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Lee SY, Park MH, Oh DK, Lim CM. Validation of Adult Sepsis Event and Epidemiologic Analysis of Sepsis Prevalence and Mortality Using Adult Sepsis Event's Electronic Health Records-Based Sequential Organ Failure Assessment Criteria: A Single-Center Study in South Korea. Crit Care Med 2024; 52:1173-1182. [PMID: 38530078 PMCID: PMC11239092 DOI: 10.1097/ccm.0000000000006270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
OBJECTIVES In 2018, the Centers for Disease Control and Prevention introduced the Adult Sepsis Event (ASE) definition, using electronic health records (EHRs) data for surveillance and sepsis quality improvement. However, data regarding ASE outside the United States remain limited. We therefore aimed to validate the diagnostic accuracy of the ASE and to assess the prevalence and mortality of sepsis using ASE. DESIGN Retrospective cohort study. SETTING A single center in South Korea, with 2732 beds including 221 ICU beds. PATIENTS During the validation phase, adult patients who were hospitalized or visiting the emergency department between November 5 and November 11, 2019, were included. In the subsequent phase of epidemiologic analysis, we included adult patients who were admitted from January to December 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS ASE had a sensitivity of 91.6%, a specificity of 98.3%, a positive predictive value (PPV) of 57.4%, and a negative predictive value of 99.8% when compared with the Sepsis-3 definition. Of 126,998 adult patient hospitalizations in 2020, 6,872 cases were diagnosed with sepsis based on the ASE (5.4% per year), and 893 patients were identified as having sepsis according to the International Classification of Diseases , 10th Edition (ICD-10) (0.7% per year). Hospital mortality rates were 16.6% (ASE) and 23.5% (ICD-10-coded sepsis). Monthly sepsis prevalence and hospital mortality exhibited less variation when diagnosed using ASE compared with ICD-10 coding (coefficient of variation [CV] for sepsis prevalence: 0.051 vs. 0.163, Miller test p < 0.001; CV for hospital mortality: 0.087 vs. 0.261, p = 0.001). CONCLUSIONS ASE demonstrated high sensitivity and a moderate PPV compared with the Sepsis-3 criteria in a Korean population. The prevalence of sepsis, as defined by ASE, was 5.4% per year and was similar to U.S. estimates. The prevalence of sepsis by ASE was eight times higher and exhibited less monthly variability compared with that based on the ICD-10 code.
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Affiliation(s)
- Su Yeon Lee
- All authors: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Vélez-Páez JL, Baldeón-Rojas L, Cañadas Herrera C, Montalvo MP, Jara FE, Aguayo-Moscoso S, Tercero-Martínez W, Saltos L, Jiménez-Alulima G, Guerrero V, Pérez-Galarza J. Receiver operating characteristic (ROC) to determine cut-off points of clinical and biomolecular markers to discriminate mortality in severe COVID-19 living at high altitude. BMC Pulm Med 2023; 23:393. [PMID: 37848858 PMCID: PMC10583315 DOI: 10.1186/s12890-023-02691-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/30/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND In 2020, Ecuador had one of the highest death rates because of COVID-19. The role of clinical and biomolecular markers in COVID disease prognosis, is still not well supported by available data. In order for these markers to have practical application in clinical decision-making regarding patient treatment and prognosis, it is necessary to know an optimal cut-off point, taking into consideration ethnic differences and geographic conditions. AIM To determine the value of clinical and biomolecular markers, to predict mortality of patients with severe COVID-19 living at high altitude. METHODS In this study, receiver operating characteristic (ROC) curves, area under the curve (AUC) of ROC, sensitivity, specificity and likelihood ratios were calculated to determine levels of clinical and biomolecular markers that best differentiate survivors versus non-survivors in severe COVID subjects that live at a high altitude setting. RESULTS Selected cut-off values for ferritin (≥ 1225 ng/dl, p = 0.026), IL-6 (≥ 11 pg/ml, p = 0.005) and NLR (≥ 22, p = 0.008) at 24 h, as well as PaFiO2 (≤ 164 mmHg, p = 0.015), NLR (≥ 16, p = p = 0.013) and SOFA (≥ 6, p = 0.031) at 72 h, appear to have good discriminating power to differentiate survivors versus non-survivors. Additionally, odds ratios for ferritin (OR = 3.38); IL-6 (OR = 17.07); PaFiO2 (OR = 4.61); NLR 24 h (OR = 4.95); NLR 72 h (OR = 4.46), and SOFA (OR = 3.77) indicate increased risk of mortality when cut-off points were taken into consideration. CONCLUSIONS We proposed a straightforward and understandable method to identify dichotomized levels of clinical and biomolecular markers that can discriminate between survivors and non-survivors patients with severe COVID-19 living at high altitudes.
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Affiliation(s)
- Jorge Luis Vélez-Páez
- Pablo Arturo Suarez Hospital, Intensive Care Unit, Clinical Research Center, Quito, Ecuador
- Faculty of Medical Sciences, Central University of Ecuador, Quito, Ecuador
| | - Lucy Baldeón-Rojas
- Faculty of Medical Sciences, Central University of Ecuador, Quito, Ecuador
- Research Institute of Biomedicine, Central University of Ecuador, Quito, Ecuador
| | | | | | - Fernando Esteban Jara
- Pablo Arturo Suarez Hospital, Intensive Care Unit, Clinical Research Center, Quito, Ecuador
| | | | - Wendy Tercero-Martínez
- Pablo Arturo Suarez Hospital, Intensive Care Unit, Clinical Research Center, Quito, Ecuador
| | - Lenin Saltos
- Pablo Arturo Suarez Hospital, Intensive Care Unit, Clinical Research Center, Quito, Ecuador
| | - Glenda Jiménez-Alulima
- Pablo Arturo Suarez Hospital, Intensive Care Unit, Clinical Research Center, Quito, Ecuador
| | - Verónica Guerrero
- Pablo Arturo Suarez Hospital, Intensive Care Unit, Clinical Research Center, Quito, Ecuador
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Sanaie S, Dolati S, Montazer M, Ranjbari S, Fathalizadeh A, Shadvar K, Faramarzi E, Mahmoodpoor A. Lipid Profile as a Predictive Marker for Organ Dysfunction after Thoracoabdominal Surgery: A Cross-sectional Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:465-473. [PMID: 37786464 PMCID: PMC10541545 DOI: 10.30476/ijms.2022.95364.2672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/16/2022] [Accepted: 09/24/2022] [Indexed: 10/04/2023]
Abstract
Background Plasma total cholesterol is considered a negative acute phase reactant. In various pathological conditions, such as trauma, sepsis, burns, and liver dysfunction, as well as post-surgery, serum cholesterol level decreases. This study aimed to investigate the role of lipid profiles in determining the probability of organ dysfunction after surgery. Methods This cross-sectional study included patients who underwent thoracoabdominal surgery and were admitted to the intensive care unit of Imam Reza Hospital in Tabriz, Iran, between October 2016 and September 2018. During the first two days of admission, blood samples were taken, and serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), Low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and albumin were measured. The relation between the changes in these laboratory markers and six organ functions including cardiovascular, respiratory, renal, central nervous system, hepatic, and hematologic, length of stay in the hospital and intensive care unit, mechanical ventilation duration, and vasopressor use were investigated. The independent t test was used to compare continuous variables. The association between different variables and organ dysfunction and mortality was evaluated by using logistic regression. Results The serum TC increased the risk of mortality (OR=1.09, 95%CI=1.06-1.11, P<0.001), renal dysfunction (OR=1.09, 95%CI=1.06-1.12; P<0.001), liver dysfunction (OR=1.07, 95%CI=1.03-1.10; P<0.001), respiratory dysfunction (OR=1.08, 95%CI=1.05-1.13; P<0.001). Moreover, LDL, HDL, and TG were found to be inversely related to mortality, organ dysfunction, length of stay in the hospital and intensive care unit, mechanical ventilation duration, and vasopressor use. Conclusion TC could be considered a risk factor for mortality, organ dysfunction, and clinical outcomes. On the other hand, LDL, HDL, and TG played a protective role in the patients' mortality, organ dysfunction, and clinical outcomes.
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Affiliation(s)
- Sarvin Sanaie
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanam Dolati
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Montazer
- Department of Cardiothoracic Surgeries, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sarina Ranjbari
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arezoo Fathalizadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamran Shadvar
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Faramarzi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Xu H, Jiao W, Zhang Y, Deng X, Dai R, Chen L. Effects of ulinastatin therapy in emergency severe multiple trauma: A single-center randomized controlled trial. Medicine (Baltimore) 2023; 102:e32905. [PMID: 36800599 PMCID: PMC9935977 DOI: 10.1097/md.0000000000032905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Severe multiple traumas are one of the most common diseases and carry a significant financial burden with high disability and mortality. There are no effective drugs in the clinical management of severe multiple traumas, and there is an absence of evidence-based medicine concerning the treatment of severe multiple traumas. METHODS The present study explored whether ulinastatin (UTI) can improve the outcome of severe multiple traumas. The present research included patients who were hospitalized in intensive care units after being diagnosed with severe multiple trauma. Patients received UTIs (400,000 IU) or placebos utilizing computer-based random sequencing (in a 1:1 ratio). The primary outcome measures were 30-day mortality, multiple organ dysfunction syndrome, inflammatory response, coagulation function, infection, liver function, renal function, and drug-related adverse effects. RESULTS A total of 239 individuals were classified into 2 groups, namely, the placebo group (n = 120) and the UTI group (n = 119). There were no statistically significant differences in baseline clinical data between the 2 groups. The 30-day mortality and multiple organ dysfunction syndrome in the UTI group were remarkably improved compared with those in the placebo group. UTI can protect against hyperinflammation and improve coagulation dysfunction, infection, liver function, and renal function. UTI patients had markedly decreased hospitalization expenditures compared with the placebo group. CONCLUSION The findings from the present research indicated that UTIs can improve the clinical outcomes of patients with severe multiple traumas and have fewer adverse reactions.
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Affiliation(s)
- Haiting Xu
- Department of Emergency, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Wei Jiao
- Department of Nursing, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Yunfei Zhang
- Department of Emergency, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Xiaoyan Deng
- Department of Emergency, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Rongrong Dai
- Department of Emergency, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Lei Chen
- Department of Neurosurgery, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
- * Correspondence: Lei Chen, Department of Neurosurgery, The 904th Hospital of Joint Logistic Support Force, Xing Yuan North Road 101, Wuxi 214044, China (e-mail: )
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Lin HC, Chou SH, Fan PC, Zhu Z, Pan J, Li J, Chang CH, Wu VCC, Chen SW, Chu PH. The association between Day-1 urine cadmium excretion and 30-day mortality in patients with acute myocardial infarction: A multi-institutional cohort study. Int J Cardiol 2023; 371:397-401. [PMID: 36103945 DOI: 10.1016/j.ijcard.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study was to investigate the relationship between day-1 urine cadmium excretion and 30-day mortality in patients with acute myocardial infarction (AMI) at two centers. METHODS A total of 286 patients (222 males and 64 females) with AMI from Huashan Hospital, Shanghai and Chang Gung Memorial Hospital, Taiwan were enrolled. Basic vital signs, history, laboratory results, and day-1 urine excretion of cadmium (D1UECd) were recorded. Disease severity was assessed during the first hospitalization using Killip score, APACHE II score, and SOFA score. The main endpoint was 30-day mortality. RESULTS Among the 286 patients, 218 were from Chung Gung Memorial Hospital and 68 were from Huashan Hospital with an average age of 64.2 years. Forty (14%) patients died within 30 days after AMI. The average 24-h urine cadmium level among the Chung Gung Memorial Hospital cohort was 1.5 ± 2.4 μg compared to 1.7 ± 1.7 μg among Huashan Hospital cohort, both higher than the local populations. A higher D1UECd level was significantly associated with a greater risk of 30-day mortality (odds ratio 1.68, 95% confidence interval 1.30-2.16) after controlling for a number of covariates. The ability of D1UECd to discriminate 30-day mortality was excellent, with a very high area under the curve (87.2%, 95% CI 82.0-92.5%). CONCLUSION D1UECd was positively correlated and an independent predictor of 30-day mortality in the enrolled AMI patients. D1UECd may be a simple, objective prognostic scoring system in AMI patients.
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Affiliation(s)
- Hung-Chen Lin
- Department of Cardiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Department of Cardiology, Huashan Hospital of Fudan University, Shanghai, China
| | - Shing-Hsien Chou
- Division of Cardiology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
| | - Pei-Chun Fan
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Zhidong Zhu
- Department of Cardiology, Huashan Hospital of Fudan University, Shanghai, China
| | - Junjie Pan
- Department of Cardiology, Huashan Hospital of Fudan University, Shanghai, China
| | - Jian Li
- Department of Cardiology, Huashan Hospital of Fudan University, Shanghai, China
| | - Chih-Hsiang Chang
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Victor Chien-Chia Wu
- Division of Cardiology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan; Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital, Linkou, Taiwan.
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Kalogianni L, Polizopoulou ZS, Kazakos G, Kontopoulou K, Triantafyllou E, Siarkou VI, Ceron JJ, Chaintoutis SC, Dovas CI, Tamvakis A, Theodoridis A, Savvas I, Diakou A, Soubasis N. The role of the sequential organ failure assessment score in evaluating the outcome in dogs with parvoviral enteritis. Res Vet Sci 2022; 150:44-51. [DOI: 10.1016/j.rvsc.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/28/2022] [Accepted: 05/09/2022] [Indexed: 11/27/2022]
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Naik R, Mandal I, Gorog DA. Scoring Systems to Predict Survival or Neurological Recovery after Out-of-hospital Cardiac Arrest. Eur Cardiol 2022; 17:e20. [PMID: 36643070 PMCID: PMC9820201 DOI: 10.15420/ecr.2022.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/30/2022] [Indexed: 11/07/2022] Open
Abstract
Numerous prediction scores have been developed to better inform clinical decision-making following out-of-hospital cardiac arrest (OHCA), however, there is no consensus among clinicians over which score to use. The aim of this review was to identify and compare scoring systems to predict survival and neurological recovery in patients with OHCA. A structured literature search of the MEDLINE database was carried out from inception to December 2021. Studies developing or validating scoring systems to predict outcome following OHCA were selected. Relevant data were extracted and synthesised for narrative review. In total, 16 scoring systems were identified: one predicting the probability of return of spontaneous circulation, six predicting survival to hospital discharge and nine predicting neurological outcome. NULL-PLEASE and CAST are recommended as the best scores to predict mortality and neurological outcome, respectively, due to the extent of external validation, ease of use and high predictive value of the variables. Whether use of these scores can lead to more cost-effective service delivery remains unclear.
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Affiliation(s)
- Rishi Naik
- Department of Anaesthetics, University Hospitals Dorset NHS TrustDorset, UK
| | - Indrajeet Mandal
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS TrustOxford, UK
| | - Diana A Gorog
- Postgraduate Medical School, University of HertfordshireHatfield, UK,Faculty of Medicine, NIHR, Imperial College LondonLondon, UK
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BALDEMİR R, ERASLAN DOĞANAY G, CIRIK MÖ, ÜLGER G, YURTSEVEN G, ZENGİN M. The relationship between acute physiology and chronic health evaluation-II, sequential organ failure assessment, Charlson comorbidity index and nutritional scores and length of intensive care unit stay of patients hospitalized in the intensive care unit due to chronic obstructive pulmonary disease. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1147178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: It is known that disease severity and nutritional status are determinants of prognosis in patients hospitalized in the intensive care unit (ICU). Different scoring systems are used to evaluate the nutritional status and disease severity of intensive care patients. It will be very useful in clinical practice to determine the intensive care scores that are in harmony with the nutritional parameters and affect the length of stay in the ICU in patients hospitalized with the diagnosis of chronic obstructive pulmonary disease (COPD). It was aimed to determine the relationship between acute physiology and chronic health evaluation-II (Apache-II), sequential organ failure assessment (SOFA), and Charlson comorbidity index (CCI) with nutritional scores in intensive care patients with a diagnosis of COPD. Also, it was aimed to determine the scoring systems that affect the length of stay in the ICU.
Material and Method: Nutritional risk score-2002 (NRS-2002), prognostic nutritional index (PNI), modified nutritional risk in critically ill (mNutric) score, albumin, Apache-II, SOFA and CCI values and intensive care unit length of stay of the patients hospitalized in the intensive care unit due to COPD were recorded. The scoring systems that affect the length of stay in the ICU and the relationship between nutritional scores and Apache-II, SOFA and CCI was analyzed using statistical methods.
Results: A significant correlation was found between only CCI and all nutritional scores. Only the CCI value was found to be significantly higher in those found to be at high risk compared to all nutritional scoring systems. CCI cut-off value determined according to nutritional scoring was determined as 4.5 according to PNI and albumin, and 5.5 according to mNutric score and NRS-2002. It was determined that CCI affects the length of stay in the intensive care unit.
Conclusion: CCI is a scoring system that is compatible with nutritional parameters and affects the length of stay in the intensive care unit. Therefore, we think that CCI can be used to predict prognosis and nutritional risk in patients with COPD in the intensive care unit and to predict the length of stay in the intensive care unit. In terms of malnutrition risk, a cut-off value of ≥6 can be used for CCI.
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Affiliation(s)
| | | | | | - Gülay ÜLGER
- Ankara Atatürk Sanatoryum Eğitim ve Araştırma Hastanesi
| | | | - Musa ZENGİN
- Ankara Atatürk Sanatoryum Eğitim ve Araştırma Hastanesi
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Preintubation Sequential Organ Failure Assessment Score for Predicting COVID-19 Mortality: External Validation Using Electronic Health Record From 86 U.S. Healthcare Systems to Appraise Current Ventilator Triage Algorithms. Crit Care Med 2022; 50:1051-1062. [PMID: 35302957 PMCID: PMC9196924 DOI: 10.1097/ccm.0000000000005534] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES: Prior research has hypothesized the Sequential Organ Failure Assessment (SOFA) score to be a poor predictor of mortality in mechanically ventilated patients with COVID-19. Yet, several U.S. states have proposed SOFA-based algorithms for ventilator triage during crisis standards of care. Using a large cohort of mechanically ventilated patients with COVID-19, we externally validated the predictive capacity of the preintubation SOFA score for mortality prediction with and without other commonly used algorithm elements. DESIGN: Multicenter, retrospective cohort study using electronic health record data. SETTING: Eighty-six U.S. health systems. PATIENTS: Patients with COVID-19 hospitalized between January 1, 2020, and February 14, 2021, and subsequently initiated on mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 15,122 mechanically ventilated patients with COVID-19, SOFA score alone demonstrated poor discriminant accuracy for inhospital mortality in mechanically ventilated patients using the validation cohort (area under the receiver operating characteristic curve [AUC], 0.66; 95% CI, 0.65–0.67). Discriminant accuracy was even poorer using SOFA score categories (AUC, 0.54; 95% CI, 0.54–0.55). Age alone demonstrated greater discriminant accuracy for inhospital mortality than SOFA score (AUC, 0.71; 95% CI, 0.69–0.72). Discriminant accuracy for mortality improved upon addition of age to the continuous SOFA score (AUC, 0.74; 95% CI, 0.73–0.76) and categorized SOFA score (AUC, 0.72; 95% CI, 0.71–0.73) models, respectively. The addition of comorbidities did not substantially increase model discrimination. Of 36 U.S. states with crisis standards of care guidelines containing ventilator triage algorithms, 31 (86%) feature the SOFA score. Of these, 25 (81%) rely heavily on the SOFA score (12 exclusively propose SOFA; 13 place highest weight on SOFA or propose SOFA with one other variable). CONCLUSIONS: In a U.S. cohort of over 15,000 ventilated patients with COVID-19, the SOFA score displayed poor predictive accuracy for short-term mortality. Our findings warrant reappraisal of the SOFA score’s implementation and weightage in existing ventilator triage pathways in current U.S. crisis standards of care guidelines.
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Abdelaleem NA, Makhlouf HA, Nagiub EM, Bayoumi HA. Prognostic biomarkers in predicting mortality in respiratory patients with ventilator-associated pneumonia. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2021. [PMCID: PMC7971396 DOI: 10.1186/s43168-021-00062-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Ventilator-associated pneumonia (VAP) is the most common nosocomial infection. Red cell distribution width (RDW) and neutrophil-lymphocyte ratio (NLR) are prognostic factors to mortality in different diseases. The aim of this study is to evaluate prognostic efficiency RDW, NLR, and the Sequential Organ Failure Assessment (SOFA) score for mortality prediction in respiratory patients with VAP. Results One hundred thirty-six patients mechanically ventilated and developed VAP were included. Clinical characteristics and SOFA score on the day of admission and at diagnosis of VAP, RDW, and NLR were assessed and correlated to mortality. The average age of patients was 58.80 ± 10.53. These variables had a good diagnostic performance for mortality prediction AUC 0.811 for SOFA at diagnosis of VAP, 0.777 for RDW, 0.728 for NLR, and 0.840 for combined of NLR and RDW. The combination of the three parameters demonstrated excellent diagnostic performance (AUC 0.889). A positive correlation was found between SOFA at diagnosis of VAP and RDW (r = 0.446, P < 0.000) and with NLR (r = 0.220, P < 0.010). Conclusions NLR and RDW are non-specific inflammatory markers that could be calculated quickly and easily via routine hemogram examination. These markers have comparable prognostic accuracy to severity scores. Consequently, RDW and NLR are simple, yet promising markers for ICU physicians in monitoring the clinical course, assessment of organ dysfunction, and predicting mortality in mechanically ventilated patients. Therefore, this study recommends the use of blood biomarkers with the one of the simplest ICU score (SOFA score) in the rapid diagnosis of critical patients as a daily works in ICU.
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Abstract
BACKGROUND Illness severity scoring systems are commonly used in critical care. When applied to the populations for whom they were developed and validated, these tools can facilitate mortality prediction and risk stratification, optimize resource use, and improve patient outcomes. OBJECTIVE To describe the characteristics and applications of the scoring systems most frequently applied to critically ill patients. METHODS A literature search was performed using MEDLINE to identify original articles on intensive care unit scoring systems published in the English language from 1980 to 2020. Search terms associated with critical care scoring systems were used alone or in combination to find relevant publications. RESULTS Two types of scoring systems are most frequently applied to critically ill patients: those that predict risk of in-hospital mortality at the time of intensive care unit admission (Acute Physiology and Chronic Health Evaluation, Simplified Acute Physiology Score, and Mortality Probability Models) and those that assess and characterize current degree of organ dysfunction (Multiple Organ Dysfunction Score, Sequential Organ Failure Assessment, and Logistic Organ Dysfunction System). This article details these systems' differing features and timing of use, score calculation, patient populations, and comparative performance data. CONCLUSION Critical care nurses must be aware of the strengths, limitations, and specific characteristics of severity scoring systems commonly used in intensive care unit patients to effectively employ these tools in clinical practice and critically appraise research findings based on their use.
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Affiliation(s)
- Tiffany Purcell Pellathy
- Tiffany Purcell Pellathy is a postdoctoral research fellow at the Veterans Administration Center for Health Equity Research and Promotion in Pittsburgh, Pennsylvania
| | - Michael R Pinsky
- Michael R. Pinsky is a professor of critical care medicine, bioengineering, cardiovascular diseases, clinical and translational science, and anesthesiology at the University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marilyn Hravnak
- Marilyn Hravnak is a professor of nursing at the University of Pittsburgh School of Nursing
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Altas OF, Kizilkaya M. The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care. Medeni Med J 2021; 36:130-137. [PMID: 34239765 PMCID: PMC8226410 DOI: 10.5222/mmj.2021.64160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/29/2021] [Indexed: 11/22/2022] Open
Abstract
Objective In this study, we aimed to reveal the level of predicting mortality of the Neutrophil/Lymphocyte (NLR) and Platelet/Lymphocyte Ratios (TLR) calculated in patients hospitalized with the diagnosis of pneumonia in the intensive care unit when compared with other prognostic scores. Method The hospital records of 112 patients who were admitted to the intensive care unit between January 2015 and January 2018 and met the inclusion criteria were retrospectively reviewed. The patients’ demographic data, the NLR and PLR levels, and the APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment) scores were calculated from the patient files. Results Of the 112 patients examined, 70 were males. The risk analysis showed that the male gender had 2.7 times higher risk of mortality. The NLR, PLR, APACHE II, and SOFA values were found statistically significant in predicting mortality (p<0.001). An evaluation of the risk ratios demonstrated that each one point increase in the NLR increased the mortality risk by 5%, and each one point increase in the SOFA score increased the mortality risk by 13% (p<0.05). In the ROC (receiver operating characteristic) analysis, the NLR assessment proved to be the most powerful, most specific, and sensitive test. The cut-off values were 11.3 for the NLR, 227 for the PLR, 29.8 for the APACHE II scores, and 5.5 for the SOFA scores Conclusion We believe that NLR and PLR are strong and independent predictors of mortality that can be easily and cost-effectively tested.
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Affiliation(s)
- Omer Faruk Altas
- Izmir Bakircay University Cigli Training and Research Hospital, Department of Anesthesiology and Reanimation, Izmir, Turkey
| | - Mehmet Kizilkaya
- Amasya University Sabuncuoğlu Serafettin Training and Research Hospital, Department of Anesthesiology and Reanimation, Amasya, Turkey
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Priestap F, Kao R, Martin CM. External validation of a prognostic model for intensive care unit mortality: a retrospective study using the Ontario Critical Care Information System. Can J Anaesth 2020; 67:981-991. [PMID: 32383124 PMCID: PMC7223438 DOI: 10.1007/s12630-020-01686-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/21/2020] [Accepted: 03/05/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To externally validate an intensive care unit (ICU) mortality prediction model that was created using the Ontario Critical Care Information System (CCIS), which includes the Multiple Organ Dysfunction Score (MODS). METHODS We applied the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) recommendations to a prospective longitudinal cohort of patients discharged between 1 July 2015 and 31 December 31 2016 from 90 adult level-3 critical care units in Ontario. We used multivariable logistic regression with measures of discrimination, calibration-in-the-large, calibration slope, and flexible calibration plots to compare prediction model performance of the entire data set and for each ICU subtype. RESULTS Among 121,201 CCIS records with ICU mortality of 11.3%, the C-statistic for the validation data set was 0.805. The C-statistic ranged from 0.775 to 0.846 among the ICU subtypes. After intercept recalibration to adjust the baseline risk, the mean predicted risk of death matched actual ICU mortality. The calibration slope was close to 1 with all CCIS data and ICU subtypes of cardiovascular and community hospitals with low ventilation rates. Calibration slopes significantly less than 1 were found for ICUs in teaching hospitals and community hospitals with high ventilation rates whereas coronary care units had a calibration slope significantly higher than 1. Calibration plots revealed over-prediction in high risk groups to a varying degree across all cohorts. CONCLUSIONS A risk prediction model primarily based on the MODS shows reproducibility and transportability after intercept recalibration. Risk adjusting models that use existing and feasible data collection can support performance measurement at the individual ICU level.
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Affiliation(s)
- Fran Priestap
- London Health Sciences Centre - Victoria Hospital, 800 Commissioner's Rd E, London, ON, Canada, N6A 5W9.
| | - Raymond Kao
- London Health Sciences Centre - Victoria Hospital, 800 Commissioner's Rd E, London, ON, Canada, N6A 5W9
- Division of Critical Care, Department of Medicine, Schulich School of Dentistry and Medicine, Western University, London, ON, Canada
| | - Claudio M Martin
- London Health Sciences Centre - Victoria Hospital, 800 Commissioner's Rd E, London, ON, Canada, N6A 5W9
- Division of Critical Care, Department of Medicine, Schulich School of Dentistry and Medicine, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
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Prognostic Analysis of Elderly Patients with Multiple Organ Dysfunction Syndrome Undergoing Invasive Mechanical Ventilation. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:6432048. [PMID: 32257085 PMCID: PMC7106932 DOI: 10.1155/2020/6432048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/17/2020] [Indexed: 12/16/2022]
Abstract
Objective To prospectively investigate early prognostic assessments of patients with Multiple Organ Dysfunction Syndrome in the Elderly (MODSE) who were receiving invasive mechanical ventilation (IMV). Methods The clinical data of 351 patients were enrolled prospectively between January 2013 and January 2018. The Acute Physiology and Chronic Health Evaluation II (APACHE II), APACHE III, Simplified Acute Physiology Score (SAPS II), and Multiple Organ Dysfunction Score (MODS) were calculated. According to the outcome of 28-day, the patients were divided into survivors and nonsurvivors. Additionally, based on whether weaning could be implemented, all patients were divided into a successful-weaning group and a failure-to-wean group. Results According to the prognosis, the areas under the receiver operating characteristic curve of the APACHE II, APACHE III, SAPS II, and MODS scoring systems were 0.837, 0.833, 0.784, and 0.860, respectively. MODS exhibited the highest sensitivity, whereas APACHE II showed the highest specificity, and successful weaning was conducive to ameliorating patients' prognosis. Multivariate logistic regression analyses revealed that underlying lung disease, plasma albumin, serum creatinine level, number of failing organs, and IMV duration were related to prognosis of weaning, with odds ratios (ORs) of 1.447, 0.820, 1.603, 2.374, and 3.105, respectively. Conclusions The APACHE II, APACHE III, SAPS II, and MODS systems could perform excellent prognostic assessment for patients with Multiple Organ Dysfunction Syndrome in the elderly. Underlying lung disease, plasma albumin, serum creatinine, number of failing organs, and IMV duration were independent prognostic factors of weaning in MODSE patients with invasive mechanical ventilation.
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Chidambaram V, Tun NL, Haque WZ, Majella MG, Sivakumar RK, Kumar A, Hsu ATW, Ishak IA, Nur AA, Ayeh SK, Salia EL, Zil-E-Ali A, Saeed MA, Sarena APB, Seth B, Ahmadzada M, Haque EF, Neupane P, Wang KH, Pu TM, Ali SMH, Arshad MA, Wang L, Baksh S, Karakousis PC, Galiatsatos P. Factors associated with disease severity and mortality among patients with COVID-19: A systematic review and meta-analysis. PLoS One 2020; 15:e0241541. [PMID: 33206661 PMCID: PMC7673562 DOI: 10.1371/journal.pone.0241541] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/17/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Understanding the factors associated with disease severity and mortality in Coronavirus disease (COVID-19) is imperative to effectively triage patients. We performed a systematic review to determine the demographic, clinical, laboratory and radiological factors associated with severity and mortality in COVID-19. METHODS We searched PubMed, Embase and WHO database for English language articles from inception until May 8, 2020. We included Observational studies with direct comparison of clinical characteristics between a) patients who died and those who survived or b) patients with severe disease and those without severe disease. Data extraction and quality assessment were performed by two authors independently. RESULTS Among 15680 articles from the literature search, 109 articles were included in the analysis. The risk of mortality was higher in patients with increasing age, male gender (RR 1.45, 95%CI 1.23-1.71), dyspnea (RR 2.55, 95%CI 1.88-2.46), diabetes (RR 1.59, 95%CI 1.41-1.78), hypertension (RR 1.90, 95%CI 1.69-2.15). Congestive heart failure (OR 4.76, 95%CI 1.34-16.97), hilar lymphadenopathy (OR 8.34, 95%CI 2.57-27.08), bilateral lung involvement (OR 4.86, 95%CI 3.19-7.39) and reticular pattern (OR 5.54, 95%CI 1.24-24.67) were associated with severe disease. Clinically relevant cut-offs for leukocytosis(>10.0 x109/L), lymphopenia(< 1.1 x109/L), elevated C-reactive protein(>100mg/L), LDH(>250U/L) and D-dimer(>1mg/L) had higher odds of severe disease and greater risk of mortality. CONCLUSION Knowledge of the factors associated of disease severity and mortality identified in our study may assist in clinical decision-making and critical-care resource allocation for patients with COVID-19.
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Affiliation(s)
- Vignesh Chidambaram
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nyan Lynn Tun
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Waqas Z. Haque
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Marie Gilbert Majella
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ranjith Kumar Sivakumar
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Amudha Kumar
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Angela Ting-Wei Hsu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Izza A. Ishak
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Aqsha A. Nur
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Samuel K. Ayeh
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Emmanuella L. Salia
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Ahsan Zil-E-Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Muhammad A. Saeed
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Bhavna Seth
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | | | - Eman F. Haque
- Southern Methodist University, Dallas, Texas, United States of America
| | - Pranita Neupane
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Kuang-Heng Wang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Tzu-Miao Pu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | - Lin Wang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sheriza Baksh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Petros C. Karakousis
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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Lambden S, Laterre PF, Levy MM, Francois B. The SOFA score-development, utility and challenges of accurate assessment in clinical trials. Crit Care 2019; 23:374. [PMID: 31775846 PMCID: PMC6880479 DOI: 10.1186/s13054-019-2663-7] [Citation(s) in RCA: 419] [Impact Index Per Article: 83.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/29/2019] [Indexed: 12/29/2022] Open
Abstract
The Sequential Organ Failure Assessment or SOFA score was developed to assess the acute morbidity of critical illness at a population level and has been widely validated as a tool for this purpose across a range of healthcare settings and environments.In recent years, the SOFA score has become extensively used in a range of other applications. A change in the SOFA score of 2 or more is now a defining characteristic of the sepsis syndrome, and the European Medicines Agency has accepted that a change in the SOFA score is an acceptable surrogate marker of efficacy in exploratory trials of novel therapeutic agents in sepsis. The requirement to detect modest serial changes in a patients' SOFA score therefore means that increased clarity on how the score should be assessed in different circumstances is required.This review explores the development of the SOFA score, its applications and the challenges associated with measurement. In addition, it proposes guidance designed to facilitate the consistent and valid assessment of the score in multicentre sepsis trials involving novel therapeutic agents or interventions.ConclusionThe SOFA score is an increasingly important tool in defining both the clinical condition of the individual patient and the response to therapies in the context of clinical trials. Standardisation between different assessors in widespread centres is key to detecting response to treatment if the SOFA score is to be used as an outcome in sepsis clinical trials.
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Affiliation(s)
- Simon Lambden
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB20Q, UK
| | - Pierre Francois Laterre
- St Luc University Hospital, Université Catholique de Louvain, Avenue Hippocrate 12, 1200, Brussels, Belgium
| | - Mitchell M Levy
- Rhode Island Hospital, Alpert Medical School, Brown University, Providence, RI, USA
| | - Bruno Francois
- Intensive care unit & Inserm CIC 1435 & Inserm UMR 1092, Dupuytren University Hospital, Limoges, France.
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[PROtocol-based MObilizaTION on intensive care units : Design of a cluster randomized pilot study]. Med Klin Intensivmed Notfmed 2019; 113:581-592. [PMID: 29026932 DOI: 10.1007/s00063-017-0358-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Despite convincing evidence for early mobilization of patients on intensive care units (ICU), implementation in practice is limited. Protocols for early mobilization, including in- and exclusion criteria, assessments, safety criteria, and step schemes may increase the rate of implementation and mobilization. HYPOTHESIS Patients (population) on ICUs with a protocol for early mobilization (intervention), compared to patients on ICUs without protocol (control), will be more frequently mobilized (outcome). METHODS A multicenter, stepped-wedge, cluster-randomized pilot study is presented. Five ICUs will receive an adapted, interprofessional protocol for early mobilization in randomized order. Before and after implementation, mobilization of ICU patients will be evaluated by randomized monthly one-day point prevalence surveys. Primary outcome is the percentage of patients mobilized out of bed, operationalized as a score of ≥3 on the ICU Mobility Scale. Secondary outcome parameters will be presence and/or length of mechanical ventilation, delirium, stay on ICU and in hospital, barriers to early mobilization, adverse events, and process parameters as identified barriers, used strategies, and adaptions to local conditions. EXPECTED RESULTS Exploratory evaluation of study feasibility and estimation of effect sizes as the basis for a future explanatory study.
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Dharap SB, Ekhande SV. An observational study of incidence, risk factors & outcome of systemic inflammatory response & organ dysfunction following major trauma. Indian J Med Res 2018; 146:346-353. [PMID: 29355141 PMCID: PMC5793469 DOI: 10.4103/ijmr.ijmr_1538_15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background & objectives: Trauma is known to lead to systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS), which is often a cause of late deaths after injury. SIRS and MODS have been objectively measured using scoring systems. This prospective observational study was carried out in a tertiary care hospital in India to evaluate SIRS and MODS following trauma in terms of their incidence, the associated risk factors and the effect on the outcome. Methods: All adult patients with major life- and limb-threatening trauma were included. Patients who died within 24 h, those with severe head injury, known comorbidity, immunocompromised state, on immunosuppressants or pregnancy were excluded. SIRS and MODS scores were recorded after initial management (baseline score), on days 3 and 6 of admission. SIRS was defined as SIRS score of ≥2 and MODS was defined as MODS score of ≥1. Results: Two hundred patients were enrolled. SIRS was noted in 156 patients (78%). MODS was noted in 145 (72.5%) patients. Overall mortality was 39 (19.5%). Both SIRS and MODS scores were significantly associated with age >60 yr, blunt injury, (lower) revised trauma score hypotension on admission and (higher) injury severity score, but not with gender, pre-hospital time or operative treatment. Interpretation & conclusions: Both SIRS and MODS scores were associated with longer Intensive Care Unit (ICU) stay, more ICU interventions and higher mortality. Incidence of MODS was significantly higher in patients with SIRS. Both scores showed rising trend with time in non-survivors and a decreasing trend in survivors. The serial assessment of scores can help prognosticate outcome and also allocate appropriate critical care resources to patients with rising scores.
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Affiliation(s)
- Satish Balkrishna Dharap
- Department of Surgery, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | - Sanket Vishnu Ekhande
- Department of Surgery, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
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Nakashima T, Miyamoto K, Shimokawa T, Kato S, Hayakawa M. The Association Between Sequential Organ Failure Assessment Scores and Mortality in Patients With Sepsis During the First Week: The JSEPTIC DIC Study. J Intensive Care Med 2018; 35:656-662. [PMID: 29764273 DOI: 10.1177/0885066618775959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Predicting prognosis is a complex process, particularly in patients with severe sepsis or septic shock. This study aimed to determine the relationship between the Sequential Organ Failure Assessment (SOFA) scores for individual organs during the first week of admission and the in-hospital mortality in patients with sepsis. METHODS This study was a post hoc evaluation of the Japan Septic Disseminated Intravascular Coagulation study and included patients admitted to 42 intensive care units in Japan for severe sepsis or septic shock, between January 2011 and December 2013. We assessed the relationship between the organ and total SOFA scores on days 1, 3, and 7 following admission and the in-hospital mortality using logistic regression analysis. RESULTS We evaluated 2732 patients and found the in-hospital mortality rate was 29.1%. The mean age of the patients (standard deviation) was 70.5 (14.1) years, and the major primary site of infection was the abdomen (33.6%). The central nervous system (CNS) SOFA score exhibited the strongest relationship with mortality on days 1 (adjusted odds ratio [aOR]: 1.49, 95% confidence interval [CI]: 1.40-1.59), 3 (aOR: 1.75, 95% CI: 1.62-1.89), and 7 (aOR: 1.93, 95% CI: 1.77-2.10). The coagulation SOFA scores showed a weak correlation with mortality on day 1, but a strong correlation with mortality on day 7 (aOR: 2.04, 95% CI: 1.87-2.24). CONCLUSIONS The CNS SOFA scores were associated with mortality in patients with severe sepsis on days 1, 3, and 7 following hospitalization. The coagulation SOFA score was associated with mortality on day 7. In clinical situations, the CNS SOFA scores during the acute phase and the CNS SOFA and coagulation SOFA scores during the subsequent phases should be evaluated in order to determine patient prognosis.
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Affiliation(s)
- Tsuyoshi Nakashima
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Kyohei Miyamoto
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Seiya Kato
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Mineji Hayakawa
- Emergency and Critical Care Center, Hokkaido University Hospital, Kita-ku, Sapporo, Japan
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Innocenti F, Tozzi C, Donnini C, De Villa E, Conti A, Zanobetti M, Pini R. SOFA score in septic patients: incremental prognostic value over age, comorbidities, and parameters of sepsis severity. Intern Emerg Med 2018; 13:405-412. [PMID: 28188577 DOI: 10.1007/s11739-017-1629-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
Abstract
Several widely used scoring systems for septic patients have been validated in an ICU setting, and may not be appropriate for other settings like Emergency Departments (ED) or High-Dependency Units (HDU), where a relevant number of these patients are managed. The purpose of this study is to find reliable tools for prognostic assessment of septic patients managed in an ED-HDU. In 742 patients diagnosed with sepsis/severe sepsis/septic shock, not-intubated, admitted in ED between June 2008 and April 2016, SOFA, qSOFA, PIRO, MEWS, Charlson Comorbidity Index, MEDS, and APACHE II were calculated at ED admission (T0); SOFA and MEWS were also calculated after 24 h of ED-High-Dependency Unit stay (T1). Discrimination and incremental prognostic value of SOFA score over demographic data and parameters of sepsis severity were tested. Primary outcome is 28-day mortality. Twenty-eight day mortality rate is 31%. The different scores show a modest-to-moderate discrimination (T0 SOFA 0.695; T1 SOFA 0.741; qSOFA 0.625; T0 MEWS 0.662; T1 MEWS 0.729; PIRO: 0.646; APACHE II 0.756; Charlson Comorbidity Index 0.596; MEDS 0.674, all p < 0.001). At a multivariate stepwise Cox analysis, including age, Charlson Comorbidity Index, MEWS, and lactates, SOFA shows an incremental prognostic ability both at T0 (RR 1.165, IC 95% 1.009-1.224, p < 0.0001) and T1 (RR 1.168, IC 95% 1.104-1.234, p < 0.0001). SOFA score shows a moderate prognostic stratification ability, and demonstrates an incremental prognostic value over the previous medical conditions and clinical parameters in septic patients.
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Affiliation(s)
- Francesca Innocenti
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy.
| | - Camilla Tozzi
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
| | - Chiara Donnini
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
| | - Eleonora De Villa
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
| | - Alberto Conti
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
| | - Maurizio Zanobetti
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
| | - Riccardo Pini
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
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Kaymak C, Sencan I, Izdes S, Sari A, Yagmurdur H, Karadas D, Oztuna D. Mortality of adult intensive care units in Turkey using the APACHE II and SOFA systems (outcome assessment in Turkish intensive care units). Arch Med Sci 2018; 14:510-515. [PMID: 29765435 PMCID: PMC5949908 DOI: 10.5114/aoms.2016.59709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/28/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate intensive care unit (ICU) performance using risk-adjusted ICU mortality rates nationally, assessing patients who died or had been discharged from the ICU. For this purpose, this study analyzed the Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) databases, containing detailed clinical and physiological information and mortality of mixed critically ill patients in a medical ICU at secondary and tertiary referral ICUs in Turkey. MATERIAL AND METHODS A total of 690 adult intensive care units in Turkey were included in the study. Among 690 ICUs evaluated, 39.7% were secondary and 60.3% were tertiary ICUs. A total of 4188 patients were enrolled in this study. Intensive care units of ministry, university, and private hospitals were evaluated all over Turkey. During the study period, clinical data that were collected concurrently for each patient contained demographic details and the diagnostic category leading to ICU admission. APACHE II and SOFA scores following ICU admission were calculated and recorded. Patients were followed up for outcome data until death or ICU discharge. RESULTS The mean age of patients was 68.8 ±19 and 54% of them were male. The mean APACHE II score was 20 ±8.7. The ICUs' mortality rate was 46.3%, and mean predicted mortality was 37.2% for APACHE II. The standardized mortality ratio was 1.28 (95% confidence interval: 1.21-1.31). CONCLUSIONS There was a wide difference in outcome for patients admitted to different ICUs and severity of illness using risk adjustment methods. The high mortality rate in patients could be related to comorbid diseases, high mechanical ventilation rates and older ages.
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Affiliation(s)
- Cetin Kaymak
- Anesthesiology and Reanimation Department, Intensive Care Unit, Ankara Training and Research Hospital, Ankara, Turkey
| | - Irfan Sencan
- General Directorate of Health Services, Ministry of Health, Ankara, Turkey
| | - Seval Izdes
- Anesthesiology and Reanimation Department, Intensive Care Unit, Faculty of Medicine, University of Yildirim Beyazit, Ankara, Turkey
| | - Aydin Sari
- Directorate of Audit Department, Ministry of Health, Ankara, Turkey
| | - Hatice Yagmurdur
- Anesthesiology and Reanimation Department, Intensive Care Clinic, Numune Training and Research Hospital, Ankara, Turkey
| | - Derya Karadas
- Directorate of Audit Department, Ministry of Health, Ankara, Turkey
| | - Derya Oztuna
- Medical Biostatistics Department, Faculty of Medicine, University of Ankara, Ankara, Turkey
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Fallenius M, Skrifvars MB, Reinikainen M, Bendel S, Raj R. Common intensive care scoring systems do not outperform age and glasgow coma scale score in predicting mid-term mortality in patients with spontaneous intracerebral hemorrhage treated in the intensive care unit. Scand J Trauma Resusc Emerg Med 2017; 25:102. [PMID: 29070068 PMCID: PMC5657126 DOI: 10.1186/s13049-017-0448-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/13/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Intensive care scoring systems are widely used in intensive care units (ICU) around the world for case-mix adjustment in research and benchmarking. The aim of our study was to investigate the usefulness of common intensive care scoring systems in predicting mid-term mortality in patients with spontaneous intracerebral hemorrhage (ICH) treated in intensive care units (ICU). METHODS We performed a retrospective observational study including adult patients with spontaneous ICH treated in Finnish ICUs during 2003-2012. We used six-month mortality as the primary outcome of interest. We used logistic regression to customize Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) for six-month mortality prediction. To assess the usefulness of the scoring systems, we compared their discrimination and calibration with two simpler models consisting of age, Glasgow Coma Scale (GCS) score, and premorbid functional status. RESULTS Totally 3218 patients were included. Overall six-month mortality was 48%. APACHE II and SAPS II outperformed SOFA (area under the receiver operator curve [AUC] 0.83 and 0.84, respectively, vs. 0.73) but did not show any benefit over the simpler models in terms of discrimination (AUC 0.84, p > 0.05 for all models). SAPS II showed satisfactory calibration (p = 0.058 in the Hosmer-Lemeshow test), whereas all other models showed poor calibration (p < 0.05). DISCUSSION In this retrospective multi-center study, we found that SAPS II and APACHE II were of no additional prognostic value to a simple model based on only age and GCS score for patients with ICH treated in the ICU. In fact, the major predictive ability of APACHE II and SAPS II comes from their age and GCS score components. SOFA performed significantly poorer than the other models and is not applicable as a prognostic model for ICH patients. All models displayed poor calibration, highlighting the need for improved prognostic models for ICH patients. CONCLUSION The common intensive care scoring systems did not outperform a simpler model based on only age and GCS score. Thus, the use of previous intensive care scoring systems is not warranted in ICH patients.
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Affiliation(s)
- Marika Fallenius
- Division of Intensive Care, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markus B. Skrifvars
- Division of Intensive Care, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matti Reinikainen
- Department of Intensive Care, North Karelia Central Hospital, Joensuu, Finland
| | - Stepani Bendel
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - Rahul Raj
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Zhang W, Danzeng Q, Feng X, Cao X, Chen W, Kang Y. Sequential Organ Failure Assessment predicts outcomes of pulse indicator contour continuous cardiac output-directed goal therapy: A prospective study. Medicine (Baltimore) 2017; 96:e8111. [PMID: 28953635 PMCID: PMC5626278 DOI: 10.1097/md.0000000000008111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
According to the new sepsis definitions, septic shock is defined as a subset of sepsis in which the underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality. We evaluated the predictive efficacy of the Sequential Organ Failure Assessment (SOFA) score in critically ill patients with septic shock undergoing pulse indicator contour continuous cardiac output (PiCCO)-directed goal therapy (PDGT).We conducted a single-center, prospective, observational study of 52 patients with septic shock undergoing PDGT. The putative prognostic factors, including the severity scores (SOFA and Acute Physiology and Chronic Health Evaluation II [APACHE II] scores), were analyzed within 24 hours after diagnosis of septic shock. We assessed and compared the predictive efficacy of risk factors for 28-day mortality of patients with septic shock undergoing PDGT.Among the patients with septic shock undergoing PDGT, the SOFA scores of nonsurvivors were significantly higher than those of survivors (P < .001); the area under the receiver operating characteristics curve was higher for SOFA than for APACHE II (P = .005). The outcomes of the logistic regression analysis for 28-day mortality showed that the odds ratio, 95% confidence interval, and P-value of SOFA were 1.6, 1.2 to 2.1, and <.001, respectively.The predictive model of the SOFA score is able to accurately predict the outcomes of critically ill patients with septic shock undergoing PDGT.
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Affiliation(s)
- Wei Zhang
- Department of Critical Care Medicine, Sichuan University West China Hospital, Chengdu, Sichuan
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical College
| | - Quzhen Danzeng
- Department of Critical Care Medicine, Sichuan University West China Hospital, Chengdu, Sichuan
| | - Xiaoting Feng
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical College
| | - Xing Cao
- Department of Critical Care Medicine, Sichuan University West China Hospital, Chengdu, Sichuan
| | - Weiwei Chen
- Department of Critical Care Medicine, First People's Hospital of Zunyi, Zunyi, Guizhou, China
| | - Yan Kang
- Department of Critical Care Medicine, Sichuan University West China Hospital, Chengdu, Sichuan
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Multiple Organ Dysfunction Score Is Superior to the Obstetric-Specific Sepsis in Obstetrics Score in Predicting Mortality in Septic Obstetric Patients. Crit Care Med 2017; 45:e49-e57. [PMID: 27618276 PMCID: PMC5364515 DOI: 10.1097/ccm.0000000000002018] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives: Mortality prediction scores have been used for a long time in ICUs; however, numerous studies have shown that they over-predict mortality in the obstetric population. With sepsis remaining a major cause of obstetric mortality, we aimed to look at five mortality prediction scores (one obstetric-based and four general) in the septic obstetric population and compare them to a nonobstetric septic control group. Subject and Design: Women in the age group of 16–50 years with an admission diagnosis or suspicion of sepsis were included. In a multicenter obstetric population (n = 797), these included all pregnant and postpartum patients up to 6 weeks postpartum. An age- and gender-matched control nonobstetric population was drawn from a single-center general critical care population (n = 2,461). Sepsis in Obstetric Score, Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment, and Multiple Organ Dysfunction Scores were all applied to patients meeting inclusion criteria in both cohorts, and their area under the receiver-operator characteristic curves was calculated to find the most accurate predictor. Measurements and Main Results: A total of 146 septic patients were found for the obstetric cohort and 299 patients for the nonobstetric control cohort. The Sepsis in Obstetric Score, Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment, and Multiple Organ Dysfunction Scores gave area under the receiver-operator characteristic curves of 0.67, 0.68, 0.72, 0.79, and 0.84 in the obstetric cohort, respectively, and 0.64, 0.72, 0.61, 0.78, and 0.74 in the nonobstetric cohort, respectively. The Sepsis in Obstetric Score performed similarly to all the other scores with the exception of the Multiple Organ Dysfunction Score, which was significantly better (p < 0.05). Conclusion: The Sepsis in Obstetric Score, designed specifically for sepsis in obstetric populations, was not better than general severity of illness scoring systems. Furthermore, the Sepsis in Obstetric Score performance was no different in an obstetric sepsis population compared to a nonobstetric sepsis population. The Multiple Organ Dysfunction Score is a simple organ-based score, and this result supports the use of organ-based outcome predictors in ICU even in an obstetric sepsis population.
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Matera G, Quirino A, Peronace C, Settembre P, Marano V, Loria MT, Marascio N, Galati L, Barreca GS, Giancotti A, Amantea B, Liberto MC, Focà A. Soluble CD14 Subtype-A New Biomarker in Predicting the Outcome of Critically Ill Septic Patients. Am J Med Sci 2017. [PMID: 28641717 DOI: 10.1016/j.amjms.2017.03.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We evaluated the role of presepsin (soluble CD14 subtype, sCD14-ST) in predicting the outcome of critically ill septic patients in parallel with procalcitonin and C-reactive protein. METHODS This study was an observational, prospective study that enrolled 58 surgical and medical intensive care unit patients with suspected sepsis. All studied subjects were retrospectively stratified into survivors and nonsurvivors based on 28 days survival and according to microbiological results in blood culture positive and negative groups. Plasma and serum samples from each patient were collected at admission (T-0), after 24-48 hours (T-1) and after 7 days (T-2). Statistics were obtained using Student׳s t test and ANOVA, as well as Bonferroni post hoc test. Receiver-operating characteristic (ROC) analysis was also performed. RESULTS Presepsin levels were significantly higher at T-0 (P = 0.0007), at T-1 (P < 0.0001) and at T-2 (P < 0.0001) in nonsurvivors versus survivors at the same time point. Presepsin concentrations were significantly increased at T-0 (P = 0.0073), T1 (P = 0.0111) and T2 (P = 0.0167) in patients with positive blood cultures in comparison to patients with negative cultures at the same time. For all time periods evaluated, presepsin data from nonsurviving and surviving individuals were subjected to ROC analysis that demonstrated an excellent accuracy and significant area under the ROC curve (P < 0.0001). Results of multivariate analysis indicated presepsin as a predictive independent variable among prognosis markers at T-0 (P = 0.016). CONCLUSIONS Presepsin revealed an optimal prognostic performance in patients with severe sepsis and provided interesting diagnostic value. Prediction of outcome in critically ill patients is crucial to optimize management decisions and level of treatment.
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Affiliation(s)
- Giovanni Matera
- Department of Health Sciences, "Magna Graecia," Institute of Clinical Microbiology, University of Catanzaro, Catanzaro, Italy.
| | - Angela Quirino
- Department of Health Sciences, "Magna Graecia," Institute of Clinical Microbiology, University of Catanzaro, Catanzaro, Italy
| | - Cinzia Peronace
- Department of Health Sciences, "Magna Graecia," Institute of Clinical Microbiology, University of Catanzaro, Catanzaro, Italy
| | - Pio Settembre
- Department of Health Sciences, "Magna Graecia," Institute of Clinical Microbiology, University of Catanzaro, Catanzaro, Italy
| | - Vito Marano
- Department of Health Sciences, "Magna Graecia," Institute of Clinical Microbiology, University of Catanzaro, Catanzaro, Italy
| | - Maria T Loria
- Department of Health Sciences, "Magna Graecia," Institute of Clinical Microbiology, University of Catanzaro, Catanzaro, Italy
| | - Nadia Marascio
- Department of Health Sciences, "Magna Graecia," Institute of Clinical Microbiology, University of Catanzaro, Catanzaro, Italy
| | - Luisa Galati
- Department of Health Sciences, "Magna Graecia," Institute of Clinical Microbiology, University of Catanzaro, Catanzaro, Italy
| | - Giorgio S Barreca
- Department of Health Sciences, "Magna Graecia," Institute of Clinical Microbiology, University of Catanzaro, Catanzaro, Italy
| | - Aida Giancotti
- Department of Health Sciences, "Magna Graecia," Institute of Clinical Microbiology, University of Catanzaro, Catanzaro, Italy
| | - Bruno Amantea
- Intensive Care Unit, Department of Health Sciences, "Magna Graecia," University of Catanzaro, Catanzaro, Italy
| | - Maria C Liberto
- Department of Health Sciences, "Magna Graecia," Institute of Clinical Microbiology, University of Catanzaro, Catanzaro, Italy
| | - Alfredo Focà
- Department of Health Sciences, "Magna Graecia," Institute of Clinical Microbiology, University of Catanzaro, Catanzaro, Italy
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de Grooth HJ, Geenen IL, Girbes AR, Vincent JL, Parienti JJ, Oudemans-van Straaten HM. SOFA and mortality endpoints in randomized controlled trials: a systematic review and meta-regression analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:38. [PMID: 28231816 PMCID: PMC5324238 DOI: 10.1186/s13054-017-1609-1] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/17/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The sequential organ failure assessment score (SOFA) is increasingly used as an endpoint in intensive care randomized controlled trials (RCTs). Although serially measured SOFA is independently associated with mortality in observational cohorts, the association between treatment effects on SOFA vs. effects on mortality has not yet been quantified in RCTs. The aim of this study was to quantify the relationship between SOFA and mortality in RCTs and to identify which SOFA derivative best reflects between-group mortality differences. METHODS The review protocol was prospectively registered (Prospero CRD42016034014). We performed a literature search (up to May 1, 2016) for RCTs reporting both SOFA and mortality, and analyzed between-group differences in these outcomes. Treatment effects on SOFA and mortality were calculated as the between-group SOFA standardized difference and log odds ratio (OR), respectively. We used random-effects meta-regression to (1) quantify the linear relationship between RCT treatment effects on mortality (logOR) and SOFA (i.e. responsiveness) and (2) quantify residual heterogeneity (i.e. consistency, expressed as I 2). RESULTS Of 110 eligible RCTs, 87 qualified for analysis. Using all RCTs, SOFA was significantly associated with mortality (slope = 0.49 (95% CI 0.17; 0.82), p = 0.006, I 2 = 5%); the overall mortality effect explained by SOFA score (R 2) was 9%. Fifty-eight RCTs used Fixed-day SOFA as an endpoint (i.e. the score on a fixed day after randomization), 25 studies used Delta SOFA as an endpoint (i.e. the trajectory from baseline score) and 15 studies used other SOFA derivatives as an endpoint. Fixed-day SOFA was not significantly associated with mortality (slope = 0.35 (95% CI -0.04; 0.75), p = 0.08, I 2 = 12%) and explained 3% of the overall mortality effect (R 2). Delta SOFA was significantly associated with mortality (slope = 0.70 (95% CI 0.26; 1.14), p = 0.004, I 2 = 0%) and explained 32% of the overall mortality effect (R 2). CONCLUSIONS Treatment effects on Delta SOFA appear to be reliably and consistently associated with mortality in RCTs. Fixed-day SOFA was the most frequently reported outcome among the reviewed RCTs, but was not significantly associated with mortality. Based on this study, we recommend using Delta SOFA rather than Fixed-day SOFA as an endpoint in future RCTs.
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Affiliation(s)
- Harm-Jan de Grooth
- Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Irma L Geenen
- Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Armand R Girbes
- Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Jacques Parienti
- Unité de Biostatistique et de Recherche Clinique, Centre Hospitalier Universitaire de Caen, Caen, France.,EA4655 « Risques microbiens », Faculté de Médecine, Université de Caen Normandie, Caen, France
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Naqvi IH, Mahmood K, Ziaullaha S, Kashif SM, Sharif A. Better prognostic marker in ICU - APACHE II, SOFA or SAP II! Pak J Med Sci 2016; 32:1146-1151. [PMID: 27882011 PMCID: PMC5103123 DOI: 10.12669/pjms.325.10080] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objectives: This study was designed to determine the comparative efficacy of different scoring system in assessing the prognosis of critically ill patients. Methods: This was a retrospective study conducted in medical intensive care unit (MICU) and high dependency unit (HDU) Medical Unit III, Civil Hospital, from April 2012 to August 2012. All patients over age 16 years old who have fulfilled the criteria for MICU admission were included. Predictive mortality of APACHE II, SAP II and SOFA were calculated. Calibration and discrimination were used for validity of each scoring model. Results: A total of 96 patients with equal gender distribution were enrolled. The average APACHE II score in non-survivors (27.97+8.53) was higher than survivors (15.82+8.79) with statistically significant p value (<0.001). The average SOFA score in non-survivors (9.68+4.88) was higher than survivors (5.63+3.63) with statistically significant p value (<0.001). SAP II average score in non-survivors (53.71+19.05) was higher than survivors (30.18+16.24) with statistically significant p value (<0.001). Conclusion: All three tested scoring models (APACHE II, SAP II and SOFA) would be accurate enough for a general description of our ICU patients. APACHE II has showed better calibration and discrimination power than SAP II and SOFA.
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Affiliation(s)
- Iftikhar Haider Naqvi
- Dr. Iftikhar Haider Naqvi, MBBS, FCPS. Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Khalid Mahmood
- Prof. Khalid Mahmood, MBBS, FCPS, FRCP(E), FRCP(G). Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Ziaullaha
- Dr. Syed Ziaullah, MBBS, FCPS II Trainee. Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Mohammad Kashif
- Dr. Syed Muhammad Kashif, MBBS, FCPS. Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Asim Sharif
- Dr. Asim Sharif, MBBS, FCPS II Trainee. Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
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Abstract
Intensivists, surgeons, neurologists, and others involved in pediatric intensive care units (PICUs) have an important investment in both short-and long-term outcomes of children and adolescents with head injury who are treated under their care. Outcomes are most often documented by either single-or multiple-item rating scales and are implemented both during and after hospital care. For this review, the authors have organized the content of rating scales into 6 general classes: (1) mortality prediction, (2) severity, (3) global recovery, (4) activity restrictions, (5) secondary adverse conditions, and (6) limitations in participation, quality of life, and health status. Rating scales that describe the outcomes of children and adolescents after head injury are used to monitor medical and functional recovery, guide clinical management, drive quality assurance initiatives, and conduct clinical research. The authors restrict their selective review to rating scales that describe child outcomes (vs family) and that have been reported and applied in the outcome literature. Although head injury is a major cause of mortality and short-and long-term morbidity in children and adolescents, there is no consensus on which rating scales are optimal for hospital care or community follow-up. Major considerations for clinical use are feasibility, type of outcome information needed, content breadth across multiple ages and levels of recovery, and utility in determining the short-term impact of PICU care on long-term outcome.
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Affiliation(s)
- Stephen M Haley
- Health and Disability Research Institute, Boston University, Boston, Massachusetts 02215-1605, USA.
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Wierstra BT, Kadri S, Alomar S, Burbano X, Barrisford GW, Kao RLC. The impact of "early" versus "late" initiation of renal replacement therapy in critical care patients with acute kidney injury: a systematic review and evidence synthesis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:122. [PMID: 27149861 PMCID: PMC4858821 DOI: 10.1186/s13054-016-1291-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 04/08/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The optimal timing of initiating renal replacement therapy (RRT) in critical illness complicated by acute kidney injury (AKI) is not clearly established. Trials completed on this topic have been marked by contradictory findings as well as quality and heterogeneity issues. Our goal was to perform a synthesis of the evidence regarding the impact of "early" versus "late" RRT in critically ill patients with AKI, focusing on the highest-quality research on this topic. METHODS A literature search using the PubMed and Embase databases was completed to identify studies involving critically ill adult patients with AKI who received hemodialysis according to "early" versus "late"/"standard" criteria. The highest-quality studies were selected for meta-analysis. The primary outcome of interest was mortality at 1 month (composite of 28- and 30-day mortality). Secondary outcomes evaluated included intensive care unit (ICU) and hospital length of stay (LOS). RESULTS Thirty-six studies (seven randomized controlled trials, ten prospective cohorts, and nineteen retrospective cohorts) were identified for detailed evaluation. Nine studies involving 1042 patients were considered to be of high quality and were included for quantitative analysis. No survival advantage was found with "early" RRT among high-quality studies with an OR of 0.665 (95 % CI 0.384-1.153, p = 0.146). Subgroup analysis by reason for ICU admission (surgical/medical) or definition of "early" (time/biochemical) showed no evidence of survival advantage. No significant differences were observed in ICU or hospital LOS among high-quality studies. CONCLUSIONS Our conclusion based on this evidence synthesis is that "early" initiation of RRT in critical illness complicated by AKI does not improve patient survival or confer reductions in ICU or hospital LOS.
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Affiliation(s)
- Benjamin T Wierstra
- Division of Internal Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sameer Kadri
- Harvard School of Public Health, Harvard University, Boston, MA, USA
| | - Soha Alomar
- Harvard School of Public Health, Harvard University, Boston, MA, USA
| | - Ximena Burbano
- Harvard School of Public Health, Harvard University, Boston, MA, USA
| | - Glen W Barrisford
- Harvard School of Public Health, Harvard University, Boston, MA, USA
| | - Raymond L C Kao
- Harvard School of Public Health, Harvard University, Boston, MA, USA. .,Division of Critical Care Medicine, Department of Medicine, Western University, 800 Commissioner's Road East, London, ON, N6A 5W9, Canada.
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Cour M, Bresson D, Hernu R, Argaud L. SOFA score to assess the severity of the post-cardiac arrest syndrome. Resuscitation 2016; 102:110-5. [PMID: 26965206 DOI: 10.1016/j.resuscitation.2016.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/17/2016] [Accepted: 03/01/2016] [Indexed: 01/31/2023]
Abstract
AIM OF THE STUDY The aim of the study was to assess the prognostic impact of organ failures at ICU admission after out-of-hospital cardiac arrest (CA) according to the SOFA score. METHODS We performed a retrospective analysis of a prospective cohort of all adult patients admitted to a 15-bed medical ICU in a university-affiliated hospital after an out-of-hospital CA. In addition to demographic and clinical data, initial illness severity was measured using the SOFA score. Outcomes (mortality and neurological prognosis) were also collected at day 28 and one year. RESULTS A total of 304 patients (age: 66±16 years, male: 55%) were admitted for post-CA management. An initial nonshockable cardiac rhythm was recorded in 274 (90%) cases. At admission, SOFA score averaged 9.8±3.1 for the entire cohort (8.1±3.3 for day 28 survivors versus 10.1±3.1 for non-survivors, p<0.001). At day 1, SOFA remained significantly (p<0.001) higher in nonsurvivors (9.8±3.8) when compared to survivors (6.5±4.1). Death occurred in 269 (88%) and 275 (90%) patients within the 28-day and one-year period, respectively. Neurological outcome at one year was favorable (CPC score 1-2) in 23patients (8%). Multivariate analysis identified the SOFA score at admission as independently associated with mortality at day28 (OR per point of SOFA score 1.17; 95% CI 1.01-1.35; p=0.03). CONCLUSIONS In the present study, early organ failures, as assessed by the SOFA score at ICU admission, were independently associated with day 28 mortality. SOFA score may help clinicians objectively evaluate the severity of the post-CA syndrome.
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Affiliation(s)
- Martin Cour
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Réanimation Médicale, F-69437 Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, F-69373 Lyon, France; INSERM, U1060 CarMeN, F-69373 Lyon, France.
| | - Didier Bresson
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Réanimation Médicale, F-69437 Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, F-69373 Lyon, France.
| | - Romain Hernu
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Réanimation Médicale, F-69437 Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, F-69373 Lyon, France.
| | - Laurent Argaud
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Réanimation Médicale, F-69437 Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, F-69373 Lyon, France; INSERM, U1060 CarMeN, F-69373 Lyon, France.
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Hsu CW, Weng CH, Lin-Tan DT, Chu PH, Yen TH, Chen KH, Lin CY, Huang WH. Association of Urinary Cadmium with Mortality in Patients at a Coronary Care Unit. PLoS One 2016; 11:e0146173. [PMID: 26741992 PMCID: PMC4711817 DOI: 10.1371/journal.pone.0146173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 12/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Determine the effect of the day 1 urinary excretion of cadmium (D1-UE-Cd) on mortality of patients admitted to a coronary care unit (CCU). METHODS A total of 323 patients were enrolled in this 6-month study. Urine and blood samples were taken within 24 h after CCU admission. Demographic data, clinical diagnoses, and hospital mortality were recorded. The scores of established systems for prediction of mortality in critically ill patients were calculated. RESULTS Compared with survivors (n = 289), non-survivors (n = 34) had higher levels of D1-UE-Cd. Stepwise multiple linear regression analysis indicated that D1-UE-Cd was positively associated with pulse rate and level of aspartate aminotransferase, but negatively associated with serum albumin level. Multivariate Cox analysis, with adjustment for other significant variables and measurements from mortality scoring systems, indicated that respiratory rate and D1-UE-Cd were independent and significant predictors of mortality. For each 1 μg/day increase of D1-UE-Cd, the hazard ratio for CCU mortality was 3.160 (95% confidence interval: 1.944-5.136, p < 0.001). The chi-square value of Hosmer-Lemeshow goodness-of-fit test for D1-UE-Cd was 10.869 (p = 0.213). The area under the receiver operating characteristic curve for D1-UE-Cd was 0.87 (95% confidence interval: 0.81-0.93). CONCLUSIONS The D1-UE-Cd, an objective variable with no inter-observer variability, accurately predicted hospital mortality of CCU patients and outperformed other established scoring systems. Further studies are needed to determine the physiological mechanism of the effect of cadmium on mortality in CCU patients.
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Affiliation(s)
- Ching-Wei Hsu
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Nephrology, Division of Clinical Toxicology, Lin-Kou Medical Center, Taoyuan, Taiwan
- Chang Gung University and School of Medicine, Taoyuan, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Nephrology, Division of Clinical Toxicology, Lin-Kou Medical Center, Taoyuan, Taiwan
- Chang Gung University and School of Medicine, Taoyuan, Taiwan
| | - Dan-Tzu Lin-Tan
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Nephrology, Division of Clinical Toxicology, Lin-Kou Medical Center, Taoyuan, Taiwan
- Chang Gung University and School of Medicine, Taoyuan, Taiwan
| | - Pao-Hsien Chu
- Chang Gung University and School of Medicine, Taoyuan, Taiwan
- Division of Cardiology, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Taoyuan, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Nephrology, Division of Clinical Toxicology, Lin-Kou Medical Center, Taoyuan, Taiwan
- Chang Gung University and School of Medicine, Taoyuan, Taiwan
| | - Kuan-Hsing Chen
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Nephrology, Division of Clinical Toxicology, Lin-Kou Medical Center, Taoyuan, Taiwan
- Chang Gung University and School of Medicine, Taoyuan, Taiwan
| | - Chung-Yin Lin
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Nephrology, Division of Clinical Toxicology, Lin-Kou Medical Center, Taoyuan, Taiwan
- Chang Gung University and School of Medicine, Taoyuan, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Nephrology, Division of Clinical Toxicology, Lin-Kou Medical Center, Taoyuan, Taiwan
- Chang Gung University and School of Medicine, Taoyuan, Taiwan
- * E-mail:
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Hong DY, Kim JW, Paik JH, Jung HM, Baek KJ, Park SO, Lee KR. Value of plasma neutrophil gelatinase-associated lipocalin in predicting the mortality of patients with sepsis at the emergency department. Clin Chim Acta 2015; 452:177-81. [PMID: 26626454 DOI: 10.1016/j.cca.2015.11.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/22/2015] [Accepted: 11/24/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sepsis is a major cause of morbidity and mortality in the emergency department. This study aimed to evaluate the assessment of severity of sepsis by and prognostic value of plasma neutrophil gelatinase-associated lipocalin (NGAL) compared with other widely used biological markers of inflammation in patients with sepsis. METHODS NGAL, procalcitonin, and C-reactive protein values were measured in 470 patients with suspected sepsis, and the Mortality in Emergency Department Sepsis (MEDS) score was obtained for all enrolled subjects, who were followed for up to 28days. RESULTS The median plasma NGAL value was increased with sepsis severity according to the MEDS score. The plasma NGAL value was higher in nonsurvivors than in survivors. The area under the receiver operating characteristic curve of NGAL (0.797) was greater than that of procalcitonin (0.599) and MEDS score (0.774) in predicting 28-day hospital mortality. Multivariable logistic regression found that the plasma NGAL value was an independent predictor for hospital mortality in patients with sepsis. The plasma NGAL values were positively correlated with C-reactive protein and procalcitonin levels, and MEDS scores. CONCLUSIONS Plasma NGAL is a valuable biological marker in the assessment of severity and prediction of prognosis of patients with sepsis in the emergency department.
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Affiliation(s)
- Dae Young Hong
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jong Won Kim
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jin Hui Paik
- Department of Emergency Medicine, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Hyun Min Jung
- Department of Emergency Medicine, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Kwang Je Baek
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang O Park
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kyeong Ryong Lee
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea.
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Elderly in the Intensive Care Unit: Age and Mortality. INT J GERONTOL 2015. [DOI: 10.1016/j.ijge.2015.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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La escala modificada de Bruselas como predictor de mortalidad en la Unidad de Terapia Intensiva. Med Intensiva 2015; 39:20-5. [DOI: 10.1016/j.medin.2013.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/23/2013] [Accepted: 10/27/2013] [Indexed: 01/31/2023]
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Rittenberger JC. Striking the Balance. Crit Care Med 2014; 42:2637-8. [DOI: 10.1097/ccm.0000000000000592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rittenberger JC. Early CT imaging of the brain – A guide to therapy. Resuscitation 2014; 85:1309-10. [DOI: 10.1016/j.resuscitation.2014.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 06/21/2014] [Indexed: 11/25/2022]
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Yu S, Leung S, Heo M, Soto GJ, Shah RT, Gunda S, Gong MN. Comparison of risk prediction scoring systems for ward patients: a retrospective nested case-control study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R132. [PMID: 24970344 PMCID: PMC4227284 DOI: 10.1186/cc13947] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 05/22/2014] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The rising prevalence of rapid response teams has led to a demand for risk-stratification tools that can estimate a ward patient's risk of clinical deterioration and subsequent need for intensive care unit (ICU) admission. Finding such a risk-stratification tool is crucial for maximizing the utility of rapid response teams. This study compares the ability of nine risk prediction scores in detecting clinical deterioration among non-ICU ward patients. We also measured each score serially to characterize how these scores changed with time. METHODS In a retrospective nested case-control study, we calculated nine well-validated prediction scores for 328 cases and 328 matched controls. Our cohort included non-ICU ward patients admitted to the hospital with a diagnosis of infection, and cases were patients in this cohort who experienced clinical deterioration, defined as requiring a critical care consult, ICU admission, or death. We then compared each prediction score's ability, over the course of 72 hours, to discriminate between cases and controls. RESULTS At 0 to 12 hours before clinical deterioration, seven of the nine scores performed with acceptable discrimination: Sequential Organ Failure Assessment (SOFA) score area under the curve of 0.78, Predisposition/Infection/Response/Organ Dysfunction Score of 0.76, VitalPac Early Warning Score of 0.75, Simple Clinical Score of 0.74, Mortality in Emergency Department Sepsis of 0.74, Modified Early Warning Score of 0.73, Simplified Acute Physiology Score II of 0.73, Acute Physiology and Chronic Health Evaluation II of 0.72, and Rapid Emergency Medicine Score of 0.67. By measuring scores over time, it was found that average SOFA scores of cases increased as early as 24 to 48 hours prior to deterioration (P = 0.01). Finally, a clinical prediction rule which also accounted for the change in SOFA score was constructed and found to perform with a sensitivity of 75% and a specificity of 72%, and this performance is better than that of any SOFA scoring model based on a single set of physiologic variables. CONCLUSIONS ICU- and emergency room-based prediction scores can also be used to prognosticate risk of clinical deterioration for non-ICU ward patients. In addition, scoring models that take advantage of a score's change over time may have increased prognostic value over models that use only a single set of physiologic measurements.
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Abstract
Severity scales are important adjuncts of treatment in the intensive care unit (ICU) in order to predict patient outcome, comparing quality-of-care and stratification for clinical trials. Even though disease severity scores are not the key elements of treatment, they are however, an essential part of improvement in clinical decisions and in identifying patients with unexpected outcomes. Prediction models do face many challenges, but, proper application of these models helps in decision making at the right time and in decreasing hospital cost. In fact, they have become a necessary tool to describe ICU populations and to explain differences in mortality. However, it is also important to note that the choice of the severity score scale, index, or model should accurately match the event, setting or application; as mis-application, of such systems can lead to wastage of time, increased cost, unwarranted extrapolations and poor science. This article provides a brief overview of ICU severity scales (along with their predicted death/survival rate calculations) developed over the last 3 decades including several of them which has been revised accordingly.
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Affiliation(s)
- Amy Grace Rapsang
- Department of Anesthesiology and Intensive Care, Jawaharlal Institute of Post graduate Medical Education and Research, Dhanvantari Nagar, Puducherry, India
| | - Devajit C Shyam
- Department of General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
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Application of APACHE II, SAPS II, SOFA and MODS scores in predicting outcome of severe acute pancreatitis (SAP). Eur J Anaesthesiol 2014. [DOI: 10.1097/00003643-201406001-00598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sinuff T, Cook DJ, Rocker GM, Griffith LE, Walter SD, Fisher MM, Dodek PM, Sjokvist P, McDonald E, Marshall JC, Kraus PA, Levy MM, Lazar NM, Guyatt GH. DNR directives are established early in mechanically ventilated intensive care unit patients. Can J Anaesth 2014; 51:1034-41. [PMID: 15574557 DOI: 10.1007/bf03018494] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Setting treatment goals in the intensive care unit (ICU) often involves resuscitation decisions. Our objective was to study the rate of establishing do-not-resuscitate (DNR) directives, determinants, and outcomes of those directives for mechanically ventilated patients. METHODS In a multicentre observational study, we included consecutive adults with no DNR directives within 24 hr of ICU admission who were mechanically ventilated for at least 48 hr. We identified the rate with which DNR directives were established, and factors associated with these directives. RESULTS Among 765 patients, DNR directives were established for 231 (30.2%) patients; 143 (62.1%) of these were established within the first week. Factors independently associated with a DNR directive were: patient age [> or = 75 yr (hazard ratio [HR] 2.3, 95% confidence interval 1.5-3.4], 65 to 74 yr (HR 1.8, 1.2-2.7), 50 to 64 yr (HR 1.4, 1.0-2.2) relative to < 50 yr); medical rather than surgical diagnosis (HR 1.8, 1.3-2.5); multiple organ dysfunction score (HR 1.7 for each five-point increment, 1.4-2.0); physician prediction of ICU survival [< 10% (HR 15.0, 6.7-33.6)], 10 to 40% [(HR 5.0, 2.3-11.2), 41 to 60% (HR 4.0, 1.8-9.0) relative to > 90%]; and physician perception of patient preference to limit life support (no advanced life support [(HR 5.8, 3.6-9.4) or partial advanced life support (HR 3.2, 2.2-4.6) compared to full measures]. CONCLUSION One third of mechanically ventilated patients had DNR directives established early during their ICU stay after the first 24 hr of admission. The strongest predictors of DNR directives were physician prediction of low probability of survival, physician perception of patient preference to limit life support, organ dysfunction, medical diagnosis and age.
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Affiliation(s)
- Tasnim Sinuff
- Department of Medicine, McMaster University Health Sciences Center, Room 2C11, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada
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Kallur SD, Patil Bada V, Reddy P, Pandya S, Nirmalan PK. Organ dysfunction and organ failure as predictors of outcomes of severe maternal morbidity in an obstetric intensive care unit. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH : JCDR 2014; 8:OC06-8. [PMID: 24959481 DOI: 10.7860/jcdr/2014/8068.4213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 12/29/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Most of the maternal deaths are preceded by severe maternal morbidity (SMM). Organ dysfunction and organ failure may occur as part of the pathophysiologic spectrum in SMM. AIM To determine the predictive and discriminative abilities of the Sequential Organ Failure Assessment (SOFA) scores to determine outcomes in pregnant women with SMM, who were admitted to a maternal ICU. MATERIALS AND METHODS A retrospective study design was used to ascertain the diagnostic effectiveness of Sequential Organ Failure Assessment (SOFA) scores. Maximum individual SOFA scores and total maximum SOFA score were compared between women with and without SMM, and in women with SMM who survived or did not survive. Primary outcome measure of interest was maternal mortality. RESULTS A majority (n=73, 85.88%) of the 85 women in the study had obstetrics related causes. The total maximum SOFA score was significantly higher in women with SMM as compared to that in women without SMM (p<0.001). The total maximum SOFA score showed ability to discriminate pregnant women with SMM who would not survive (AUROC 0.77, 95% CI: 0.46, 1.00). The positive likelihood ratios and accuracy for total SOFA scores of ≥10 and ≥12 were 19.20 and 38.40, and 94.20% and 95.65% respectively. The post-test probabilities for maternal deaths in women with SMM for SOFA scores ≥10 and ≥12 were 60.01% and 75.01% respectively. CONCLUSION The total maximum SOFA score showed good predictive and discriminative abilities for maternal mortality in pregnant women with SMM, who were admitted to ICU.
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Affiliation(s)
| | | | - Pratibha Reddy
- Consultant, Department of Obstetrics, Fernandez Hospital , Hyderabad, India
| | - Sunil Pandya
- Head, Department of Anesthesia, Critical Care and Pain Medicine, Fernandez Hospital , Hyderabad, India
| | - Praveen K Nirmalan
- Head, Department of Woman and Child Health Research, Fernandez Hospital , Hyderabad, India
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Raj R, Skrifvars M, Bendel S, Selander T, Kivisaari R, Siironen J, Reinikainen M. Predicting six-month mortality of patients with traumatic brain injury: usefulness of common intensive care severity scores. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R60. [PMID: 24708781 PMCID: PMC4056363 DOI: 10.1186/cc13814] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 03/25/2014] [Indexed: 01/31/2023]
Abstract
Introduction The aim of this study was to evaluate the usefulness of the APACHE II (Acute Physiology and Chronic Health Evaluation II), SAPS II (Simplified Acute Physiology Score II) and SOFA (Sequential Organ Failure Assessment) scores compared to simpler models based on age and Glasgow Coma Scale (GCS) in predicting long-term outcome of patients with moderate-to-severe traumatic brain injury (TBI) treated in the intensive care unit (ICU). Methods A national ICU database was screened for eligible TBI patients (age over 15 years, GCS 3–13) admitted in 2003–2012. Logistic regression was used for customization of APACHE II, SAPS II and SOFA score-based models for six-month mortality prediction. These models were compared to an adjusted SOFA-based model (including age) and a reference model (age and GCS). Internal validation was performed by a randomized split-sample technique. Prognostic performance was determined by assessing discrimination, calibration and precision. Results In total, 1,625 patients were included. The overall six-month mortality was 33%. The APACHE II and SAPS II-based models showed good discrimination (area under the curve (AUC) 0.79, 95% confidence interval (CI) 0.75 to 0.82; and 0.80, 95% CI 0.77 to 0.83, respectively), calibration (P > 0.05) and precision (Brier score 0.166 to 0.167). The SOFA-based model showed poor discrimination (AUC 0.68, 95% CI 0.64 to 0.72) and precision (Brier score 0.201) but good calibration (P > 0.05). The AUC of the SOFA-based model was significantly improved after the insertion of age and GCS (∆AUC +0.11, P < 0.001). The performance of the reference model was comparable to the APACHE II and SAPS II in terms of discrimination (AUC 0.77; compared to APACHE II, ΔAUC −0.02, P = 0.425; compared to SAPS II, ΔAUC −0.03, P = 0.218), calibration (P > 0.05) and precision (Brier score 0.181). Conclusions A simple prognostic model, based only on age and GCS, displayed a fairly good prognostic performance in predicting six-month mortality of ICU-treated patients with TBI. The use of the more complex scoring systems APACHE II, SAPS II and SOFA added little to the prognostic performance.
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Mansour M, Galal I, Kassem E. Study of the role of different severity scores in respiratory ICU. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2013. [DOI: 10.4103/1687-8426.123995] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Lee KS, Sheen SS, Jung YJ, Park RW, Lee YJ, Chung WY, Park JH, Park KJ. Consideration of additional factors in Sequential Organ Failure Assessment score. J Crit Care 2013; 29:185.e9-185.e12. [PMID: 24262274 DOI: 10.1016/j.jcrc.2013.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 09/26/2013] [Accepted: 10/09/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE The Sequential Organ Failure Assessment (SOFA) score, originally developed to assess organ failure status, is widely used as a prognostic indicator in intensive care unit patients. Additional prognostic factors, such as age and comorbidities, may complement the predictive performance of the SOFA. METHODS In total, 1049 consecutive patients were enrolled prospectively. SOFA and other admission-based intensive care unit scores were recorded during the first 24 hours. A complemented SOFA (cSOFA) score model was constructed by adding age and comorbidity scores to the original SOFA score, based on logistic regression analysis. The predictive performance was evaluated with regard to hospital mortality by receiver operating characteristics analysis. The Hosmer-Lemeshow goodness-of-fit test was used to assess calibration of the model, and leave-one-out cross-validation was performed. RESULTS The cSOFA score (maximum 30 points) was calculated as the SOFA score (24 points) + age score (2 points) + comorbidity score (4 points). The cSOFA score model showed satisfactory calibration and cross-validation performance. The AUC (95% CI) of the cSOFA score (0.812 [0.787-0.835]) was higher than the SOFA score (0.743 [0.715-0.769], P < .0001). CONCLUSION The performance of the SOFA score to predict hospital mortality can be improved by considering age and comorbidity factors.
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Affiliation(s)
- Keu Sung Lee
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, 443-721, South Korea
| | - Seung Soo Sheen
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, 443-721, South Korea
| | - Yun Jung Jung
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, 443-721, South Korea
| | - Rae Woong Park
- Department of Medical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Young Joo Lee
- Department of Anesthesiology, Ajou University School of Medicine, Suwon, South Korea
| | - Wou Young Chung
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, 443-721, South Korea
| | - Joo Hun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, 443-721, South Korea
| | - Kwang Joo Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, 443-721, South Korea.
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von Rüden C, Woltmann A, Röse M, Wurm S, Rüger M, Hierholzer C, Bühren V. Outcome after severe multiple trauma: a retrospective analysis. J Trauma Manag Outcomes 2013; 7:4. [PMID: 23675931 PMCID: PMC3698044 DOI: 10.1186/1752-2897-7-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 05/04/2013] [Indexed: 11/25/2022]
Abstract
Background Aim of this study was to evaluate prognosis of severely injured patients. Methods All severely injured patients with an Injury Severity Score (ISS) ≥ 50 were identified in a 6-year-period between 2000 and 2005 in German Level 1 Trauma Center Murnau. Data was evaluated from German Trauma Registry and Polytrauma Outcome Chart of the German Society for Trauma Surgery and a personal interview to assess working ability and disability and are presented as average. Results 88 out of 1435 evaluated patients after severe polytrauma demonstrated an ISS ≥ 50 (6.5%), among them 23% women and 77% men. 66 patients (75%) had an ISS of 50-60, 14 (16%) 61-70, and 8 (9%) ≥ 70. In 27% of patients trauma was caused by motor bike accidents. 3.6 body regions were involved. Patients had to be operated 5.3 times and were treated 23 days in the ICU and stayed 73 days in hospital. Mortality rate was 36% and rate of multi-organ failure 28%. 15% of patients demonstrated severe senso-motoric dysfunction as well as residues of severe head injury. 25% recovered well or at least moderately. 29 out of 56 survivors answered the POLO-chart. A personal interview was performed with 13 patients. The state of health was at least moderate in 72% of patients. In 48% interpersonal problems and in 41% severe pain was observed. In 57% of patients problems with working ability regarding duration, as well as quantitative and qualitative performance were observed. Symptoms of post-traumatic stress disorder were found in 41%. The more distal the lesions were located (foot/ankle) the more functional disability affected daily life. In only 15%, working ability was not impaired. 8 out of 13 interviewed patients demonstrated complete work disability. Conclusions Even severely injured patients after multiple trauma have a good prognosis. The ISS is an established tool to assess severity and prognosis of trauma, whereas prediction of clinical outcome cannot be deducted from this score.
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Gebhardt K, Guyette FX, Doshi AA, Callaway CW, Rittenberger JC. Prevalence and effect of fever on outcome following resuscitation from cardiac arrest. Resuscitation 2013; 84:1062-7. [PMID: 23619740 DOI: 10.1016/j.resuscitation.2013.03.038] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 03/25/2013] [Accepted: 03/29/2013] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Evaluate the prevalence of fever in the first 48 h after cardiac arrest and its effect on outcomes. METHODS Review of patients treated between 1/1/2005 and 6/30/2010. Fever was defined as T ≥ 38.0°C. We classified categories of post-cardiac arrest illness severity as (I) awake, (II) coma+mild cardiopulmonary dysfunction (SOFA cardiac+respiratory score <4), (III) coma+moderate-severe cardiopulmonary dysfunction, and (IV) deep coma. Associations between fever and survival or good neurologic outcome were examined between hypothermia (TH) and non-TH groups. RESULTS In 336 patients, mean age was 60 years (SD 16), 63% experienced out-of-hospital cardiac arrest and 65% received TH. A shockable rhythm was present in 40%. Post arrest illness severity was category II in 38%, category III in 20%, and category IV in 42%. Fever was present in 42% of subjects, with a post-arrest median onset of 15 h in the non-TH cohort and 36 h in TH cohort. Fever was not associated with survival within the whole cohort (OR 0.32, CI 0.15, 0.68) or TH cohort (OR 1.21, CI 0.69, 2.14), but was associated with survival in non-TH cohort (OR 0.47, CI 0.20, 1.10). Fever was not associated with good outcomes in the whole cohort (OR 0.83, CI 0.49, 1.40), TH cohort (OR 1.09, CI 0.56, 2.12) or non-TH cohort (OR 0.34, CI 0.11, 1.06). CONCLUSIONS The development of fever within the first 48 h after ROSC is common. Fever is associated with death in non-TH patients. TH treatment appears to mitigate this effect, perhaps by delaying fever onset.
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Affiliation(s)
- Kory Gebhardt
- Northwestern University, Department of Emergency Medicine, United States
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Schneider AG, Lipcsey M, Bailey M, Pilcher DV, Bellomo R. Simple translational equations to compare illness severity scores in intensive care trials. J Crit Care 2013; 28:885.e1-8. [PMID: 23566728 DOI: 10.1016/j.jcrc.2013.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 01/20/2013] [Accepted: 02/04/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE Comparison of illness severity for intensive care unit populations assessed according to different scoring systems should increase our ability to compare and meta-analyze past and future trials but is currently not possible. Accordingly, we aimed to establish a methodology to translate illness severity scores obtained from one system into another. MATERIALS AND METHODS Using the Australian and New-Zealand intensive care adult patient database, we obtained simultaneous admission Acute Physiology and Chronic Health Evaluation (APACHE) II and APACHE III scores and Simplified Acute Physiology Score (SAPS) II in 634428 patients admitted to 153 units between 2001 and 2010. We applied linear regression analyses to create models enabling translation of one score into another. Sensitivity analyses were performed after removal of diagnostic categories excluded from the original APACHE database, after matching for similar risk of death, after splitting data according to country of origin (Australia or New Zealand) and after splitting admissions occurring before or after 2006. RESULTS The translational models were APACHE III=3.08×APACHE II+5.75; APACHE III=1.47×SAPS II+8.6; and APACHE II=0.36×SAPS II+4.4. The area under the receiver operating curve for mortality prediction was 0.853 (95% confidence interval, 0.851-0.855) for the "APACHE II derived APACHE III" score and 0.854 (0.852-0.855) for the "SAPS II derived APACHE III" vs 0.854 (0.852-0.855) for the original APACHE III score. Similarly, it was 0.841 (0.839-0.843) for the "SAPS II derived APACHE II score" vs 0.842 (0.840-0.843) for the original APACHE II score. Correlation coefficients as well as intercepts remained very similar in all subgroups analyses. CONCLUSIONS Simple and robust translational formulas can be developed to allow clinicians to compare illness severity between studies involving critically ill patients. Further studies in other countries and health care systems are needed to confirm the generalizability of these results.
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Affiliation(s)
- Antoine G Schneider
- Department of Intensive Care, Austin Health, Intensive Care Unit, Heidelberg, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Center, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
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Wertz J, Doshi AA, Guyette FX, Callaway CW, Rittenberger JC. Thrombin-antithrombin levels are associated with survival in patients resuscitated from cardiac arrest. Resuscitation 2013; 84:1400-3. [PMID: 23523825 DOI: 10.1016/j.resuscitation.2013.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/25/2013] [Accepted: 03/11/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Following successful resuscitation from cardiac arrest, a prothrombotic state may contribute to end-organ dysfunction. We examined whether the level of serum thrombin-antithrombin (TAT) in patients hospitalized after cardiac arrest was associated with survival or the development of multiple organ failure (MOF). METHODOLOGY A prospective cohort study of subjects with in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) treated between 1/1/2007 and 5/30/2010 at a single tertiary care referral center. TAT levels were measured at hospital arrival and 24h after cardiac arrest. Logistic regression was used to determine associations between TAT levels and survival and development of MOF. RESULTS Data were available for 86 subjects. TAT levels decreased over time. Initial TAT levels (OR 0.03; 95%CI 0.001, 0.62) and category of illness severity (OR 0.39; 95% CI 0.21, 0.73) were associated with survival. Male gender (OR 3.86; 95% CI 1.17, 12.75) and category of illness severity (OR 1.86; 95% CI 1.09, 3.20), but not TAT levels were associated with development of MOF. Neither the 24-h TAT level, nor the change in TAT from initial to 24h was associated with survival when adjusted for category of illness severity. CONCLUSIONS Initial serum TAT levels and category of illness severity are associated with survival. TAT levels are not associated with development of MOF. Initial TAT levels may be a useful prognostic adjunct in the post arrest population.
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Affiliation(s)
- Jonathon Wertz
- University of Pittsburgh Department of Medicine, United States
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Yavuz L, Aynali G, Aynali A, Alaca A, Kutuk S, Ceylan BG. The effects of adjuvant immunoglobulin M-enriched immunoglobulin therapy on mortality rate and renal function in sepsis-induced multiple organ dysfunction syndrome: retrospective analysis of intensive care unit patients. J Int Med Res 2013; 40:1166-74. [PMID: 22906291 DOI: 10.1177/147323001204000337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To determine the effect of immunoglobulin (Ig)M-enriched Ig therapy on mortality rate and renal function in sepsis-induced multiple organ dysfunction syndrome (MODS), using the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. METHODS Retrospective study of patients with sepsis-induced MODS treated with standard antibiotic plus supportive therapy (control group) or IgM-enriched Ig therapy adjuvant to control group therapy (IVIg group). Total length of stay in the intensive care unit (ICU), overall mortality rate and 28-day case fatality rate (CFR), as well as APACHE II scores and renal function parameters at day 1 and day 4 of therapy, were recorded. RESULTS A total of 118 patients were included (control group, n = 62; IVIg group, n = 56). In both groups, day 4 APACHE II scores decreased significantly compared with day 1 scores; the effect of treatment on renal function was minimal. Length of ICU stay, overall mortality rate and 28-day CFR were significantly lower in the IVIg group compared with the control group. CONCLUSIONS Adding IgM-enriched Ig therapy to standard therapy for MODS improved general clinical conditions and significantly reduced APACHE II scores, overall mortality rate and 28-day CFR, although effects on renal function were minimal.
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Affiliation(s)
- L Yavuz
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey.
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