scholarly journals Relationship of on Admission Hypocalcaemia and Illness Severity as Measured by APACHE-II and SOFA Score in Intensive Care Patients’

2017 ◽  
Author(s):  
Samarjit Dey
Keyword(s):  
Intensive Care ◽  
Sofa Score ◽  
Illness Severity ◽  
Apache Ii ◽  
Intensive Care Patients ◽  
Relationship Of

scholarly journals The Value of Admission Serological Indicators for Predicting 28-Day Mortality in Intensive Care Patients With Acute Heart Failure: Construction and Validation of a Nomogram

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaoyuan Wei ◽  
Yu Min ◽  
Jiangchuan Yu ◽  
Qianli Wang ◽  
Han Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care ◽  
Acute Heart Failure ◽  
Sofa Score ◽  
Medical Information ◽  
Troponin T ◽  
Adequate Treatment ◽  
Intensive Care Patients ◽  
Creatine Kinase Mb ◽  
Death Group

Background: Acute heart failure (AHF) is a severe clinical syndrome characterized as rapid onset or worsening of symptoms of chronic heart failure (CHF). Risk stratification for patients with AHF in the intensive care unit (ICU) may help clinicians to predict the 28-day mortality risk in this subpopulation and further raise the quality of care.Methods: We retrospectively reviewed and analyzed the demographic characteristics and serological indicators of patients with AHF in the Medical Information Mart for Intensive Care III (MIMIC III) (version 1.4) between June 2001 and October 2012 and our medical center between January 2019 and April 2021. The chi-squared test and the Fisher's exact test were used for comparison of qualitative variables among the AHF death group and non-death group. The clinical variables were selected by using the least absolute shrinkage and selection operator (LASSO) regression. A clinical nomogram for predicting the 28-day mortality was constructed based on the multivariate Cox proportional hazard regression analysis and further validated by the internal and external cohorts.Results: Age > 65 years [hazard ratio (HR) = 2.47], the high Sequential Organ Failure Assessment (SOFA) score (≥3 and ≤8, HR = 2.21; ≥9 and ≤20, HR = 3.29), lactic acid (Lac) (>2 mmol/l, HR = 1.40), bicarbonate (HCO3-) (>28 mmol/l, HR = 1.59), blood urea nitrogen (BUN) (>21 mg/dl, HR = 1.75), albumin (<3.5 g/dl, HR = 2.02), troponin T (TnT) (>0.04 ng/ml, HR = 4.02), and creatine kinase-MB (CK-MB) (>5 ng/ml, HR = 1.64) were the independent risk factors for predicting 28-day mortality of intensive care patients with AHF (p < 0.05). The novel nomogram was developed and validated with a promising C-index of 0.814 (95% CI: 0.754–0.882), 0.820 (95% CI: 0.721–0.897), and 0.828 (95% CI: 0.743–0.917), respectively.Conclusion: This study provides a new insight in early predicting the risk of 28-day mortality in intensive care patients with AHF. The age, the SOFA score, and serum TnT level are the leading three predictors in evaluating the short-term outcome of intensive care patients with AHF. Based on the nomogram, clinicians could better stratify patients with AHF at high risk and make adequate treatment plans.

scholarly journals Comparison of qSOFA score, SOFA score, and SIRS criteria for the prediction of infection and mortality among surgical intermediate and intensive care patients

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Christian Koch ◽  
Fabian Edinger ◽  
Tobias Fischer ◽  
Florian Brenck ◽  
Andreas Hecker ◽  
...  
Keyword(s):  
Intensive Care ◽  
Sofa Score ◽  
Mortality Prediction ◽  
Adequate Treatment ◽  
Suspected Infection ◽  
Intensive Care Patients ◽  
Retrospective Data Analysis ◽  
Surgical Icu ◽  
Qsofa Score ◽  
Sirs Criteria

Abstract Background It is crucial to rapidly identify sepsis so that adequate treatment may be initiated. Accordingly, the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) scores are used to evaluate intensive care unit (ICU) and non-ICU patients, respectively. As demand for ICU beds rises, the intermediate care unit (IMCU) carries greater importance as a bridge between the ICU and the regular ward. This study aimed to examine the ability of SOFA and qSOFA scores to predict suspected infection and mortality in IMCU patients. Methods Retrospective data analysis included 13,780 surgical patients treated at the IMCU, ICU, or both between January 01, 2012, and September 30, 2018. Patients were screened for suspected infection (i.e., the commencement of broad-spectrum antibiotics) and then evaluated for the SOFA score, qSOFA score, and the 1992 defined systemic inflammatory response syndrome (SIRS) criteria. Results Suspected infection was detected in 1306 (18.3%) of IMCU, 1365 (35.5%) of ICU, and 1734 (62.0%) of IMCU/ICU encounters. Overall, 458 (3.3%) patients died (IMCU 45 [0.6%]; ICU 250 [6.5%]; IMCU/ICU 163 [5.8%]). All investigated scores failed to predict suspected infection independently of the analyzed subgroup. Regarding mortality prediction, the qSOFA score performed sufficiently within the IMCU cohort (AUCROC SIRS 0.72 [0.71–0.72]; SOFA 0.52 [0.51–0.53]; qSOFA 0.82 [0.79–0.84]), while the SOFA score was predictive in patients of the IMCU/ICU cohort (AUCROC SIRS 0.54 [0.53–0.54]; SOFA 0.73 [0.70–0.77]; qSOFA 0.59 [0.58–0.59]). Conclusions None of the assessed scores was sufficiently able to predict suspected infection in surgical ICU or IMCU patients. While the qSOFA score is appropriate for mortality prediction in IMCU patients, SOFA score prediction quality is increased in critically ill patients.

Prediction of Acquired Morbidity Using Illness Severity Indices in Pediatric Intensive Care Patients*

2020 ◽  
Vol 21 (11) ◽  
pp. e972-e980 ◽  
Author(s):  
Stephanie Senna ◽  
Chengsi Ong ◽  
Judith Ju-Ming Wong ◽  
John Carson Allen ◽  
Rehena Sultana ◽  
...  
Keyword(s):  
Intensive Care ◽  
Pediatric Intensive Care ◽  
Illness Severity ◽  
Intensive Care Patients

Interrater Reliability of APACHE II Scores for Medical-Surgical Intensive Care Patients: A Prospective Blinded Study

2007 ◽  
Vol 16 (4) ◽  
pp. 378-383 ◽  
Author(s):  
Michelle E. Kho ◽  
Ellen McDonald ◽  
Paul W. Stratford ◽  
Deborah J. Cook
Keyword(s):  
Intensive Care ◽  
Interrater Reliability ◽  
Intraclass Correlation ◽  
Illness Severity ◽  
Apache Ii ◽  
Surgical Intensive Care Unit ◽  
Apache Ii Score ◽  
Surgical Intensive Care ◽  
Chronic Health ◽  
Severity Scores

Background Despite widespread use of the Acute Physiology and Chronic Health Evaluation II (APACHE II), its interrater reliability has not been well studied. Objective To determine interrater reliability of APACHE II scores among 1 intensive care nurse and 2 research clerks. Methods In a prospective, blinded, observational study, 3 raters collected APACHE II scores on 37 consecutive patients in a medical-surgical intensive care unit. One research clerk was blinded to the study’s start date to minimize observer bias. The nurse and the other research clerk were blinded to each other’s scores and did not communicate with the first research clerk about the study. The data analyst was blinded to the identity and source of all 3 raters’ scores. Intraclass correlation coefficients and 95% confidence intervals were assessed. Results Mean (standard deviation) APACHE II scores were 21.8 (9.2) for the nurse, 20.4 (7.7) for research clerk 1, and 20.5 (8.1) for research clerk 2. Among the 3 raters, the intraclass correlation coefficient (95% confidence interval) was 0.90 (0.84, 0.94) for the APACHE II total score. Within APACHE II score components, the highest reliability was for age (0.98 [0.97, 0.99]), with lower reliabilities for the Chronic Health Index (0.64 [0.50, 0.80]) and the verbal component of the Glasgow Coma Scale (0.40 [0.20, 0.60]). Results were similar between pairs of raters. Conclusions Use of trained nonmedical personnel to collect illness severity scores for clinical, research, and administrative purposes is reasonable. This method could be used to assess reliability of other illness severity scores.

scholarly journals Fungal Infections in COVID-19 Intensive Care Patients

2021 ◽  
Vol 70 (3) ◽  
pp. 395-400
Author(s):  
AYŞENUR SÜMER COŞKUN ◽  
ŞENAY ÖZTÜRK DURMAZ
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Mortality Rate ◽  
Opportunistic Infections ◽  
Fungal Infections ◽  
Tracheal Aspirate ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Period Increase ◽  
Intensive Care Patients

Opportunistic fungal infections increase morbidity and mortality in COVID-19 patients monitored in intensive care units (ICU). As patients’ hospitalization days in the ICU and intubation period increase, opportunistic infections also increase, which prolongs hospital stay days and elevates costs. The study aimed to describe the profile of fungal infections and identify the risk factors associated with mortality in COVID-19 intensive care patients. The records of 627 patients hospitalized in ICU with the diagnosis of COVID-19 were investigated from electronic health records and hospitalization files. The demographic characteristics (age, gender), the number of ICU hospitalization days and mortality rates, APACHE II scores, accompanying diseases, antibiotic-steroid treatments taken during hospitalization, and microbiological results (blood, urine, tracheal aspirate samples) of the patients were recorded. Opportunistic fungal infection was detected in 32 patients (5.10%) of 627 patients monitored in ICU with a COVID-19 diagnosis. The average APACHE II score of the patients was 28 ± 6. While 25 of the patients (78.12%) died, seven (21.87%) were discharged from the ICU. Candida parapsilosis (43.7%) was the opportunistic fungal agent isolated from most blood samples taken from COVID-19 positive patients. The mortality rate of COVID-19 positive patients with candidemia was 80%. While two out of the three patients (66.6%) for whom fungi were grown from their tracheal aspirate died, one patient (33.3%) was transferred to the ward. Opportunistic fungal infections increase the mortality rate of COVID-19-positive patients. In addition to the risk factors that we cannot change, invasive procedures should be avoided, constant blood sugar regulation should be applied, and unnecessary antibiotics use should be avoided.

scholarly journals Acute pulmonary oedema in chronic dialysis patients, causes, clinical course and outcome admitted into emergency department

2017 ◽  
Vol 4 (6) ◽  
pp. 1541
Author(s):  
Jimnaz P. A. ◽  
Ajmal Abdul Kharim
Keyword(s):  
Intensive Care ◽  
Weight Gain ◽  
Pulmonary Oedema ◽  
Sofa Score ◽  
Clinical Course ◽  
Chronic Dialysis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Acute Pulmonary Oedema ◽  
Interdialytic Weight Gain

Background: Chronic dialysis (CD) patient are at increased risk of multiple organ dysfunction. Recent study, estimated that 2% of CD patients require intensive care unit (ICU) admission every year. Acute Pulmonary Oedema is major cause for ICU admissions, objective of the study is to determine the cause, clinical course and outcome of APO in CD patients admitted in Intensive Care Units under Emergency Department.Methods: Prospective and observational study conducted for 1 year in our institute, a tertiary care centre, was done on chronic dialysis(CD) who presented with Acute pulmonary oedema(APO) for determine cause for APO, severity of outcome by APACHE II and sofa score. Data was entered in Microsoft Excel spread sheet and analyzed using SPSS software. Descriptive analysis and chi square test was done.Results: Study included 100 CD patients. Main etiologic factor of CKD was T2DM 56%. Etiology of APO in this study showed as 34% are due to excessive interdialytic weight gain. Only 4 patients were assessed by SOFA score and high sofa score no patients had expired. Study showed survived patients got mean APACHE II score of 24±3.4 and expired patients got mean APACHE II score of 32.9±2.5, with a significant P value <0.001.Conclusions: Main etiology of APO in CD patients were excessive interdialytic weight gain 34 %. APACHE II score as outcome predictors. APACHE II score of more than 30 have poor outcome 

scholarly journals Predictors of Physician Confidence to Diagnose Pneumonia and Determine Illness Severity in Ventilated Patients. Australian and New Zealand Practice in Intensive Care (ANZPIC II)

2005 ◽  
Vol 33 (1) ◽  
pp. 112-119 ◽  
Author(s):  
R. J. Boots ◽  
J. Lipman ◽  
R. Bellomo ◽  
D. Stephens ◽  
R. F. Heller
Keyword(s):  
Intensive Care ◽  
Sofa Score ◽  
Clinical Signs ◽  
Illness Severity ◽  
Diagnostic Methods ◽  
Diagnostic Confidence ◽  
Saps Ii ◽  
Saps Ii Score ◽  
Life Threatening ◽  
Ventilated Patients

The manner in which elements of clinical history, physical examination and investigations influence subjectively assessed illness severity and outcome prediction is poorly understood. This study investigates the relationship between clinician and objectively assessed illness severity and the factors influencing clinician's diagnostic confidence and illness severity rating for ventilated patients with suspected pneumonia in the intensive care unit (ICU). A prospective study of fourteen ICUs included all ventilated admissions with a clinical diagnosis of pneumonia. Data collection included pneumonia type – community-acquired (CAP), hospital-acquired (HAP) and ventilator-associated (VAP), clinician determined illness severity (CDIS), diagnostic methods, clinical diagnostic confidence (CDC), microbiological isolates and antibiotic use. For 476 episodes of pneumonia (48% CAP, 24% HAP, 28% VAP), CDC was greatest for CAP (64% CAP, 50% HAP and 49% VAP, P<0.01) or when pneumonia was considered “life-threatening” (84% high CDC, 13% medium CDC and 3% low CDC, P<0.001). “Life-threatening” pneumonia was predicted by worsening gas exchange (OR 4.8, CI 95% 2.3–10.2, P<0.001), clinical signs of consolidation (OR 2.0, CI 95% 1.2–3.2, P<0.01) and the Sepsis-Related Organ Failure Assessment (SOFA) Score (OR 1.1, CI 95% 1.1–1.2, P<0.001). Diagnostic confidence increased with CDIS (OR 16.3, CI 95% 8.4–31.4, P<0.001), definite pathogen isolation (OR 3.3, CI 95% 2.0–5.6) and clinical signs of consolidation (OR 2.1, CI 95% 1.3–3.3, P=0.001). Although the CDIS, SOFA Score and the Simplified Acute Physiologic Score (SAPS II) were all associated with mortality, the SAPS II Score was the best predictor of mortality (P=0.02). Diagnostic confidence for pneumonia is moderate but increases with more classical presentations. A small set of clinical parameters influence subjective assessment. Objective assessment using SAPS II Scoring is a better predictor of mortality.

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