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2021 ◽  
Author(s):  
Faisal Aziz ◽  
Alexander Christian Reisinger ◽  
Felix Aberer ◽  
Caren Sourij ◽  
Norbert Tripolt ◽  
...  

Abstract Background: TheSimplified Acute Physiology Score 3 (SAPS 3) is routinely used in intensive care units (ICUs) to predict in-hospital mortality. However, its predictive performance has not been widely evaluated in Coronavirus disease 19 (COVID-19) patients.This studyevaluated and comparedthe performance of SAPS 3for predicting in-hospital mortalityinCOVID-19patients with and without diabetesin Austria.Methods: This study analyzed the Austrian national public health institute (GÖG) data ofCOVID-19patients admitted to ICUs (N=5,850)fromMarch 2020 to March 2021.The SAPS 3 score was calculated and the predicted in-hospital mortality was estimatedusingthreelogit regression equations: standard equation, Central European equation, and Austrian equation recalibrated for COVID-19 patients. Concordance between observed and predicted mortalities was assessed using the standardized mortality ratio (SMR). Discrimination was assessed using the C-statistic. The DeLong test was applied to compare discrimination between diabetes and non-diabetes patients. Accuracy was assessed using the Brier score andcalibration using the calibration plot and Hosmer-Lemeshow test. Results: Theobservedin-hospital mortality was 38.9% in all patients, 42.9% in diabetes, and 37.3% innon-diabetes patients. Themean ±SD SAPS 3 score was 57.4 ±13.2 in all patients,58.8 ±12.9 in diabetes, and 56.8 ±13.2 in non-diabetes patients.The SMR was significantly greater than 1 for standard and Central European equations, while it was close to 1 for the Austrian equation in all, diabetes, and non-diabetes patients. TheC-statistics was 0.69 with aninsignificant (P=0.193) difference between diabetes (0.70)and non-diabetes (0.68)patients. The Brier score was >0.20 for all SAPS 3 equations. Calibration was unsatisfactory for both standard and Central European equations in all cohorts, whereas it was satisfactory for the Austrian equation in diabetes patients.Conclusions:The SAPS 3 score demonstratedlow discrimination and accuracy in COVID-19 patients in Austria with aninsignificant difference between diabetes and non-diabetes patients. All three equations of SAPS 3 were miscalibrated particularly in non-diabetes patients, while the Austrian equation demonstrated satisfactory calibration in diabetes patients. These findingssuggest that both uncalibrated and calibrated versions ofSAPS 3 should be used with caution in COVID-19 patients.


PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12332
Author(s):  
Nadeem Kassam ◽  
Eric Aghan ◽  
Samina Somji ◽  
Omar Aziz ◽  
James Orwa ◽  
...  

Background Illness predictive scoring systems are significant and meaningful adjuncts of patient management in the Intensive Care Unit (ICU). They assist in predicting patient outcomes, improve clinical decision making and provide insight into the effectiveness of care and management of patients while optimizing the use of hospital resources. We evaluated mortality predictive performance of Simplified Acute Physiology Score (SAPS 3) and Mortality Probability Models (MPM0-III) and compared their performance in predicting outcome as well as identifying disease pattern and factors associated with increased mortality. Methods This was a retrospective cohort study of adult patients admitted to the ICU of the Aga Khan Hospital, Dar- es- Salaam, Tanzania between August 2018 and April 2020. Demographics, clinical characteristics, outcomes, source of admission, primary admission category, length of stay and the support provided with the worst physiological data within the first hour of ICU admission were extracted. SAPS 3 and MPM0-III scores were calculated using an online web-based calculator. The performance of each model was assessed by discrimination and calibration. Discrimination between survivors and non–survivors was assessed by the area under the receiver operator characteristic curve (ROC) and calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. Results A total of 331 patients were enrolled in the study with a median age of 58 years (IQR 43-71), most of whom were male (n = 208, 62.8%), of African origin (n = 178, 53.8%) and admitted from the emergency department (n = 306, 92.4%). In- hospital mortality of critically ill patients was 16.1%. Discrimination was very good for all models, the area under the receiver-operating characteristic (ROC) curve for SAPS 3 and MPM0-III was 0.89 (95% CI [0.844–0.935]) and 0.90 (95% CI [0.864–0.944]) respectively. Calibration as calculated by Hosmer-Lemeshow goodness-of-fit test showed good calibration for SAPS 3 and MPM0-III with Chi- square values of 4.61 and 5.08 respectively and P–Value > 0.05. Conclusion Both SAPS 3 and MPM0-III performed well in predicting mortality and outcome in our cohort of patients admitted to the intensive care unit of a private tertiary hospital. The in-hospital mortality of critically ill patients was lower compared to studies done in other intensive care units in tertiary referral hospitals within Tanzania.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ingrid Steinvall ◽  
Moustafa Elmasry ◽  
Islam Abdelrahman ◽  
Ahmed El-Serafi ◽  
Folke Sjöberg

AbstractRisk adjustment and mortality prediction models are central in optimising care and for benchmarking purposes. In the burn setting, the Baux score and its derivatives have been the mainstay for predictions of mortality from burns. Other well-known measures to predict mortality stem from the ICU setting, where, for example, the Simplified Acute Physiology Score (SAPS 3) models have been found to be instrumental. Other attempts to further improve the prediction of outcome have been based on the following variables at admission: Sequential Organ Failure Assessment (aSOFA) score, determinations of aLactate or Neutrophil to Lymphocyte Ratio (aNLR). The aim of the present study was to examine if estimated mortality rate (EMR, SAPS 3), aSOFA, aLactate, and aNLR can, either alone or in conjunction with the others, improve the mortality prediction beyond that of the effects of age and percentage total body surface area (TBSA%) burned among patients with severe burns who need critical care. This is a retrospective, explorative, single centre, registry study based on prospectively gathered data. The study included 222 patients with median (25th–75th centiles) age of 55.0 (38.0 to 69.0) years, TBSA% burned was 24.5 (13.0 to 37.2) and crude mortality was 17%. As anticipated highest predicting power was obtained with age and TBSA% with an AUC at 0.906 (95% CI 0.857 to 0.955) as compared with EMR, aSOFA, aLactate and aNLR. The largest effect was seen thereafter by adding aLactate to the model, increasing AUC to 0.938 (0.898 to 0.979) (p < 0.001). Whereafter, adding EMR, aSOFA, and aNLR, separately or in combinations, only marginally improved the prediction power. This study shows that the prediction model with age and TBSA% may be improved by adding aLactate, despite the fact that aLactate levels were only moderately increased. Thereafter, adding EMR, aSOFA or aNLR only marginally affected the mortality prediction.


PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0255522
Author(s):  
Beatriz Lobo-Valbuena ◽  
Federico Gordo ◽  
Ana Abella ◽  
Sofía Garcia-Manzanedo ◽  
Maria-Mercedes Garcia-Arias ◽  
...  

Objective We aimed to analyze risk factors related to the development of delirium, aiming for early intervention in patients with greater risk. Material and methods Observational study, including prospectively collected patients treated in a single general ICU. These were classified into two groups, according to whether they developed delirium or not (screening performed using CAM-ICU tool). Demographics and clinical data were analyzed. Multivariate logistic regression analyses were performed to quantify existing associations. Results 1462 patients were included. 93 developed delirium (incidence: 6.3%). These were older, scored higher on the Clinical Frailty Scale, on the risk scores on admission (SAPS-3 and SOFA), and had a greater number of organ failures (OF). We observed more incidence of delirium in patients who (a) presented more than two OF (20.4%; OR 4.9; CI95%: 2.9–8.2), and (b) were more than 74 years old albeit having <2 OF (8.6%; OR 2.1; CI95%: 1.3–3.5). Patients who developed delirium had longer ICU and hospital length-of-stays and a higher rate of readmission. Conclusions The highest risk observed for developing delirium clustered in patients who presented more than 2 OF and patients over 74 years old. The detection of patients at high risk for developing delirium could imply a change in management and improved quality of care.


F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 865
Author(s):  
Erik Svensk ◽  
Jonas Tydén ◽  
Jakob Walldén

Background: Non-invasive ventilation (NIV) is a common treatment for acute respiratory failure in intensive care units (ICU). While there is increasing data on outcomes after NIV treatment, there are large variations in staffing and monitoring where NIV is provided, making results hard to generalize. The aim of this study was to characterize patients treated with NIV, describe outcomes, and identify factors associated with outcome in an ICU at a Swedish county hospital. Methods: A single-centre retrospective observational study during 2018 of patients treated with NIV in a six-bed ICU at a Swedish county hospital. Patient characteristics, including comorbidities, details of ICU stay, simplified acute physiology score (SAPS-3), details of NIV treatment and 30-day mortality were collected, and the Charlson co-morbidity index (CCI) was calculated. Primary outcomes were 30-day mortality and associated factors. Results: 92 patients with mean age (71,3, SD 12,1) were treated with NIV during the study period. 42 (46%) were women. Median CCI was 3 (25th-75th percentiles 1.4)) and median SAPS-3 score was 66 (25th-75th percentiles 58). The 30-day mortality was 37% and in the univariate analysis, SAPS-3 score >66, Charlson comorbidity index, CCI>=3, pCO2 <5.5 and limitation of care were factors associated with increased 30-day mortality. pH <7.35 and pO2<8 at admission showed no associations with 30-day mortality. Conclusions: We found that patients treated with NIV in ICU were a diverse population where comorbidities and presence of limitations of care might be considered as better predictors of 30-day mortality, rather than physiological parameters.


2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Attila Frigyesi ◽  
Maria Lengquist ◽  
Martin Spångfors ◽  
Martin Annborn ◽  
Tobias Cronberg ◽  
...  

Abstract Background Our aim was to investigate the prognostic potential of circulating dipeptidyl peptidase 3 (cDPP3) to predict mortality and development of organ dysfunction in a mixed intensive care unit (ICU) population, and for this reason, we analysed prospectively collected admission blood samples from adult ICU patients at four Swedish hospitals. Blood samples were stored in a biobank for later batch analysis. The association of cDPP3 levels with 30-day mortality and Sequential Organ Failure Assessment (SOFA) scores on day two was investigated before and after adjustment for the simplified acute physiology score III (SAPS-3), using multivariable (ordinal) logistic regression. The predictive power of cDPP3 was assessed using the area under the receiver operating characteristic curve (AUROC). Results Of 1978 included consecutive patients in 1 year (2016), 632 fulfilled the sepsis 3-criteria, 190 were admitted after cardiac arrest, and 157 because of trauma. Admission cDPP3 was independently (of SAPS-3) associated with 30-day mortality with odds ratios of 1.45 (95% confidence interval (CI) 1.28–1.64) in the entire ICU population, 1.30 (95% CI 1.08–1.57) in the sepsis subgroup and 2.28 (95% CI 1.50–3.62) in cardiac arrest. For trauma, there was no clear association. Circulating DPP3 alone was a moderate predictor of 30-day mortality with AUROCs of 0.68, 0.62, and 0.72 in the entire group, the sepsis subgroup, and the cardiac arrest subgroup, respectively. By adding cDPP3 to SAPS-3, AUROC improved for the entire group, the sepsis subgroup, and the cardiac arrest subgroup (p = 0.023). Conclusion Circulating DPP3 on admission is a SAPS-3 independent prognostic factor of day-two organ dysfunction and 30-day mortality in a mixed ICU population and needs further evaluation.


2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Wagner Luis Nedel ◽  
Afonso Kopczynski ◽  
Marcelo Salimen Rodolphi ◽  
Nathan Ryzewski Strogulski ◽  
Marco De Bastiani ◽  
...  

Abstract Background Septic shock is a life-threatening condition that challenges immune cells to reprogram their mitochondrial metabolism towards to increase ATP synthesis for building an appropriate immunity. This could print metabolic signatures in mitochondria whose association with disease progression and clinical outcomes remain elusive. Method This is a single-center prospective cohort study performed in the ICU of one tertiary referral hospital in Brazil. Between November 2017 and July 2018, 90 consecutive patients, aged 18 years or older, admitted to the ICU with septic shock were enrolled. Seventy-five patients had Simplified Acute Physiology Score (SAPS 3) assessed at admission, and Sequential Organ Failure Assessment (SOFA) assessed on the first (D1) and third (D3) days after admission. Mitochondrial respiration linked to complexes I, II, V, and biochemical coupling efficiency (BCE) were assessed at D1 and D3 and Δ (D3–D1) in isolated lymphocytes. Clinical and mitochondrial endpoints were used to dichotomize the survival and death outcomes. Our primary outcome was 6-month mortality, and secondary outcomes were ICU and hospital ward mortality. Results The mean SAPS 3 and SOFA scores at septic shock diagnosis were 75.8 (± 12.9) and 8 (± 3) points, respectively. The cumulative ICU, hospital ward, and 6-month mortality were 32 (45%), 43 (57%), and 50 (66%), respectively. At the ICU, non-surviving patients presented elevated arterial lactate (2.8 mmol/L, IQR, 2–4), C-reactive protein (220 mg/L, IQR, 119–284), and capillary refill time (5.5 s, IQR, 3–8). Respiratory rates linked to CII at D1 and D3, and ΔCII were decreased in non-surviving patients. Also, the BCE at D1 and D3 and the ΔBCE discriminated patients who would evolve to death in the ICU, hospital ward, and 6 months after admission. After adjusting for possible confounders, the ΔBCE value but not SOFA scores was independently associated with 6-month mortality (RR 0.38, CI 95% 0.18–0.78; P = 0.009). At a cut-off of − 0.002, ΔBCE displayed 100% sensitivity and 73% specificity for predicting 6-month mortality Conclusions The ΔBCE signature in lymphocytes provided an earlier recognition of septic shock patients in the ICU at risk of long-term deterioration of health status.


2021 ◽  
Vol 15 (7) ◽  
pp. e0009594
Author(s):  
Yuri Costa Sarno Neves ◽  
Victor Augusto Camarinha de Castro-Lima ◽  
Davi Jorge Fontoura Solla ◽  
Vivian Simone de Medeiros Ogata ◽  
Fernando Linhares Pereira ◽  
...  

Background Yellow fever (YF) is a hemorrhagic disease caused by an arbovirus endemic in South America, with recent outbreaks in the last years. Severe cases exhibit fulminant hepatitis, but there are no studies regarding its late-term effects on liver parenchyma. Thus, the aim of this study was to determine the frequency and grade of liver fibrosis in patients who recovered from severe YF and to point out potential predictors of this outcome. Methodology/Principal findings We followed-up 18 patients who survived severe YF during a recent outbreak (January-April 2018) in Brazil using ultrasound (US) with shear-wave elastography (SWE) at 6 months after symptoms onset. No patient had previous history of liver disease. Median liver stiffness (LS) was 5.3 (4.6–6.4) kPa. 2 (11.1%) patients were classified as Metavir F2, 1 (8.3%) as F3 and 1 (8.3%) as F4; these two last patients had features of cardiogenic liver congestion on Doppler analysis. Age and cardiac failure were associated with increased LS (p = 0.036 and p = 0.024, respectively). SAPS-3 at ICU admission showed a tendency of association with significant fibrosis (≥ F2; p = 0.053). 7 patients used sofosbuvir in a research protocol, of which none showed liver fibrosis (p = 0.119). Conclusions/Significance We found a low frequency of liver fibrosis in severe YF survivors. US with SWE may have a role in the follow up of patients of age and / or with comorbidities after hospital discharge in severe YF, a rare but reemergent disease.


Author(s):  
Pedro Kurtz ◽  
Leonardo S. L. Bastos ◽  
Jorge I. F. Salluh ◽  
Fernando A. Bozza ◽  
Marcio Soares

Author(s):  
Jose Ivan Rodriguez de Molina Serrano

Introduction: The mechanical ventilation is the cornerstone of treatment for patients with acute respiratory failure and is one of the pivotal therapies in critical care medicine. The epidemiology of mechanical ventilation in México is scarce and usually a transpolated of the information in high specialty centers. The mechanical ventilation has the aim of assisting in the elimination of CO2 (carbon dioxide) and / or favoring the adequate exchange of oxygen while the patient is unable to do so or due to conditions external to the respiratory system. Quality indicators of attention are a quantitative measure that are used to assess important aspects of clinical practice. Objective: Describe the epidemiology and mortality factors in mechanically ventilated patients treated at second level ICU in Piedras Negras, Coahuila México. Material and Methods: retrospective study from December 2016 to December 2019 all patients treated with MV. We collected general demographic characteristics, quality indicators and complications, severity of disease and mortality. Results: 164 patients were enrolled. Female 54.8%, main diagnoses Sepsis 30.5%, and DKA 13.4%, mean age 44.1 SD ± mean SOFA 7.2 SD ± 6.2, mean SAPS3 50.6 SD ± 20.2, ICU LOS 4.5 SD ± 5.1, Hospital LOS 11.7 SD ± 10.2 p<0.0001. ICU and Hospital mortality 14 % and 23.8%. The factors associated with ICU mortality were: Age, MV hours, Respiratory SOFA, and Hepatic SOFA and with Hospital mortality: Age, Neurological SOFA, Unstable at admission, SOFA and SAPS 3. Conclusions: MV is a primordial need of critical care patients, our mortality was reported lower than expected but quality of attention indicators most be improved in order to maintain this trend. This study has several limitations in population and applicability but contributes with primordial information about MV critical care patients treated at México.


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