STUDY OF MICROALBUMINURIA IN SEPSIS WITH REFERENCE TO APACHE II SCORE

2021 ◽  
pp. 87-90
Author(s):  
Nikitha Shirine Todeti ◽  
M Ajith Kumar
Keyword(s):  
Standard Deviation ◽  
Critically Ill ◽  
Diagnostic Methods ◽  
Apache Ii ◽  
Medical Emergency ◽  
Apache Ii Score ◽  
P Value ◽  
High Morbidity ◽  
Spot Urine ◽  
Urine Albumin

Sepsis has very high morbidity and mortality, which leads to major healthcare burden in the world. Though there is far from advancement in the therapeutic options, the mortality rate remains high due to the delay in the diagnosis because of lack of availability of reliable diagnostic methods. In sepsis there is potent activation of inammatory cascade leads to endothelial dysfunction and increase in systemic capillary permeability. In kidney there is loss of barrier integrity and capillary leak in the glomerulus results in increased excretion of albumin in the urine. This study was done to evaluate the degree of microalbuminuria in sepsis in correlation with APACHE II score and to test whether the degree of microalbuminuria could predict the mortality in critically ill sepsis patients. Methodology: The present study was conducted on 50 patients admitted to medical emergency/ Medical ICU in Kamineni Institute of Medical Sciences Narketpally. Spot urine sample was collected within 6 hours and at 24 hours of admission to medical emergency/ICU /ward. Sample testedfor urine micro albumin by using immunoturbidometric method and for urine creatinine by Jaffee method. Urine albumin: creatinine ratio was calculated. (At 6 hours ACR-1 and at 24 hours ACR-2). APACHE II scoring was done at 24 hours of admission. Patients was followed up during hospital stay and the outcome of the patient (i.e., Death/Survival) is recorded. RESULTS: The present study included 50 patients, among which 31 were males and 19 were females. Mean age was 43.5 years. Mortality was 38%. Mortality was more among male patients than in female. APACHE II score ranges from 6 - 37, mean APACHE II among survivors were 16.35 with Standard Deviation of 6.78 and among non survivors were 25.47 with Standard Deviation of 6.93 with p value of <0.0001 for predicting mortality. Urine ACR 1 was 74.06±20.83 µgm/mg among survivors and 164.53±46.61 µgm /mg among non survivors and ACR 2 was 45.81±17.92µgm/mg among survivors and 157.84±36.96 µgm/mg among non survivors. Both were statistically signicant with p value of 0.0001 for predicting mortality. The degree of microalbuminuria correlates with disease severity. CONCLUSION: Signicant microalbuminuria is predictive of mortality which is equivalent to APACHE II score. Microalbuminuria is an inexpensive and rapid diagnostic tool. Serial measurements may help in the clinical assessment of critically ill patients at risk of worse prognosis, even in resource poor areas.

scholarly journals Impact of Thyroid Dysfunction in Correlation to Mortality Rate of the Critically ILL ICU Patients (Prospective Observational Study)

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A E Mohammed ◽  
A M Saied ◽  
W Z Selima ◽  
W S Ibrahim
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Thyroid Dysfunction ◽  
Study Groups ◽  
The Body ◽  
Apache Ii ◽  
Apache Ii Score ◽  
P Value ◽  
Normal Thyroid Function ◽  
Significant Difference

Abstract Background during critical illness, changes in circulating hormonal levels are a common phenomenon. These alterations are correlated with the severity and outcome of patients in intensive care unit (ICU). Thyroid hormone stays a key role in the maintenance of the body growth. Modulating metabolism and the immune system. Aim of the Work is to access the relation between thyroid dysfunction and mortality in critically ill patients and to access the strength of thyroid dysfunction as a predictor of mortality against APACHE II score and CRP, also to assess the additive effect of low FT3 and high APACHE II score as a predictor of mortality. Patients and Methods the study population (n = 40) included 21 males (52.2%) and 19 females (47.5). their age range from (21 years) to (91 years) were selected from critically ill patients admitted to El Demerdash hospital general ICU in the period from March 2017 to March 2018. Patients were divided into 2 groups according to 7th day thyroid profile: Group 1 Normal thyroid function group (24 patients). Group 2 thyroid dysfunction group (16 patients). Results the most significant abnormality between the 2 groups was TT3 and FT3. The patients in thyroid dysfunction group showed significantly higher APACHE II score and CRP but lower GCS. They also needed more mechanical ventilation with longer duration. There was no significant difference between the 2 study groups as regard cardiovascular complication. Conclusion our study also showed highly significant correlation between thyroid dysfunction and mortality. FT3 appeared to be better predictor of mortality among critically ill patients with AUC 83% and p value &lt; 0.001 with sensitivity 99% and specificity 61%. The predictive value of FT3 for mortality increased by the addition of APACHE II score &gt; 25.

scholarly journals Risk factors for mortality in critically ill patients with COVID-19: a multicenter retrospective case-control study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jinghua Gao ◽  
Li Zhong ◽  
Ming Wu ◽  
Jingjing Ji ◽  
Zheying Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Organ Failure ◽  
Critically Ill ◽  
Sofa Score ◽  
Lymphocyte Count ◽  
Cox Regression ◽  
Survival Curve ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Hospital Death

Abstract Background Coronavirus disease 2019 (COVID-19) has spread around the world, until now, the number of positive and death cases is still increasing. Therefore, it remains important to identify risk factors for death in critically patients. Methods We collected demographic and clinical data on all severe inpatients with COVID-19. We used univariable and multivariable Cox regression methods to determine the independent risk factors related to likelihood of 28-day and 60-day survival, performing survival curve analysis. Results Of 325 patients enrolled in the study, Multi-factor Cox analysis showed increasing odds of in-hospital death associated with basic illness (hazard ratio [HR] 6.455, 95% Confidence Interval [CI] 1.658–25.139, P = 0.007), lymphopenia (HR 0.373, 95% CI 0.148–0.944, P = 0.037), higher Sequential Organ Failure Assessment (SOFA) score on admission (HR 1.171, 95% CI 1.013–1.354, P = 0.033) and being critically ill (HR 0.191, 95% CI 0.053–0.687, P = 0.011). Increasing 28-day and 60-day mortality, declining survival time and more serious inflammation and organ failure were associated with lymphocyte count < 0.8 × 109/L, SOFA score > 3, Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 7, PaO2/FiO2 < 200 mmHg, IL-6 > 120 pg/ml, and CRP > 52 mg/L. Conclusions Being critically ill and lymphocyte count, SOFA score, APACHE II score, PaO2/FiO2, IL-6, and CRP on admission were associated with poor prognosis in COVID-19 patients.

scholarly journals APHACHE Score as a Predictive Indices for Weanability from Mechanical Ventilation

2013 ◽  
Vol 1 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Md Sayedul Islam
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Private Hospital ◽  
Total Duration ◽  
Apache Ii ◽  
Apache Ii Score ◽  
P Value ◽  
Apache Score ◽  
Number Of Patients ◽  
Weaning Outcome

Objective: To determine the significance of acute physiology and chronic health evaluation (APACHE) score as an important parameter of weaning outcome for mechanical ventilation. Design: prospective, observational. Setting: The medical ICU of a modernized private hospital, Dhaka. Method: The study was carried out during the period of 2008 to 2009 in a specialized private hospital Dhaka. Critical care physicians were asked to filled up the data sheets having detail problem of the patients including the APACHE II score. The APACHE II score is divided into three steps High score>25, Medium score 20-24 and Low score < 20. The clinicians were suggested to predict whether it would take < 3 days or 4to 7days or >8days to wean each patients from mechanical ventilation. The cause of respiratory failure and total duration of weaning were recorded. The significance was set at p<.05. Result: Total number of patients included in this study were 40. Male were 22 (55%) and female were 18 (45%), the mean age of the patients were 51.1±13.9. The most common cause of respiratory failure were COPD 11(24.5%) and next common were pneumonia and ARDS due to sepsis 8 (20%) each. Among the studied population 20 (50%) having low APACHE score (<20), 12 (30%) were medium score (20-24) and 8 (20%) patients were high score (>25). Total 25 (62.5%) of the patients were successfully weaned from mechanical ventilation, 10 (25%) of the patient died and 5 (12.5%) of the patent were shifted to other low cost hospital. The successfully weaned groups 17 (68%) had lower APACHE II score than the unsuccessfully (failure) group which were statistically significant ÷2 =.8546, df =2, p-value >.005. Conclusions: The overall severity of illness as assessed by APACHE II score correlates better with weaning outcome. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14360 Bangladesh Crit Care J March 2013; 1: 18-22

scholarly journals The Characteristics of Mortality Predictor Scoring for Sepsis Patients in Haji Adam Malik Hospital

2021 ◽  
Vol 8 (10) ◽  
pp. 339-344
Author(s):  
Abdul Halim Harahap ◽  
Franciscus Ginting ◽  
Lenni Evalena Sihotang
Keyword(s):  
Sofa Score ◽  
Scoring System ◽  
Scoring Systems ◽  
Developed Countries ◽  
Apache Ii ◽  
Apache Ii Score ◽  
P Value ◽  
Cross Sectional ◽  
Cross Sectional Design ◽  
Score Apache

Introduction: Sepsis is a leading cause of death in the Intensive Care Unit (ICU) in developed countries and its incidence is increasing. Many scoring systems are used to assess the severity of disease in patients admitted to the ICU. SOFA score to assess the degree of organ dysfunction in septic patients. The Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system is most often used for patients admitted to the ICU. CCI scoring system to assess the effect of comorbid disease in critically ill patients on mortality. The study aimed to describe the characteristics of the use of scoring to predict patients’ mortality admitted to Haji Adam Malik Hospital. Methods: This is an observational study with a cross-sectional design. A total of 299 study subjects met the inclusion criteria and exclusion criteria, three types of scoring, namely SOFA score, APACHE II score, and CCI score were used to assess the prognosis of septic patients. Data analysis was performed using SPSS. P-value <0.05 was considered statistically significant. Results: A total of 252 people (84.3%) of sepsis patients died. The mean age of the septic patients who died was 54.25 years. The SOFA score ranged from 0-24, the median SOFA score in deceased sepsis patients was 5.0. The APACHE II score ranged from 0-71, the median APACHE II score in deceased sepsis patients was 23.0. The CCI score ranged from 0-37, the median CCI score in deceased sepsis patients was 5.0. Conclusion: Higher scores are associated with an increased probability of death in septic patients. Keywords: Sepsis; mortality predictor; SOFA score; APACHE II score, CCI score.

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

2018 ◽  
Vol 46 (3) ◽  
pp. 1254-1262 ◽  
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.

APACHE II score for critically ill patients with a solid tumor: A reclassification study

2018 ◽  
Vol 65 (8) ◽  
pp. 447-455 ◽  
Author(s):  
F.D. Martos-Benítez ◽  
I. Cordero-Escobar ◽  
A. Soto-García ◽  
I. Betancourt-Plaza ◽  
I. González-Martínez
Keyword(s):  
Critically Ill ◽  
Solid Tumor ◽  
Critically Ill Patients ◽  
Apache Ii ◽  
Apache Ii Score

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

2012 ◽  
Vol 30 (1) ◽  
pp. 7-11 ◽  
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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