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Wang H, Kang X, Shi Y, Bai ZH, Lv JH, Sun JL, Pei HH. SOFA score is superior to APACHE-II score in predicting the prognosis of critically ill patients with acute kidney injury undergoing continuous renal replacement therapy. Ren Fail 2021; 42:638-645. [PMID: 32660294 PMCID: PMC7470067 DOI: 10.1080/0886022x.2020.1788581] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Acute kidney injury (AKI) is the most common cause of organ failure in multiple organ dysfunction syndrome (MODS) and is associated with increased mortality. This study aimed at determining the efficacy of sequential organ failure assessment (SOFA), and acute physiology and chronic health evaluation II (APACHE-II) scoring systems in assessing the prognosis of critically ill patients with AKI undergoing continuous renal replacement therapy (CRRT). At present, APACHE-II score and SOFA score were also used to evaluate and predict the prognosis of critically ill patients with AKI. Methods The predictive value of SOFA and APACHE-II scores for 28- and 90-d mortality in patients with AKI undergoing CRRT were determined by multivariate analysis, sensitivity analysis, and curve-fitting analysis. Results A total of 836 cases were included in this study. Multivariate Cox logistic regression analysis showed that SOFA scores were associated with 28- and 90-d mortality in patients with AKI undergoing CRRT. The adjusted HR of SOFA for 28-d mortality were 1.18 (1.14, 1.21), 1.24 (1.18, 1.31), and 1.19 (1.13, 1.24) in the three models, respectively, and the adjusted HR of SOFA for 90-d mortality was 1.12 (1.09, 1.16), 1.15 (1.10, 1.19), and 1.15 (1.10, 1.19), respectively. The subgroup analysis showed that the SOFA score was associated with 28-d and 90-d mortality in patients with AKI undergoing CRRT. APACHE-II score was not associated with 28- and 90-d mortality patients with AKI undergoing CRRT. Curve fitting analysis showed that SOFA scores increased had a higher prediction accuracy for 28- and 90-d than APACHE-II. Conclusions The SOFA score showed a higher accuracy of mortality prediction in critically ill patients with AKI undergoing CRRT than the APACHE-II score.
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Affiliation(s)
- Hai Wang
- Emergency Department and EICU, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Xiao Kang
- Emergency Department and EICU, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Yu Shi
- Emergency Department and EICU, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Zheng-Hai Bai
- Emergency Department and EICU, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Jun-Hua Lv
- Emergency Department and EICU, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Jiang-Li Sun
- Emergency Department and EICU, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Hong Hong Pei
- Emergency Department and EICU, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
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An R, Chang GM, Fan YY, Ji LL, Wang XH, Hong S. Machine learning-based patient classification system for adult patients in intensive care units: A cross-sectional study. J Nurs Manag 2021; 29:1752-1762. [PMID: 33565196 DOI: 10.1111/jonm.13284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to develop a patient classification system that stratifies patients admitted to the intensive care unit based on their disease severity and care needs. BACKGROUND Classifying patients into homogenous groups based on clinical characteristics can optimize nursing care. However, an objective method for determining such groups remains unclear. METHODS Predictors representing disease severity and nursing workload were considered. Patients were clustered into subgroups with different characteristics based on the results of a clustering algorithm. A patient classification system was developed using a partial least squares regression model. RESULTS Data of 300 patients were analysed. Cluster analysis identified three subgroups of critically patients with different levels of clinical trajectories. Except for blood potassium levels (p = .29), the subgroups were significantly different according to disease severity and nursing workload. The predicted value ranges of the regression model for Classes A, B and C were <1.44, 1.44-2.03 and >2.03. The model was shown to have good fit and satisfactory prediction efficiency using 200 permutation tests. CONCLUSIONS Classifying patients based on disease severity and care needs enables the development of tailored nursing management for each subgroup. IMPLICATIONS FOR NURSING MANAGEMENT The patient classification system can help nurse managers identify homogeneous patient groups and further improve the management of critically ill patients.
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Affiliation(s)
- Ran An
- Nursing School, Harbin Medical University, Harbin, China
| | - Guang-Ming Chang
- The Party Committee, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yu-Ying Fan
- Nursing School, Harbin Medical University, Harbin, China
| | - Ling-Ling Ji
- Department of Pediatrics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiao-Hui Wang
- Department of Intensive Care Unit, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Su Hong
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Guo L, Xiong W, Liu D, Feng Y, Wang P, Dong X, Chen R, Wang Y, Zhang L, Huang J, Summah HD, Lu F, Xie Y, Lin H, Yan J, Lu H, Zhou M, Qu J. The mNCP-SPI Score Predicting Risk of Severe COVID-19 among Mild-Pneumonia Patients on Admission. Infect Drug Resist 2020; 13:3593-3600. [PMID: 33116679 PMCID: PMC7569081 DOI: 10.2147/idr.s263157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/29/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose To predict the risk of developing severe pneumonia among mild novel coronavirus pneumonia (mNCP) patients on admission. Methods A retrospective cohort study was conducted at three hospitals in Shanghai and Wuhan from January 2020 to February 2020. Real-time polymerasechain–reaction assays were used to detect COVID-19. A total of 529 patients diagnosed with NCP were recruited from three hospitals and classified by four severity types during hospitalization following the standards of the Chinese Diagnosis and Treatment of Pneumonia Caused by New Coronavirus Infection (eighth version). Patients were excluded if admitted by ICU on admission (n=92, on a general ward while meeting the condition of severe or critical type on admission (n=25), or there was insufficient clinical information (n=64). In sum, 348 patients with mNCP were finally included, and 68 developed severe pneumonia. Results mNCP severity prognostic index values were calculated based on multivariate logistic regression: history of diabetes (OR 2.064, 95% CI 1.010–4.683; p=0.043), time from symptom onset to admission ≥7 days (OR 1.945, 95% CI 1.054–3.587; p=0.033), lymphocyte count ≤0.8 (OR 1.816, 95% CI 1.008–3.274; p=0.047), myoglobin ≥90 mg/L (OR 2.496, 95% CI 1.235–5.047; p=0.011), and D-dimer ≥0.5 mg/L (OR 2.740, 95% CI 1.395–5.380; p=0.003). This model showed a c-statistics of 0.747, with sensitivity and specificity 0.764 and 0.644, respectively, under cutoff of 165. Conclusion We designed a clinical predictive tool for risk of severe pneumonia among mNCP patients to provided guidance for medicines. Further studies are required for external validation.
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Affiliation(s)
- Lingxi Guo
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Weining Xiong
- Department of Respiratory and Critical Care Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Dong Liu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yun Feng
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Peng Wang
- Departement of Respiratory and Critical Care Medicine, Baoshan Branch of Shanghai First People's Hospital, Shanghai, People's Republic of China
| | - Xuan Dong
- Tuberculosis and Respiratory Department, Wuhan Jinyintan Hospital, Wuhan, People's Republic of China
| | - Rong Chen
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yi Wang
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Key Cite of National Clinical Research Center for Respiratory Disease, Wuhan Clinical Medical Research Center for Chronic Airway Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan, People's Republic of China
| | - Lei Zhang
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Key Cite of National Clinical Research Center for Respiratory Disease, Wuhan Clinical Medical Research Center for Chronic Airway Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan, People's Republic of China
| | - Jingwen Huang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | | | - Fangying Lu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yusang Xie
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Huihuang Lin
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jiayang Yan
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Hongzhou Lu
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai, People's Republic of China
| | - Min Zhou
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jieming Qu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Performance of three prognostic models in critically ill patients with cancer: a prospective study. Int J Clin Oncol 2020; 25:1242-1249. [PMID: 32212014 DOI: 10.1007/s10147-020-01659-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the study was to evaluate the performance of "Acute Physiology and Chronic Health Evaluation II" (APACHE-II), "Simplified Acute Physiology Score 3" (SAPS-3), and "APACHE-II Score for Critically Ill Patients with a Solid Tumor" (APACHE-IICCP) models in cancer patients admitted to ICU. METHODS Prospective cohort study of 414 patients with an active solid tumor. Discrimination was assessed by area under receiver operating characteristic (AROC) curves and calibration by Hosmer-Lemeshow goodness-of-fit C test (H-L). RESULTS The hospital mortality rate was 32.6%. In the total cohort, discrimination for prognostic models were: APACHE-IICCP (AROC 0.98), APACHE-II (AROC 0.96), SAPS-3 for Central and South American countries (SAPS-3CSA) (AROC 0.95), and SAPS-3 (AROC 0.91). Calibration was good (p value of H-L test > 0.05) using APACHE-IICCP, APACHE-II and SAPS-3CSA models. Estimation of the probability of death was more precise with APACHE-IICCP (standardized mortality ratio, SMR = 1.03) and SAPS-3 (SMR = 1.08) models. Further analysis showed that discrimination was high with all prognostic model whether for patients with planned ICU admission (AROC APACHE-IICCP 0.97, APACHE-II 0.96, SAPS-3 0.95, SAPS-3CSA 0.95) or for patients with unplanned ICU admission (AROC APACHE-IICCP 0.97, APACHE-II 0.94, SAPS-3 0.86, SAPS-3CSA 0.95). Calibration was good for all predictive models in both subgroups (p value of H-L test > 0.05, except for APACHE-II model inpatients with planned ICU admission). CONCLUSIONS In this prospective study, general predictive models (e.g., APACHE-II, SAPS-3) and cancer-specific models (e.g., APACHE-IICCP) are accurate in predicting hospital mortality. Other studies confirming these results are required.
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