH were significantly improved over time. Patients with intra-abdominal sepsis as well as those with Gram-negative bacilli (GNB) infections seemed to benefit the most from the therapy. Key Messages: CRRT with the oXiris® haemofilter resulted in higher observed survival than predicted by a severity score (SAPS II) for the most severe patients. Haemodynamic status and lactataemia appeared to improve, especially in intra-abdominal sepsis and GNB infections.

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

Time course of plasma and pulmonary lymph endothelin-like immunoreactivity during sustained endotoxaemia in chronically instrumented sheep

1991 ◽  
Vol 81 (3) ◽  
pp. 357-365 ◽  
Author(s):  
D. R. Morel ◽  
J. F. Pittet ◽  
K. Gunning ◽  
A. Hemsen ◽  
J. S. Lacroix ◽  
...  
Keyword(s):  
Septic Shock ◽  
Organ Failure ◽  
Thoracic Duct ◽  
Time Course ◽  
Reversed Phase ◽  
Left Ventricular ◽  
Endotoxin Infusion ◽  
Endothelin 1 ◽  
Multi Organ Failure ◽  
Conscious Sheep

1. Endothelin, a novel vasoconstrictor 21-residue peptide isolated from the supernatant of cultured porcine endothelial cells, has been shown to be increased in plasma in a variety of cardiovascular disease states, including acute myocardial infarction, acute renal failure and essential hypertension. We determined the time course of plasma and pulmonary lymph endothelin-like immunoreactivity in relation to the progressive deterioration of cardiopulmonary function in an ovine septic shock model leading to multi-organ failure syndrome and death within 42 h of a continuous intravenous infusion of Escherichia coli endotoxin (40 ng min−1 kg−1). 2. Plasma and pulmonary lymph endothelin-like immunoreactivity were measured by r.i.a. using a specific antiserum raised in rabbits against porcine endothelin-1. Endothelin-like immunoreactivity was further determined in lung tissue and the thoracic duct lymph of endotoxin-treated sheep by reversed-phase h.p.l.c. In control instrumented conscious sheep not infused with endotoxin, there were no significant changes in any of the measured cardiopulmonary and biochemical variables, with plasma and pulmonary lymph endothelin-like immunoreactivity remaining below the detection limit (< 1 pg/tube) throughout the 72 h study period. 3. Conscious sheep receiving endotoxin showed a major hypotensive septic syndrome, including persistently decreased systemic blood pressure, systemic vascular resistance, stroke volume, left ventricular stroke work, associated with sustained pulmonary vasoconstriction and protein-rich pulmonary oedema (> five-fold increase in pulmonary lymph flow and protein clearance), and marked lactic acidosis, leading to the death of animals within 14–42 h despite institution of mechanical ventilation and adequate intravascular volume replacement. 4. Appearance of endothelin-like immunoreactivity, as revealed by r.i.a., in arterial plasma and pulmonary lymph was simultaneous in both circulatory beds, with peak values measured between 4 and 12 h after the start of endotoxin infusion (plasma: 68 ± 8 pg/ml, pulmonary lymph: 88 ± 18 pg/ml, P < 0.05 compared with control sheep). After 12 h of endotoxaemia, endothelin-like immunoreactivity in both fluids progressively decreased up to the death of the animals, although remaining significantly above that measured in control sheep. The analysis of extracts of lung and thoracic duct by reversed-phase h.p.l.c. revealed that the r.i.a. method used in the present study mainly detected endothelin-1. 5. Our results demonstrate the presence of a marked and persistent increase in endothelin-like immunoreactivity in plasma and pulmonary lymph of sheep during lethal endotoxin shock with multi-organ failure, suggesting a continuous production and/or release of endothelin-1 into the pulmonary lymph and the systemic circulation upon continuous endotoxin infusion. These findings suggest that endothelin may contribute to the vasomotor disturbances observed during the development of septic shock, although studies using selective receptor antagonists or synthesis inhibitors are required to definitively confirm a potential pathophysiological role of endothelin during endotoxaemia.

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