Plasma Glutamine Levels in Relation to Intensive Care Unit Patient Outcome

Low and high plasma glutamine levels are associated with increased mortality. This study aimed to measure glutamine levels in critically ill patients admitted to the intensive care unit (ICU), correlate the glutamine values with clinical outcomes, and identify proxy indicators of abnormal glutamine levels. Patients were enrolled from three ICUs in South Africa, provided they met the inclusion criteria. Clinical and biochemical data were collected. Plasma glutamine was categorized as low (<420 µmol/L), normal (420–700 µmol/L), or high (>700 µmol/L). Three hundred and thirty patients (median age 46.8 years, 56.4% male) were enrolled (median APACHE II score) 18.0 and SOFA) score 7.0). On admission, 58.5% had low (median 299.5 µmol/L) and 14.2% high (median 898.9 µmol/L) plasma glutamine levels. Patients with a diagnosis of polytrauma and sepsis on ICU admission presented with the lowest, and those with liver failure had the highest glutamine levels. Admission low plasma glutamine was associated with higher APACHE II scores (p = 0.003), SOFA scores (p = 0.003), C-reactive protein (CRP) values (p < 0.001), serum urea (p = 0.008), and serum creatinine (p = 0.023) and lower serum albumin (p < 0.001). Low plasma glutamine was also associated with requiring mechanical ventilation and receiving nutritional support. However, it was not significantly associated with length of stay or mortality. ROC curve analysis revealed a CRP threshold value of 87.9 mg/L to be indicative of low plasma glutamine levels (area under the curve (AUC) 0.7, p < 0.001). Fifty-nine percent of ICU patients had low plasma glutamine on admission, with significant differences found between diagnostic groupings. Markers of infection and disease severity were significant indicators of low plasma glutamine.

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Comparison of APACHE II scores and mortality with CRP/albumin, neutrophil/lymphocyte and thrombocyte/lymphocyte ratios in patients admitted to internal medicine and anesthesia reanimation intensive care unit

Journal of Laboratory Medicine ◽

10.1515/labmed-2021-0061 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Ahmet Usta ◽

Emin Gemcioglu ◽

Salih Baser ◽

Osman Ersoy ◽

Yunus Halil Polat ◽

...

Keyword(s):

Internal Medicine ◽

Intensive Care Unit ◽

Intensive Care ◽

Acute Exacerbation ◽

Kidney Injury ◽

Apache Ii ◽

Apache Ii Score ◽

Laboratory Findings ◽

Reactive Protein ◽

The Relationship

Abstract Objectives This study aimed to evaluate the relationship between C-reactive protein/albumin (CRP/Alb), neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR) ratios and the Acute Physiology And Chronic Health Evaluation II (APACHE II) score and 28-day mortality among 400 patients admitted to internal medicine and anesthesia reanimation intensive care unit (ICU). Methods This prospective study included a total of 400 patients who were admitted to hospital internal medicine and anesthesia reanimation ICUs. Results The most common reasons for ICU admission were pneumonia (29.3%), gastrointestinal bleeding (10.3%), acute exacerbation of chronic kidney disease (CKD) (10.3%), and acute kidney injury (7.5%). The comparison of the laboratory findings with survival outcomes revealed that among the patients with acute exacerbation of CKD, the median NLR (p=0.043) and median CRP/Alb (p=0.021) were significantly higher in patients who died. For all of the patients, the APACHE II score was positively correlated with CRP (p<0.001) and CRP/Alb (p<0.001), negatively correlated with Alb (p<0.001), positively correlated with the NLR (p<0.001), and positively correlated with the PLR. Conclusions The APACHE II score was significantly correlated with the CRP/Alb ratio, NLR, and PLR. The NLR and CRP/Alb ratio were statistically associated with mortality in patients hospitalized for acute exacerbation of CKD.

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Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit

Journal of International Medical Research ◽

10.1177/0300060517744427 ◽

2018 ◽

Vol 46 (3) ◽

pp. 1254-1262 ◽

Cited By ~ 3

Author(s):

Surat Tongyoo ◽

Tanuwong Viarasilpa ◽

Chairat Permpikul

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Serum Potassium ◽

Critically Ill Patients ◽

Medical Intensive Care Unit ◽

Apache Ii ◽

Apache Ii Score ◽

Icu Mortality ◽

Medical Intensive Care

Objective To compare the outcomes of patients with and without a mean serum potassium (K+) level within the recommended range (3.5–4.5 mEq/L). Methods This prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients’ baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K+ level, and hospital outcomes were recorded. Patients with a mean K+ level of 3.5 to 4.5 mEq/L and with all individual K+ values of 3.0 to 5.0 mEq/L were allocated to the normal K+ group. The remaining patients were allocated to the abnormal K+ group. Results In total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K+ group comprised 74 (46.3%) patients. The abnormal K+ group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal serum K+ level was associated with significantly higher ICU mortality and incidence of ventricular fibrillation. Conclusion Critically ill patients with abnormal K+ levels had a higher incidence of ventricular arrhythmia and ICU mortality than patients with normal K+ levels.

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APACHE II Score and Evaluation of Intensive Care Unit Patients

Korean Journal of Anesthesiology ◽

10.4097/kjae.1994.27.2.191 ◽

1994 ◽

Vol 27 (2) ◽

pp. 191

Author(s):

Kyoung Min Lee ◽

Gie Hoan Lee ◽

Dae Ja Um ◽

Ryoung Choi

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Apache Ii ◽

Apache Ii Score

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Innovative haematological parameters for early diagnosis of sepsis in adult patients admitted in intensive care unit

Journal of Clinical Pathology ◽

10.1136/jclinpath-2017-204643 ◽

2017 ◽

Vol 71 (4) ◽

pp. 330-335 ◽

Cited By ~ 3

Author(s):

Sabrina Buoro ◽

Barbara Manenti ◽

Michela Seghezzi ◽

Paola Dominoni ◽

Tiziano Barbui ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Early Diagnosis ◽

Area Under The Curve ◽

Clinical Information ◽

Operating Characteristics ◽

Early Management ◽

Reactive Protein ◽

Icu Stay ◽

Immature Platelet Fraction

AimsThis study was aimed to investigate the role of erythrocyte, platelet and reticulocyte (RET) parameters, measured by new haematological analyser Sysmex XN and C reactive protein (CRP), for early diagnosis of sepsis during intensive care unit (ICU) stay.MethodsThe study population consisted of 62 ICU patients, 21 of whom developed sepsis during ICU stay and 41 who did not. The performance for early diagnosing of sepsis was calculated as area under the curve (AUC) of receiver operating characteristics curves analysis.ResultsCompared with CRP (AUC 0.81), immature platelet fraction (IPF) (AUC 0.82) showed comparable efficiency for identifying the onset of sepsis. The association with the risk of developing sepsis during ICU stay was also assessed. One day before the onset of sepsis, a decreased of RET% was significantly associated with the risk of developing sepsis (OR=0.35, 95% CI 0.14 to 0.87), whereas an increased of IPF absolute value (IPF#) was significantly associated with the risk of developing sepsis (OR=1.13, 95% CI 1.03 to 1.24) 2 days before the onset of sepsis. The value of CRP was not predictive of sepsis at either time points.ConclusionsIPF# and RET% may provide valuable clinical information for predicting the risk of developing sepsis, thus allowing early management of patients before the onset of clinically evident systemic infections.

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Prognostic factors and outcome of adult allogeneic hematopoietic stem cell transplantation patients admitted to intensive care unit during transplant hospitalization

Scientific Reports ◽

10.1038/s41598-019-56322-0 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Christian S. Michel ◽

Daniel Teschner ◽

Irene Schmidtmann ◽

Matthias Theobald ◽

Beate Hauptrock ◽

...

Keyword(s):

Intensive Care Unit ◽

Stem Cell ◽

Intensive Care ◽

Hematopoietic Stem Cell Transplantation ◽

Apache Ii ◽

Prognostic Scores ◽

Apache Ii Score ◽

Hematopoietic Stem ◽

Short And Long Term

AbstractPatients undergoing allogeneic hematopoietic stem cell transplantation have a high morbidity and mortality, especially after admission to intensive care unit (ICU) during peri-transplant period. The objective of this study was to identify new clinical and biological parameters and validate prognostic scores associated with ICU, short-and long-term survival. Significant differences between ICU survivors and ICU non-survivors for the clinical parameters invasive mechanical ventilation, urine output, heart rate, mean arterial pressure, and amount of vasopressors have been measured. Among prognostic scores (SOFA, SAPSII, PICAT, APACHE II, APACHE IV) assessing severity of disease and predicting outcome of critically ill patients on ICU, the APACHE II score has shown most significant difference (p = 0.002) and the highest discriminative power (area under the ROC curve (AUC) 0.74). An elevated level of lactate at day of admission was associated with poor survival on ICU and the most significant independent parameter (p < 0.001). In our cohort kidney damage with low urine output has a highly relevant impact on ICU, short- and long-term overall survival. The APACHE II score was superior predicting ICU mortality compared to all other tested prognostic scores for patients on ICU during peri-transplant period.

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Acute Physiology and Chronic Health Evaluation (APACHE) II Score – the Clinical Predictor in Neurosurgical Intensive Care Unit

Acta Clinica Croatica ◽

10.20471/acc.2019.58.01.07 ◽

2019 ◽

Cited By ~ 1

Author(s):

Phuping Akavipat

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Chronic Health Evaluation ◽

Apache Ii ◽

Apache Ii Score ◽

Health Evaluation ◽

Chronic Health ◽

Clinical Predictor ◽

Neurosurgical Intensive Care ◽

Neurosurgical Intensive Care Unit

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Outcomes of Critically Ill Gynecological Cancer Patients Admitted to Intensive Care Unit

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909112437028 ◽

2012 ◽

Vol 30 (1) ◽

pp. 7-11 ◽

Cited By ~ 4

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.

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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

Infection Control and Hospital Epidemiology ◽

10.1086/665731 ◽

2012 ◽

Vol 33 (6) ◽

pp. 558-564 ◽

Cited By ~ 15

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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