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Weir TE, Bihari S. Factors associated with intubation in patients with acute hypoxaemic respiratory failure treated with high-flow nasal cannula oxygen therapy: A prospective, observational study. Aust Crit Care 2024; 37:455-460. [PMID: 37230828 DOI: 10.1016/j.aucc.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND High-flow nasal cannula (HFNC) oxygen is an alternative to conventional oxygen in acute hypoxaemic respiratory failure. Some patients require intubation, with a risk of delay; thus, early predictors may identify those requiring earlier intubation. The "ROX" index (ratio of pulse oximetry/fraction of inspired oxygen to respiratory rate) predicts intubation in patients with pneumonia treated with HFNC therapy, but this index has not been validated in non-pneumonia causes of acute hypoxaemic respiratory failure. AIM/OBJECTIVE The aim of this study was to identify factors associated with intubation in a heterogeneous group of patients with acute hypoxaemic respiratory failure treated with HFNC oxygen. METHODS This prospective observational study was undertaken in an Australian tertiary intensive care unit and included patients over 18 y of age with acute hypoxaemic respiratory failure who were treated with oxygen via HFNC. Vital signs and arterial blood gases were recorded prospectively at baseline and regular prespecified intervals for 48 h after HFNC initiation. Multivariate logistic regression was used to identify the factors associated with intubation. RESULTS Forty-three patients were included (N = 43). The multivariate factors associated with intubation were admission Sequential Organ Failure Assessment score (odds ratio [OR]: 1.94 [95% confidence interval {CI}: 1.06-3.57]; p = 0.032) and Pneumonia Severity Index (OR: 0.95 [95% CI: 0.90-0.99]; p = 0.034). The ROX index was not independently associated with intubation when adjusted for Sequential Organ Failure Assessment score (OR: 0.71 [95% CI: 0.47-1.06]; p = 0.09). There was no difference in mortality between patients intubated early (<24 h) compared to those intubated late. CONCLUSIONS Intubation was associated with admission Sequential Organ Failure Assessment score and Pneumonia Severity Index. The ROX index was not associated with intubation when adjusted for admission Sequential Organ Failure Assessment score. Outcomes were similar irrespective of whether patients were intubated late rather than early.
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Affiliation(s)
- Timothy E Weir
- Intensive and Critical Care Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, Australia.
| | - Shailesh Bihari
- Intensive and Critical Care Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, Australia; Department of Critical Care Medicine, Flinders University, Bedford Park, SA, Australia
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Buzatti KC, Petroianu A, Laurberg S, Silva RG, Rodrigues BD, Christensen P, Lacerda-Filho A, Juul T. Validation of low anterior resection syndrome score in Brazil with Portuguese. Ann Coloproctol 2023; 39:402-409. [PMID: 35569837 PMCID: PMC10626332 DOI: 10.3393/ac.2022.00136.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE This study was performed to investigate the convergent validity, discriminative validity, and reliability of the Brazilian version of the low anterior resection syndrome (LARS) score in a population with low educational and socioeconomic levels. METHODS The LARS score was translated into the Portuguese language by forward- and back-translation procedures. In total, 127 patients from a public hospital in Brazil completed the questionnaires. The convergent validity was tested by comparing the LARS score with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core Module 30 (QLQ-C30) and with patients' self-reported quality of life. For the discriminative validity, we tested the ability of the score to differentiate among subgroups of patients regarding neoadjuvant radiotherapy, type of surgery, and tumor distance from the anal verge. The test-retest reliability was investigated in a subgroup of 36 patients who responded to the survey twice in 2 weeks. RESULTS The LARS score demonstrated a strong correlation with 5 of 6 items from the EORTC QLQ-C30 (P<0.05) and good concordance with patients' self-reported quality of life (95.3%), confirming the convergent validity. The score was able to discriminate between subgroups of patients with different clinical characteristics related to LARS (P<0.001). The agreement between the test and retest showed that 86.1% of the patients remained in the same LARS category, and there was no significant difference between the LARS score numerical values (P=0.80), indicating good reliability overall. CONCLUSION The Brazilian version of the LARS score is a valid and reliable instrument to assess postoperative bowel function in a population with low educational and socioeconomic levels.
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Affiliation(s)
- Kelly C.L.R. Buzatti
- Departament of Surgery, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Andy Petroianu
- Departament of Surgery, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Søren Laurberg
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Rodrigo G. Silva
- Departament of Surgery, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Beatriz D.S. Rodrigues
- Departament of Surgery, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Antonio Lacerda-Filho
- Departament of Surgery, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Therese Juul
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
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Stösser S, Kleusch L, Schenk A, Schmid M, Petzold GC. Derivation and validation of a screening tool for stroke-associated sepsis. Neurol Res Pract 2023; 5:32. [PMID: 37438794 DOI: 10.1186/s42466-023-00258-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/16/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Post-stroke infections may cause sepsis, which is associated with poor clinical outcome. Sepsis is defined by life-threatening organ dysfunction that can be identified using the Sequential Organ Failure Assessment (SOFA) score. The applicability of the SOFA score for patients not treated on an intensive care unit (ICU) is limited. The aim of this study was to develop and validate an easier-to-use modification of the SOFA score for stroke patients. METHODS Using a registry-based cohort of 212 patients with large vessel occlusion stroke and infection, potential predictors of a poor outcome indicating sepsis were assessed by logistic regression. The derived score was validated on a separate cohort of 391 patients with ischemic stroke and infection admitted to our hospital over a period of 1.5 years. RESULTS The derived Stroke-SOFA (S-SOFA) score included the following predictors: National Institutes of Health stroke scale ≥ 14, peripheral oxygen saturation < 90%, mean arterial pressure < 70 mmHg, thrombocyte count < 150 109/l and creatinine ≥ 1.2 mg/dl. The area under the receiver operating curve for the prediction of a poor outcome indicating sepsis was 0.713 [95% confidence interval: 0.665-0.762] for the S-SOFA score, which was comparable to the standard SOFA score (0.750 [0.703-0.798]), but the prespecified criteria for non-inferiority were not met (p = 0.115). However, the S-SOFA score was non-inferior compared to the SOFA score in non-ICU patients (p = 0.013). CONCLUSIONS The derived S-SOFA score may be useful to identify non-ICU patients with stroke-associated sepsis who have a high risk of a poor outcome.
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Affiliation(s)
- Sebastian Stösser
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Lisa Kleusch
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alina Schenk
- Institute of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, Bonn, Germany
| | - Matthias Schmid
- Institute of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, Bonn, Germany
| | - Gabor C Petzold
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
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Tang X, Li H, Deng G, Zheng X, Wang X, Huang Y, Gao Y, Meng Z, Qian Z, Liu F, Lu X, Shi Y, Li B, Gu W, Xiang X, Xiong Y, Hou Y, Chen J, Gao N, Luo S, Ji L, Li J, Zheng R, Ren H, Chen J. New Algorithm Rules Out Acute-on-chronic Liver Failure Development within 28 Days from Acute Decompensation of Cirrhosis. J Clin Transl Hepatol 2023; 11:550-559. [PMID: 36969896 PMCID: PMC10037523 DOI: 10.14218/jcth.2022.00196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/27/2022] [Accepted: 07/16/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS Approximately 10% of patients with acute decompensated (AD) cirrhosis develop acute-on-chronic liver failure (ACLF) within 28 days. Such cases have high mortality and are difficult to predict. Therefore, we aimed to establish and validate an algorithm to identify these patients on hospitalization. METHODS Hospitalized patients with AD who developed ACLF within 28 days were considered pre-ACLF. Organ dysfunction was defined according to the chronic liver failure-sequential organ failure assessment (CLIF-SOFA) criteria, and proven bacterial infection was taken to indicate immune system dysfunction. A retrospective multicenter cohort and prospective one were used to derive and to validate the potential algorithm, respectively. A miss rate of <5% was acceptable for the calculating algorithm to rule out pre-ACLF. RESULTS In the derivation cohort (n=673), 46 patients developed ACLF within 28 days. Serum total bilirubin, creatinine, international normalized ratio, and present proven bacterial infection at admission were associated with the development of ACLF. AD patients with ≥2 organ dysfunctions had a higher risk for pre-ACLF patients [odds ratio=16.581 95% confidence interval: (4.271-64.363), p<0.001]. In the derivation cohort, 67.5% of patients (454/673) had ≤1 organ dysfunction and two patients (0.4%) were pre-ACLF, with a miss rate of 4.3% (missed/total, 2/46). In the validation cohort, 65.9% of patients (914/1388) had ≤1 organ dysfunction, and four (0.3%) of them were pre-ACLF, with a miss rate of 3.4% (missed/total, 4/117). CONCLUSIONS AD patients with ≤1 organ dysfunction had a significantly lower risk of developing ACLF within 28 days of admission and could be safely ruled out with a pre-ACLF miss rate of <5%.
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Affiliation(s)
- Xiaoting Tang
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hai Li
- Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China
| | - Guohong Deng
- Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xin Zheng
- Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xianbo Wang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yan Huang
- Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanhang Gao
- Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhongji Meng
- Department of Infectious Diseases, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Zhiping Qian
- Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Feng Liu
- Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Xiaobo Lu
- Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Yu Shi
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Hangzhou, Zhejiang, China
- National Clinical Research Center of Infectious Disease, Hangzhou, Zhejiang, China
| | - Beiling Li
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Wenyi Gu
- Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China
| | - Xiaomei Xiang
- Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yan Xiong
- Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yixin Hou
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jun Chen
- Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Na Gao
- Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Sen Luo
- Department of Infectious Diseases, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Liujuan Ji
- Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jing Li
- Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Rongjiong Zheng
- Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Haotang Ren
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Hangzhou, Zhejiang, China
- National Clinical Research Center of Infectious Disease, Hangzhou, Zhejiang, China
| | - Jinjun Chen
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Hepatology Unit, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Correspondence to: Jinjun Chen, Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China. ORCID: https://orcid.org/0000-0003-4275-9149. Tex/Fax: +86-20-62787423, E-mail:
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Terres AZ, Balbinot RS, Muscope ALF, Longen ML, Schena B, Cini BT, Rost Jr GL, Balensiefer JIL, Eberhardt LZ, Balbinot RA, Balbinot SS, Soldera J. Acute-on-chronic liver failure is independently associated with higher mortality for cirrhotic patients with acute esophageal variceal hemorrhage: Retrospective cohort study. World J Clin Cases 2023; 11:4003-4018. [PMID: 37388802 PMCID: PMC10303600 DOI: 10.12998/wjcc.v11.i17.4003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/15/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Acute esophageal variceal hemorrhage (AEVH) is a common complication of cirrhosis and might precipitate multi-organ failure, causing acute-on-chronic liver failure (ACLF).
AIM To analyze if the presence and grading of ACLF as defined by European Society for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) is able to predict mortality in cirrhotic patients presenting AEVH.
METHODS Retrospective cohort study executed in Hospital Geral de Caxias do Sul. Data from medical records from 2010 to 2016 were obtained by searching the hospital electronic database for patients who received terlipressin. Medical records were reviewed in order to determine the diagnosis of cirrhosis and AEVH, including 97 patients. Kaplan-Meier survival analysis was used for univariate analysis and a stepwise approach to the Cox regression for multivariate analysis.
RESULTS All- cause mortality for AEVH patients was 36%, 40.2% and 49.4% for 30-, 90- and 365-day, respectively. The prevalence of ACLF was 41.3%. Of these, 35% grade 1, 50% grade 2 and 15% grade 3. In multivariate analysis, the non-use of non-selective beta-blockers, presence and higher grading of ACLF and higher Model for End-Stage Liver Disease scores were independently associated with higher mortality for 30-day with the addition of higher Child-Pugh scores for 90-day period.
CONCLUSION Presence and grading of ACLF according to the EASL-CLIF criteria was independently associated with higher 30- and 90-day mortality in cirrhotic patients admitted due to AEVH.
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Affiliation(s)
- Alana Zulian Terres
- Clinical Gastroenterology, Universidade de Caxias do Sul, Caxias do Sul 95020-002, Brazil
| | | | | | - Morgana Luisa Longen
- School of Medicine, Universidade de Caxias do Sul, Caxias do Sul 95020-002, Brazil
| | - Bruna Schena
- School of Medicine, Universidade de Caxias do Sul, Caxias do Sul 95020-002, Brazil
| | - Bruna Teston Cini
- School of Medicine, Universidade de Caxias do Sul, Caxias do Sul 95020-002, Brazil
| | | | | | | | - Raul Angelo Balbinot
- Clinical Gastroenterology, Universidade de Caxias do Sul, Caxias do Sul 95020-002, Brazil
| | | | - Jonathan Soldera
- Department of Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
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Chung YH, Jung J, Kim SH. Mortality scoring systems for liver transplant recipients: before and after model for end-stage liver disease score. Anesth Pain Med (Seoul) 2023; 18:21-28. [PMID: 36746898 PMCID: PMC9902634 DOI: 10.17085/apm.22258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/13/2023] [Indexed: 02/01/2023] Open
Abstract
The mortality scoring systems for patients with end-stage liver disease have evolved from the Child-Turcotte-Pugh score to the model for end-stage liver disease (MELD) score, affecting the wait list for liver allocation. There are inherent weaknesses in the MELD score, with the gradual decline in its accuracy owing to changes in patient demographics or treatment options. Continuous refinement of the MELD score is in progress; however, both advantages and disadvantages exist. Recently, attempts have been made to introduce artificial intelligence into mortality prediction; however, many challenges must still be overcome. More research is needed to improve the accuracy of mortality prediction in liver transplant recipients.
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Affiliation(s)
| | | | - Sang Hyun Kim
- Corresponding Author: Sang Hyun Kim, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea Tel: 82-32-621-5328 Fax: 82-32-621-5322 E-mail:
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Lee HJ, Ko BS, Ryoo SM, Han E, Suh GJ, Choi SH, Chung SP, Lim TH, Kim WY, Kwon WY, Hwang SY, Jo YH, Shin J, Shin TG, Kim K, Chung TN, Lee JH, Kim KS, Park YS, Yoon YH, Choi HS, Han KS, Kang G, Kim YJ, Cho H. Modified cardiovascular SOFA score in sepsis: development and internal and external validation. BMC Med 2022; 20:263. [PMID: 35989336 PMCID: PMC9394016 DOI: 10.1186/s12916-022-02461-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Sepsis-3 criteria introduced the system that uses the Sequential Organ-Failure Assessment (SOFA) score to define sepsis. The cardiovascular SOFA (CV SOFA) scoring system needs modification due to the change in guideline-recommended vasopressors. In this study, we aimed to develop and to validate the modified CV SOFA score. METHODS We developed, internally validated, and externally validated the modified CV SOFA score using the suspected infection cohort, sepsis cohort, and septic shock cohort. The primary outcome was 28-day mortality. The modified CV SOFA score system was constructed with consideration of the recently recommended use of the vasopressor norepinephrine with or without lactate level. The predictive validity of the modified SOFA score was evaluated by the discrimination for the primary outcome. Discrimination was assessed using the area under the receiver operating characteristics curve (AUC). Calibration was assessed using the calibration curve. We compared the prognostic performance of the original CV/total SOFA score and the modified CV/total SOFA score to detect mortality in patients with suspected infection, sepsis, or septic shock. RESULTS We identified 7,393 patients in the suspected cohort, 4038 patients in the sepsis cohort, and 3,107 patients in the septic shock cohort in seven Korean emergency departments (EDs). The 28-day mortality rates were 7.9%, 21.4%, and 20.5%, respectively, in the suspected infection, sepsis, and septic shock cohorts. The model performance is higher when vasopressor and lactate were used in combination than the vasopressor only used model. The modified CV/total SOFA score was well-developed and internally and externally validated in terms of discrimination and calibration. Predictive validity of the modified CV SOFA was significantly higher than that of the original CV SOFA in the development set (0.682 vs 0.624, p < 0.001), test set (0.716 vs 0.638), and all other cohorts (0.648 vs 0.557, 0.674 vs 0.589). Calibration was modest. In the suspected infection cohort, the modified model classified more patients to sepsis (66.0 vs 62.5%) and identified more patients at risk of septic mortality than the SOFA score (92.6 vs 89.5%). CONCLUSIONS Among ED patients with suspected infection, sepsis, and septic shock, the newly-developed modified CV/total SOFA score had higher predictive validity and identified more patients at risk of septic mortality.
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Affiliation(s)
- Hui Jai Lee
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Byuk Sung Ko
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, University of Ulsan College of Medicine Asan Medical Center, Seoul, South Korea
| | - Eunah Han
- Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Gil Joon Suh
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Sung-Hyuk Choi
- Department of Emergency Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine Asan Medical Center, Seoul, South Korea
| | - Woon Yong Kwon
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - You Hwan Jo
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jonghwan Shin
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Kyuseok Kim
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Gyeonggi-Do, South Korea.
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Nishimoto Y, Ohbe H, Matsui H, Nakajima M, Sasabuchi Y, Goto T, Morita K, Fushimi K, Sato Y, Yasunaga H. Predictive ability of the sequential organ failure assessment score for in-hospital mortality in patients with cardiac critical illnesses: a nationwide observational study. Eur Heart J Acute Cardiovasc Care 2022; 11:312-321. [PMID: 35156119 DOI: 10.1093/ehjacc/zuac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/10/2022] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
AIMS Several studies have reported a high predictive ability of the Sequential Organ Failure Assessment (SOFA) score for in-hospital mortality specifically for patients with cardiac critical illnesses, however, differences according to the admission classification (surgical or non-surgical) are unknown. The present study aimed to evaluate the predictive ability of the SOFA score in surgical and non-surgical patients with cardiac critical illnesses. METHODS AND RESULTS Using the Japanese nationwide Diagnosis Procedure Combination database, we identified patients with cardiac critical illnesses, defined as patients admitted to the intensive care unit (ICU) and treated by cardiologists or cardiovascular surgeons as their physicians in charge from April 2018 to March 2020. The discriminatory ability of the SOFA score for in-hospital mortality was assessed by calculating the area under the receiver operating characteristic curve (AUROC). Among 52 819 eligible patients with available data on their SOFA scores, 33 526 (64%) were postoperative cardiac surgeries. The median SOFA score on ICU admission was 5.0 (interquartile range, 2.0-8.0) and overall in-hospital mortality 6.8%. The AUROC of the SOFA score was 0.75 [95% confidence interval (CI), 0.75-0.76]. In the subgroup analyses, the AUROCs were 0.76 (95% CI, 0.74-0.77) in the surgical patients, 0.83 (95% CI, 0.83-0.84) in the non-surgical patients, and 0.88 (95% CI, 0.87-0.89) in the non-surgical acute coronary syndrome patients. CONCLUSIONS The predictive ability of the SOFA score on the day of ICU admission for in-hospital mortality was confirmed to be acceptable in the patients with cardiac critical illnesses and varied according to the admission classification and primary diagnoses.
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Affiliation(s)
- Yuji Nishimoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki 6608550, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan
| | - Mikio Nakajima
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan
- Emergency Life-Saving Technique Academy of Tokyo, Foundation for Ambulance Service Development, 4-6 Minamiosawa, Hachioji-shi, Tokyo 1920364, Japan
| | - Yusuke Sasabuchi
- Data Science Center, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 3290498, Japan
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan
- TXP Medical Co. Ltd., 7-3-1-252 Hongo, Bunkyo-ku, Tokyo 1138454, Japan
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 1138510, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki 6608550, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan
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Heldt S, Neuböck M, Kainzbauer N, Shao G, Tschoellitsch T, Duenser M, Kaiser B, Winkler M, Paar C, Meier J, Lamprecht B, Salzer HJF. qSOFA score poorly predicts critical progression in COVID-19 patients. Wien Med Wochenschr 2021; 172:211-219. [PMID: 34185216 PMCID: PMC8239483 DOI: 10.1007/s10354-021-00856-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Abstract
Background In December 2019, the new virus infection coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged. Simple clinical risk scores may improve the management of COVID-19 patients. Therefore, the aim of this pilot study was to evaluate the quick Sequential Organ Failure Assessment (qSOFA) score, which is well established for other diseases, as an early risk assessment tool predicting a severe course of COVID-19. Methods We retrospectively analyzed data from adult COVID-19 patients hospitalized between March and July 2020. A critical disease progress was defined as admission to intensive care unit (ICU) or death. Results Of 64 COVID-19 patients, 33% (21/64) had a critical disease progression from which 13 patients had to be transferred to ICU. The COVID-19-associated mortality rate was 20%, increasing to 39% after ICU admission. All patients without a critical progress had a qSOFA score ≤ 1 at admission. Patients with a critical progress had in only 14% (3/21) and in 20% (3/15) of cases a qSOFA score ≥ 2 at admission (p = 0.023) or when measured directly before critical progression, respectively, while 95% (20/21) of patients with critical progress had an impairment oxygen saturation (SO2) at admission time requiring oxygen supplementation. Conclusion A low qSOFA score cannot be used to assume short-term stable or noncritical disease status in COVID-19.
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Affiliation(s)
- Sven Heldt
- Department of Pulmonary Medicine, Kepler University Hospital, Krankenhausstraße 9, 4021, Linz, Austria
| | - Matthias Neuböck
- Department of Pulmonary Medicine, Kepler University Hospital, Krankenhausstraße 9, 4021, Linz, Austria
| | - Nora Kainzbauer
- Department of Pulmonary Medicine, Kepler University Hospital, Krankenhausstraße 9, 4021, Linz, Austria
| | - Guangyu Shao
- Department of Pulmonary Medicine, Kepler University Hospital, Krankenhausstraße 9, 4021, Linz, Austria
| | - Thomas Tschoellitsch
- Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital, Linz, Austria
| | - Martin Duenser
- Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital, Linz, Austria
| | - Bernhard Kaiser
- Department of Pulmonary Medicine, Kepler University Hospital, Krankenhausstraße 9, 4021, Linz, Austria
| | - Markus Winkler
- Department of Pathology and Microbiology, Kepler University Hospital, Linz, Austria
| | - Christian Paar
- Institute of Laboratory Medicine, Kepler University Hospital, Linz, Austria
| | - Jens Meier
- Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital, Linz, Austria
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler University Hospital, Krankenhausstraße 9, 4021, Linz, Austria
| | - Helmut J F Salzer
- Department of Pulmonary Medicine, Kepler University Hospital, Krankenhausstraße 9, 4021, Linz, Austria.
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Martín-Rodríguez F, Sanz-García A, Del Pozo Vegas C, Ortega GJ, Castro Villamor MA, López-Izquierdo R. Time for a prehospital-modified sequential organ failure assessment score: An ambulance-Based cohort study. Am J Emerg Med 2021; 49:331-337. [PMID: 34224955 DOI: 10.1016/j.ajem.2021.06.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To adapt the Sequential Organ Failure Assessment (SOFA) score to fit the prehospital care needs; to do that, the SOFA was modified by replacing platelets and bilirubin, by lactate, and tested this modified SOFA (mSOFA) score in its prognostic capacity to assess the mortality-risk at 2 days since the first Emergency Medical Service (EMS) contact. METHODS Prospective, multicentric, EMS-delivery, ambulance-based, pragmatic cohort study of adults with acute diseases, referred to two tertiary care hospitals (Spain), between January 1st and December 31st, 2020. The discriminative power of the predictive variable was assessed through a prediction model trained using the derivation cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC) on the validation cohort. RESULTS A total of 1114 participants comprised two separated cohorts recruited from 15 ambulance stations. The 2-day mortality rate (from any cause) was 5.9% (66 cases). The predictive validity of the mSOFA score was assessed by the calculation of the AUC of ROC in the validation cohort, resulting in an AUC of 0.946 (95% CI, 0.913-0.978, p < .001), with a positive likelihood ratio was 23.3 (95% CI, 0.32-46.2). CONCLUSIONS Scoring systems are now a reality in prehospital care, and the mSOFA score assesses multiorgan dysfunction in a simple and agile manner either bedside or en route. Patients with acute disease and an mSOFA score greater than 6 points transferred with high priority by EMS represent a high early mortality group. TRIAL REGISTRATION ISRCTN48326533, Registered Octuber 312,019, Prospectively registered (doi:https://doi.org/10.1186/ISRCTN48326533).
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Affiliation(s)
- Francisco Martín-Rodríguez
- Unidad Móvil de Emergencias Valladolid I, Gerencia de Emergencias Sanitarias, Gerencia Regional de Salud de Castilla y León (SACYL), Spain; Centro de Simulación Clínica Avanzada, Departamento de Medicina, Dermatología y Toxicología, Universidad de Valladolid, Spain.
| | - Ancor Sanz-García
- Unidad de Análisis de Datos (UAD) del Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain.
| | - Carlos Del Pozo Vegas
- Servicio de Urgencias, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Spain
| | - Guillermo J Ortega
- Unidad de Análisis de Datos (UAD) del Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
| | - Miguel A Castro Villamor
- Centro de Simulación Clínica Avanzada, Departamento de Medicina, Dermatología y Toxicología, Universidad de Valladolid, Spain
| | - Raúl López-Izquierdo
- Servicio de Urgencias, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Spain
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11
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Wang DX, Wang MK, Rochwerg B, Burns KEA. Predictive performance of SOFA & qSOFA for in-hospital mortality in patients with severe novel coronavirus disease: Correspondence. Am J Emerg Med 2021; 50:793-794. [PMID: 33722433 PMCID: PMC7939992 DOI: 10.1016/j.ajem.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Dominic Xiang Wang
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
| | - Michael Ke Wang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto - St. Michael's Hospital, Toronto, Ontario, Canada
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12
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Jiang W, Li X, Ding H, Wang K, Liu X, Wang Q, Li Y, Zhou M, Chen S, Zhong W, Li X, Zeng H. PD-1 in Tregs predicts the survival in sepsis patients using sepsis-3 criteria: A prospective, two-stage study. Int Immunopharmacol 2020; 89:107175. [PMID: 33223466 DOI: 10.1016/j.intimp.2020.107175] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The expression of Tregs co-signaling molecules serves as the marker of immune dysfunction. The present study aimed to verify their predictive role in the 28-day mortality of sepsis patients. METHODS A prospective, observational, two-stage cohort study was conducted. The patients who fulfilled the sepsis-3 criteria were enrolled, and peripheral blood samples were collected within 24 h post-enrollment. The expression of the four co-signaling molecules of Tregs, namely, PD-1, CD28, PD-L1 and CD86, was measured, and sequential organ failure assessment (SOFA) scores were recorded on day 1 of inclusion. Patients were followed up for 28 days or, otherwise, deceased. Multivariate regression analysis was used to assess the independent risk factors for 28-day mortality, and a prognostic prediction model was established, which was verified in the validation set. RESULTS A total of 292 patients were recruited in the study, of which 120 patients were finally included in the analysis, that is 58 patients in stage I (test set) and 62 patients in stage II (validation set). In stage I, 14 (24.1%), patients died during 28 days, and the expression of PD-1 in Tregs (OR:1.037;95%CI:1.003-1.071) and SOFA scores(OR:1.262;95%CI:1.046-1.524) were independent risk factors for 28-day mortality. The ability of Tregs PD-1 in predicting 28-day mortality was validated in stage II (AUC = 0.792). CONCLUSION PD-1 overexpression in Tregs was associated with poor outcomes, and PD-1 in Tregs is considered to be a valuable tool for the prediction of prognosis in septic patients using sepsis-3.0 criteria.
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13
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Pamies-Guilabert J, Del Val Antoñana A, Collado JJ, Rudenko P, Meseguer A. Pancreatic necrosis volume - A new imaging biomarker of acute pancreatitis severity. Eur J Radiol 2020; 130:109193. [PMID: 32768889 DOI: 10.1016/j.ejrad.2020.109193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/28/2020] [Accepted: 07/21/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Determine if the pancreatic necrosis volume (PNV) in computed tomography scan (CT) is a useful marker to predict the severity of acute pancreatitis (AP) comparing its predictive value with current clinical scoring systems. METHODS This retrospective study was conducted in a tertiary hospital, including patients hospitalized with AP during the period of 24 months. Demographic, clinical data, length of hospital stay and analytical parameters were collected from the hospital clinical information digital systems. Other information on the severity of the disease was also reviewed, including BISAP score, organ failure (OF) or admission to the ICU, as well as, complications during hospitalization as infected necrotic collections, surgical procedure or death. The quantification of the necrosis volume, CT severity index and Balthazar score were assessed in the CT studies. ROC curves were carried to compare the correlation between different scoring systems and the acute complications. RESULTS This study included 163 patients with AP. The calculated average value of PNV in the CT studies was 242 cc (0-1575 cc). PNV showed lineal correlation with hospital stay (Pearson 0.696) and statistically significant association with acute complications as OF, multiple organ failure, infection, need of treatment or hospitalization at ICU (P < 0.05). The optimal cut-off value for predicting complications of necrosis as infections or need of surgery treatments was 75 cc. Sensibility and specificity were 100 % and 78 %, respectively. ROC curves showed that PNV was the best radiological finding correlated with AP complications. CONCLUSION Necrosis volume is a radiological biomarker highly correlated with AP complications.
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Affiliation(s)
- Jose Pamies-Guilabert
- Medical Imaging Department, University and Polytechnic Hospital la Fe, Valencia, Spain.
| | | | - Javier Jesús Collado
- Medical Imaging Department, University and Polytechnic Hospital la Fe, Valencia, Spain.
| | - Polina Rudenko
- Medical Imaging Department, University and Polytechnic Hospital la Fe, Valencia, Spain.
| | - Angels Meseguer
- Department of Radiology, Hospital Arnau de Vilanova-Llíria, Valencia, Spain.
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14
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Vacheron CH, Friggeri A, Iwaz J, Allaouchiche B, Bohe J, Monneret G, Venet F, Cour M, Argaud L, Aubrun F, Rimmele T, Pachot A, Piriou V, Lepape A, Maucort-Boulch D. A new simplified and accurate sa-SOFA score. J Crit Care 2020; 57:240-5. [PMID: 31926636 DOI: 10.1016/j.jcrc.2019.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/30/2019] [Accepted: 11/14/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE Several remarks have been raised regarding the variables and cut-points used in the Sequential Organ Failure Assessment (SOFA) score. This study revisited the SOFA score and created a new simplified and accurate sa-SOFA score. METHODS The study grouped four prospective cohorts (2005-2016) of patients with Systemic Inflammatory Response Syndrome. It collected 28-day mortality, sociodemographic characteristics, and the SOFA score with all variable values at Day 1. A logistic regression analysis was used to select the most relevant variables and a minimum p value approach with a 10-fold cross-validation were used to find the optimal partition of selected variables. The minimum number of cut-points (2, 3, or 4) was also tested by comparing the distributions of areas under receiver operating characteristic (AUROC) curves. RESULTS Among the 1436 participants, 416 died within 28 days (28.9%). The sa-SOFA kept one variable per dimension and two cut-points per variable. The AUROC curves that investigated the abilities of the sa-SOFA and SOFA scores to predict 28-day mortality were 0.739 [0.712-0.768] and 0.687 [0.656-0.717], respectively (p-value of DeLong test <0.001). CONCLUSION Keeping the conventional SOFA dimension variables, the new sa-SOFA proved to be simpler and more accurate in predicting 28-day mortality.
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15
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Lee J, Song JU. Performance of a quick sofa-65 score as a rapid sepsis screening tool during initial emergency department assessment: A propensity score matching study. J Crit Care 2019; 55:1-8. [PMID: 31670148 DOI: 10.1016/j.jcrc.2019.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/04/2019] [Accepted: 09/16/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE We sought to elucidate the performance of a Quick Sequential Organ Function Assessment-65 (qSOFA-65) score in recognizing sepsis and to compare the qSOFA-65 score to systemic inflammatory response syndrome (SIRS) and qSOFA scores. METHODS We performed a matched case-control study using propensity score matching. The number of patients meeting qSOFA-65, qSOFA, and SIRS positive criteria were calculated between the sepsis and non-sepsis groups. We compared the diagnostic performance of the three scoring systems in predicting sepsis. RESULTS A total of 2441 patients were included in the study. In propensity matched cohorts, the percentage of patients who met qSOFA-65, qSOFA, and SIRS positive criteria were 46.7%, 14.3%, and 55.6%, respectively. The sensitivity and specificity scores for the qSOFA-65, qSOFA, and SIRS positive criteria for sepsis were 0.66 and 0.73, 0.28 and 0.97, and 0.66 and 0.55, respectively. The AUC value of qSOFA-65 positive criteria in predicting sepsis was significantly higher than that of qSOFA and SIRS positive criteria (adjusted AUC 0.688 vs. 0.630 vs. 0.596, respectively). CONCLUSIONS We found that qSOFA-65 was more likely to identify patients with sepsis on the initial ED visit relative to qSOFA or SIRS. This may have quality improvement implications in predicting sepsis.
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Affiliation(s)
- Jonghoo Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea.
| | - Jae-Uk Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Zinter MS, Logan BR, Fretham C, Sapru A, Abraham A, Aljurf MD, Arnold SD, Artz A, Auletta JJ, Chhabra S, Copelan E, Duncan C, Gale RP, Guinan E, Hematti P, Keating AK, Marks DI, Olsson R, Savani BN, Ustun C, Williams KM, Pasquini MC, Dvorak CC. Comprehensive Prognostication in Critically Ill Pediatric Hematopoietic Cell Transplant Patients: Results from Merging the Center for International Blood and Marrow Transplant Research (CIBMTR) and Virtual Pediatric Systems (VPS) Registries. Biol Blood Marrow Transplant 2020; 26:333-42. [PMID: 31563573 DOI: 10.1016/j.bbmt.2019.09.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/29/2019] [Accepted: 09/23/2019] [Indexed: 12/26/2022]
Abstract
Critically ill pediatric allogeneic hematopoietic cell transplant (HCT) patients may benefit from early and aggressive interventions aimed at reversing the progression of multiorgan dysfunction. Therefore, we evaluated 25 early risk factors for pediatric intensive care unit (PICU) mortality to improve mortality prognostication. We merged the Virtual Pediatric Systems and Center for International Blood and Marrow Transplant Research databases and analyzed 936 critically ill patients ≤21 years of age who had undergone allogeneic HCT and subsequently required PICU admission between January 1, 2009, and December 31, 2014. Of 1532 PICU admissions, the overall PICU mortality rate was 17.4% (95% confidence interval [CI], 15.6% to 19.4%) but was significantly higher for patients requiring mechanical ventilation (44.0%), renal replacement therapy (56.1%), or extracorporeal life support (77.8%). Mortality estimates increased significantly the longer that patients remained in the PICU. Of 25 HCT- and PICU-specific characteristics available at or near the time of PICU admission, moderate/severe pre-HCT renal injury, pre-HCT recipient cytomegalovirus seropositivity, <100-day interval between HCT and PICU admission, HCT for underlying acute myeloid leukemia, and greater admission organ dysfunction as approximated by the Pediatric Risk of Mortality 3 score were each independently associated with PICU mortality. A multivariable model using these components identified that patients in the top quartile of risk had 3 times greater mortality than other patients (35.1% versus 11.5%, P < .001, classification accuracy 75.2%; 95% CI, 73.0% to 77.4%). These data improve our working knowledge of the factors influencing the progression of critical illness in pediatric allogeneic HCT patients. Future investigation aimed at mitigating the effect of these risk factors is warranted.
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Garbero RDF, Simões AA, Martins GA, Cruz LVD, von Zuben VGM. SOFA and qSOFA at admission to the emergency department: Diagnostic sensitivity and relation with prognosis in patients with suspected infection. Turk J Emerg Med 2019; 19:106-110. [PMID: 31321343 PMCID: PMC6612625 DOI: 10.1016/j.tjem.2019.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/25/2019] [Accepted: 05/29/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate the adequacy of SOFA and qSOFA for predicting unfavorable outcomes, and of qSOFA as a screening tool for sepsis in patients admitted to the emergency department (ED) of a Brazilian public hospital. METHODS This was a single-center retrospective study conducted on a cohort of patients admitted to a Brazilian public hospital between August 2016 and November 2017 due to suspected infection. Exclusion criteria were: age <18 years, admission to the ED after 24 h of hospitalization, lack of information in the medical records, advanced comorbidities, or request of limited invasive care. RESULTS A total of 184 patients were included; 84.24% had a SOFA score of 2 or higher. The relative risk of death, need for intensive care unit (ICU) and mechanical ventilation (MV) related to a positive SOFA on admission were: 5.17 (2.11-12.87), 1.45 (1.09-2.15) and 2.74 (1.63-5.16), respectively; sensitivity was 93.7% for death, 88.5% for ICU need and 93.6% for undergoing MV. The mean length of hospital stay was 38.83 days for patients with a positive SOFA score and 8.95 days for patients with a negative score (p = 0.02). The median SOFA value was higher for the patients who died; 41% of the patients had a positive qSOFA and its sensitivity for a positive SOFA was 46.4%. The relative risk of death, ICU and MV need related to qSOFA at admission were 1.83 (1.39-2.44), 0.98 (0.82-1.16) and 1.60 (1.23-1.97), respectively, and its sensitivity was 56.8% for death, 41.4% for ICU need and 53.6% for MV. CONCLUSION qSOFA did not perform well as a screening tool for sepsis and for predicting a poor prognosis in the ED. SOFA, on the other hand, showed reasonable sensitivity for predicting unfavorable outcomes and scores ≥2 were related to a poor prognosis.
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Umemura Y, Ogura H, Gando S, Shiraishi A, Saitoh D, Fujishima S, Mayumi T, Kushimoto S, Abe T, Shiino Y, Nakada TA, Tarui T, Hifumi T, Otomo Y, Okamoto K, Kotani J, Sakamoto Y, Sasaki J, Shiraishi SI, Takuma K, Tsuruta R, Hagiwara A, Masuno T, Takeyama N, Yamashita N, Ikeda H, Ueyama M, Yamakawa K; Japanese Association for Acute Medicine (JAAM) Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) Study Group. Prognostic Accuracy of Quick SOFA is different according to the severity of illness in infectious patients. J Infect Chemother 2019; 25:943-9. [PMID: 31182332 DOI: 10.1016/j.jiac.2019.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/25/2019] [Accepted: 05/15/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sepsis-3 proposed the quick Sequential Organ Failure Assessment (qSOFA) to identify sepsis patients likely to have poor outcome. The clinical utility of qSOFA still remains controversial because its predictive accuracy for mortality is quite different across the validation studies. We hypothesized that one of the major causes for these controversial findings was the heterogeneity in severity across the studies, and evaluated the association between severity of illness and the prognostic accuracy of qSOFA. MATERIALS AND METHODS This was a post hoc analysis of a prospective nationwide cohort of consecutive adult patients with sepsis in 59 intensive care units in Japan. Regression trees analysis for survival was used to classify patients according to severity of illness as determined by SOFA score on registration. We conducted receiver operating characteristic (ROC) analyses and evaluated the differences in the area under the ROC curve (AUROC). As a subgroup analysis, we conducted the above evaluations in emergency department (ED) and non-ED patients separately. RESULTS We included 1114 patients fulfilling the criteria and classified them into three subsets according to severity. The AUROC for mortality was significantly different according to the severity of illness (p = 0.007), with the highest AUROC being in the low-severity subset (patients with SOFA score ≤ 7). Interestingly, our subgroup analysis revealed that a significant difference in the AUROC of qSOFA was observed only in ED patients. CONCLUSION This study suggested that lower severity of illness was associated with the relatively higher prognostic accuracy of qSOFA, especially in ED patients.
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Soo A, Zuege DJ, Fick GH, Niven DJ, Berthiaume LR, Stelfox HT, Doig CJ. Describing organ dysfunction in the intensive care unit: a cohort study of 20,000 patients. Crit Care 2019; 23:186. [PMID: 31122276 PMCID: PMC6533687 DOI: 10.1186/s13054-019-2459-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/26/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Multiple organ dysfunction is a common cause of morbidity and mortality in intensive care units (ICUs). Original development of the Sequential Organ Failure Assessment (SOFA) score was not to predict outcome, but to describe temporal changes in organ dysfunction in critically ill patients. Organ dysfunction scoring may be a reasonable surrogate outcome in clinical trials but further exploration of the impact of case mix on the temporal sequence of organ dysfunction is required. Our aim was to compare temporal changes in SOFA scores between hospital survivors and non-survivors. METHODS We performed a population-based observational retrospective cohort study of critically ill patients admitted from January 1, 2004, to December 31, 2013, to 4 multisystem adult intensive care units (ICUs) in Calgary, Canada. The primary outcome was temporal changes in daily SOFA scores during the first 14 days of ICU admission. SOFA scores were modeled between hospital survivors and non-survivors using generalized estimating equations (GEE) and were also stratified by admission SOFA (≤ 11 versus > 11). RESULTS The cohort consisted of 20,007 patients with at least one SOFA score and was mostly male (58.2%) with a median age of 59 (interquartile range [IQR] 44-72). Median ICU length of stay was 3.5 (IQR 1.7-7.5) days. ICU and hospital mortality were 18.5% and 25.5%, respectively. Temporal change in SOFA scores varied by survival and admission SOFA score in a complicated relationship. Area under the receiver operating characteristic (ROC) curve using admission SOFA as a predictor of hospital mortality was 0.77. The hospital mortality rate was 5.6% for patients with an admission SOFA of 0-2 and 94.4% with an admission SOFA of 20-24. There was an approximately linear increase in hospital mortality for SOFA scores of 3-19 (range 8.7-84.7%). CONCLUSIONS Examining the clinical course of organ dysfunction in a large non-selective cohort of patients provides insight into the utility of SOFA. We have demonstrated that hospital outcome is associated with both admission SOFA and the temporal rate of change in SOFA after admission. It is necessary to further explore the impact of additional clinical factors on the clinical course of SOFA with large datasets.
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Affiliation(s)
- Andrea Soo
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada.
| | - Danny J Zuege
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Gordon H Fick
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Luc R Berthiaume
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
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Yasufumi O, Morimura N, Shirasawa A, Honzawa H, Oyama Y, Niida S, Abe T, Imaki S, Takeuchi I. Quantitative capillary refill time predicts sepsis in patients with suspected infection in the emergency department: an observational study. J Intensive Care 2019; 7:29. [PMID: 31080620 PMCID: PMC6501379 DOI: 10.1186/s40560-019-0382-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/16/2019] [Indexed: 12/17/2022] Open
Abstract
Background Outcomes in emergent patients with suspected infection depend on how quickly clinicians evaluate the patients and start treatment. This study was performed to compare the predictive ability of the quantitative capillary refill time (Q-CRT) as a new rapid index versus the quick sequential organ failure assessment (qSOFA) score and the systemic inflammatory response syndrome (SIRS) score for sepsis screening in the emergency department. Methods This was a multicenter, observational, retrospective study of adult patients with suspected infection. The area under the curve (AUC) of receiver operating characteristic curve analyses and multivariate analyses were used to explore associations of the Q-CRT with the qSOFA score, SIRS score, and lactate concentration. Results Of the 75 enrolled patients, 48 had sepsis. The AUC, sensitivity, and specificity of Q-CRT were 0.74, 58%, and 81%, respectively; those for the qSOFA score were 0.83, 66%, and 100%, respectively; those for the SIRS score were 0.61, 81%, and 40%, respectively, for SIRS score; and those for the lactate concentration were 0.76, 72%, and 81%, respectively. We found no statistically significant differences in the AUC between the scores. We then combined the Q-CRT and qSOFA score (Q-CRT/qSOFA combination) for sepsis screening. The AUC, sensitivity, and specificity of Q-CRT/qSOFA combination were 0.82, 83%, and 81%, respectively. Conclusions In this study, Q-CRT/qSOFA combination had better sensitivity than the qSOFA score alone and better specificity than the SIRS score alone. There was no significant difference in accuracy between Q-CRT/qSOFA combination and the qSOFA score or lactate concentration. The ability of the Q-CRT to predict sepsis may be similar to that of the qSOFA score or serum lactate concentration; therefore, measurement of the Q-CRT may be an alternative for invasive measurement of the blood lactate concentration in evaluating patients with suspected sepsis. Electronic supplementary material The online version of this article (10.1186/s40560-019-0382-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Oi Yasufumi
- 1Emergency and Critical Care Medical Center, Yokohama Municipal Citizen's Hospital, 56 Okazawacho, Hodogayaku, Yokohama City, Kanagawa 240-8555 Japan.,2Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Naoto Morimura
- 2Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan.,3Department of Acute Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Shirasawa
- 1Emergency and Critical Care Medical Center, Yokohama Municipal Citizen's Hospital, 56 Okazawacho, Hodogayaku, Yokohama City, Kanagawa 240-8555 Japan.,2Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hiroshi Honzawa
- 1Emergency and Critical Care Medical Center, Yokohama Municipal Citizen's Hospital, 56 Okazawacho, Hodogayaku, Yokohama City, Kanagawa 240-8555 Japan.,2Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yutaro Oyama
- 1Emergency and Critical Care Medical Center, Yokohama Municipal Citizen's Hospital, 56 Okazawacho, Hodogayaku, Yokohama City, Kanagawa 240-8555 Japan.,2Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Shoko Niida
- 1Emergency and Critical Care Medical Center, Yokohama Municipal Citizen's Hospital, 56 Okazawacho, Hodogayaku, Yokohama City, Kanagawa 240-8555 Japan.,2Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takeru Abe
- 2Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan.,4Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shouhei Imaki
- 1Emergency and Critical Care Medical Center, Yokohama Municipal Citizen's Hospital, 56 Okazawacho, Hodogayaku, Yokohama City, Kanagawa 240-8555 Japan.,2Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Ichiro Takeuchi
- 2Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Japan.,4Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
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21
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Kotani Y, Fujii T, Uchino S, Doi K. Modification of sequential organ failure assessment score using acute kidney injury classification. J Crit Care 2019; 51:198-203. [PMID: 30878015 DOI: 10.1016/j.jcrc.2019.02.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 02/06/2019] [Accepted: 02/25/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE To assess the predictive validity of a modified Sequential Organ Failure Assessment (SOFA) score, of which the renal component was replaced with Kidney Disease Improving Global Outcomes (KDIGO) classification of Acute Kidney Injury (AKI). MATERIALS AND METHODS Using a prospective cohort study on AKI in Japan, we replaced the renal component of SOFA score with AKI stages according to the KDIGO criteria except that initiation of renal replacement therapy was assigned four points. We assessed the predictive validity of KDIGO-based SOFA score for hospital and ICU mortality by comparing the areas under the receiver operating characteristic curve (AUC) derived from logistic regression models with that of the original SOFA score. RESULTS 2292 patients were registered. Overall hospital mortality was 11.6%, and ICU mortality was 5.1%. KDIGO-based SOFA score was moderately correlated with APACHE II score (rho = 0.476). The AUC for hospital and ICU mortality of KDIGO-based and the original SOFA score were 0.749 vs 0.745 (p = .393) and 0.790 vs 0.791 (p = .900). CONCLUSIONS The prognostic performance of KDIGO-based SOFA score was not superior but comparable to that of the original SOFA score.
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Affiliation(s)
- Yuki Kotani
- Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, 4-20, Komatsubara-dori, Wakayama, Japan; Department of Intensive Care Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Japan.
| | - Tomoko Fujii
- Department of Epidemiology and Preventive Medicine, Kyoto University Graduate School of Medicine, Yoshida Hon-machi, Sakyo-ku, Kyoto, Japan; Japan Society for the Promotion of Science. 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, Japan.
| | - Shigehiko Uchino
- Intensive Care Unit, Department of Anaesthesiology, Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, Japan
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
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22
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Song H, Moon HG, Kim SH. Efficacy of quick Sequential Organ Failure Assessment with lactate concentration for predicting mortality in patients with community-acquired pneumonia in the emergency department. Clin Exp Emerg Med 2019; 6:1-8. [PMID: 30781940 PMCID: PMC6453698 DOI: 10.15441/ceem.17.262] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/26/2017] [Indexed: 12/29/2022] Open
Abstract
Objective Community-acquired pneumonia (CAP) is a major cause of sepsis, and sepsis-related acute organ dysfunction affects patient mortality. Although the quick Sequential Organ Failure Assessment (qSOFA) is a new screening tool for patients with suspected infection, its predictive value for the mortality of patients with CAP has not been validated. Lactate concentration is a valuable biomarker for critically ill patients. Thus, we investigated the predictive value of qSOFA with lactate concentration for in-hospital mortality in patients with CAP in the emergency department (ED). Methods From January 2015 to June 2015, 443 patients, who were diagnosed with CAP in the ED, were retrospectively analyzed. We defined high qSOFA or lactate concentrations as a qSOFA score ≥2 or a lactate concentration >2 mmol/L upon admission at the ED. The primary outcome was all-cause in-hospital mortality. Results Among the 443 patients, 44 (9.9%) died. Based on the receiver operating characteristic (ROC) analysis, the areas under the curves for the prediction of mortality were 0.720, 0.652, and 0.686 for qSOFA, CURB-65 (confusion, urea, respiratory rate, blood pressure, and age), and Pneumonia Severity Index, respectively. The area under the ROC curve of qSOFA was lower than that of SOFA (0.720 vs. 0.845, P=0.004). However, the area under the ROC curve of qSOFA with lactate concentration was not significantly different from that of SOFA (0.828 vs. 0.845, P=0.509). The sensitivity and specificity of qSOFA with lactate concentration were 71.4% and 83.2%, respectively. Conclusion qSOFA with lactate concentration is a useful and practical tool for the early prediction of in-hospital mortality among patients with CAP in the ED.
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Affiliation(s)
- Hwan Song
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyung Gi Moon
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Soo Hyun Kim
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Ramazani J, Hosseini M. Prediction of ICU mortality in critically ill children : Comparison of SOFA, GCS, and FOUR score. Med Klin Intensivmed Notfmed 2019; 114:717-23. [PMID: 30276565 DOI: 10.1007/s00063-018-0484-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/24/2018] [Accepted: 08/20/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The SOFA (Sequential Organ Failure Assessment), GCS (Glasgow Coma Scale), and FOUR (Full Outline of UnResponsiveness) scores are the most commonly used scoring systems to predict the risk of mortality and morbidity in intensive care units (ICUs). The aim of the current study was to compare the predictive ability of these three models for predicting medical/surgical ICU mortality in critically ill children. METHODS In the current observational and prospective study, a total of 90 consecutive patients, age ≤18 years, admitted to medical and surgical ICUs, were enrolled. The SOFA, GCS, FOUR score and demographic characteristics of all children were recorded on the first day of admission. For statistical analyses, a receiver operator characteristic (ROC) curve, the Hosmer-Lemeshow goodness of fit test, and logistic regression were used (95% confidence interval). RESULTS The SOFA, GCS, and FOUR scores between survivors and nonsurvivors were statistically different (p = 0.002, p < 0.001, p = 0.004, respectively). The discrimination power for SOFA, GCS, and FOUR score was moderate (area under ROC [AUC] curve: 75.1%; standard error [SE]: 6.0%, 72.9% [SE: 7.2%], 78.7% [SE: 6.6%], respectively). The only well-calibrated model was GCS (x2 = 2.76, p = 0.59). CONCLUSIONS The performance of the three predictive models SOFA, GCS, and FOUR score for predicting outcomes in children admitted to medical and surgical ICUs was good. The discrimination was moderate for all three models, and calibration was good just for GCS. GCS was superior in predicting outcome in critically ill children; however, further studies are needed to validate these scores in the pediatric population.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lie KC, Lau CY, Van Vinh Chau N, West TE, Limmathurotsakul D. Utility of SOFA score, management and outcomes of sepsis in Southeast Asia: a multinational multicenter prospective observational study. J Intensive Care 2018; 6:9. [PMID: 29468069 PMCID: PMC5813360 DOI: 10.1186/s40560-018-0279-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/05/2018] [Indexed: 12/16/2022] Open
Abstract
Background Sepsis is a global threat but insufficiently studied in Southeast Asia. The objective was to evaluate management, outcomes, adherence to sepsis bundles, and mortality prediction of maximum Sequential Organ Failure Assessment (SOFA) scores in patients with community-acquired sepsis in Southeast Asia. Methods We prospectively recruited hospitalized adults within 24 h of admission with community-acquired infection at nine public hospitals in Indonesia (n = 3), Thailand (n = 3), and Vietnam (n = 3). In patients with organ dysfunction (total SOFA score ≥ 2), we analyzed sepsis management and outcomes and evaluated mortality prediction of the SOFA scores. Organ failure was defined as the maximum SOFA score ≥ 3 for an individual organ system. Results From December 2013 to December 2015, 454 adult patients presenting with community-acquired sepsis due to diverse etiologies were enrolled. Compliance with sepsis bundles within 24 h of admission was low: broad-spectrum antibiotics in 76% (344/454), ≥ 1500 mL fluid in 50% of patients with hypotension or lactate ≥ 4 mmol/L (115/231), and adrenergic agents in 71% of patients with hypotension (135/191). Three hundred and fifty-five patients (78%) were managed outside of ICUs. Ninety-nine patients (22%) died. Total SOFA score on admission of those who subsequently died was significantly higher than that of those who survived (6.7 vs. 4.6, p < 0.001). The number of organ failures showed a significant correlation with 28-day mortality, which ranged from 7% in patients without any organ failure to 47% in those with failure of at least four organs (p < 0.001). The area under the receiver operating characteristic curve of the total SOFA score for discrimination of mortality was 0.68 (95% CI 0.62–0.74). Conclusions Community-acquired sepsis in Southeast Asia due to a variety of pathogens is usually managed outside the ICU and with poor compliance to sepsis bundles. In this population, calculation of SOFA scores is feasible and SOFA scores are associated with mortality. Trial registration ClinicalTrials.gov, NCT02157259. Registered 5 June 2014, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s40560-018-0279-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Khie Chen Lie
- 1Department of Internal Medicine, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Chuen-Yen Lau
- 2Collaborative Clinical Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - Nguyen Van Vinh Chau
- 3Department of Internal Medicine, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,4Department of Internal Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - T Eoin West
- 5Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA USA.,6Department of Global Health, University of Washington, Seattle, WA USA
| | - Direk Limmathurotsakul
- 7Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,8Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,9Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400 Thailand
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Umemura Y, Ogura H, Gando S, Kushimoto S, Saitoh D, Mayumi T, Fujishima S, Abe T, Ikeda H, Kotani J, Miki Y, Shiraishi SI, Shiraishi A, Suzuki K, Suzuki Y, Takeyama N, Takuma K, Tsuruta R, Yamaguchi Y, Yamashita N, Aikawa N; JAAM Sepsis Registry (JAAMSR) Study Group. Assessment of mortality by qSOFA in patients with sepsis outside ICU: A post hoc subgroup analysis by the Japanese Association for Acute Medicine Sepsis Registry Study Group. J Infect Chemother 2017; 23:757-62. [PMID: 28847586 DOI: 10.1016/j.jiac.2017.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/10/2017] [Accepted: 07/10/2017] [Indexed: 11/20/2022]
Abstract
Quick sequential organ failure assessment (qSOFA) was proposed in the new sepsis definition (Sepsis-3). Although qSOFA was created to identify patients with suspected infection and likely to have poor outcomes, the clinical utility of qSOFA to screen sepsis has not been fully evaluated. We investigated the number of patients diagnosed as having severe sepsis who could not be identified by the qSOFA criteria and what clinical signs could complement the qSOFA score. This retrospective analysis of a multicenter prospective registry included adult patients with severe sepsis diagnosed outside the intensive care unit (ICU) by conventional criteria proposed in 2003. We conducted receiver operating characteristic (ROC) analyses to assess the predictive value for in-hospital mortality and compared clinical characteristics between survivors and non-survivors with qSOFA score ≤ 1 point (qSOFA-negative). Among 387 eligible patients, 63 (16.3%) patients were categorized as qSOFA-negative, and 10 (15.9%) of these patients died. The area under the ROC curve for the qSOFA score was 0.615, which was superior to that for the systemic inflammatory response syndrome score (0.531, P = 0.019) but inferior to that for the SOFA score (0.702, P = 0.005). Multivariate logistic regression analysis showed that hypothermia might be associated with poor outcome independently of qSOFA criteria. Our findings suggested that qSOFA had a suboptimal level of predictive value outside the ICU and could not identify 16.3% of patients who were once actually diagnosed with sepsis. Hypothermia might be associated with an increased risk of death that cannot be identified by qSOFA.
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Copeland CC, Young A, Grogan T, Gabel E, Dhillon A, Gudzenko V. Preoperative risk stratification of critically ill patients. J Clin Anesth 2017; 39:122-127. [PMID: 28494887 DOI: 10.1016/j.jclinane.2017.03.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/07/2017] [Accepted: 03/31/2017] [Indexed: 01/31/2023]
Abstract
STUDY OBJECTIVE Risk assessment historically emphasized cardiac morbidity and mortality in elective, outpatient, non-cardiac surgery. However, critically ill patients increasingly present for therapeutic interventions. Our study investigated the relationship of American Society of Anesthesiologists (ASA) class, revised cardiac risk index (RCRI), and sequential organ failure assessment (SOFA) score with survival to discharge in critically ill patients with respiratory failure. DESIGN Retrospective cohort analysis over a 21-month period. SETTING Five adult intensive care units (ICUs) at a single tertiary medical center. PATIENTS Three hundred fifty ICU patients in respiratory failure, who underwent 501 procedures with general anesthesia. MEASUREMENTS Demographic, clinical, and surgical variables were collected from the pre-anesthesia evaluation forms and preoperative ICU charts. The primary outcome was survival to discharge. MAIN RESULTS Ninety-six patients (27%) did not survive to discharge. There were significant differences between survivors and non-survivors for ASA (3.7 vs. 3.9, p=0.001), RCRI (1.6 vs. 2.0, p=0.003), and SOFA score (8.1 vs. 11.2, p<0.001). Based on the area under the receiver operating characteristic curve for these relationships, there was only modest discrimination between the groups, ranging from the most useful SOFA (0.68) to less useful RCRI (0.60) and ASA (0.59). CONCLUSIONS This single center retrospective study quantified a high perioperative risk for critically ill patients with advanced airways: one in four did not survive to discharge. Preoperative ASA score, RCRI, and SOFA score only partially delineated survivors and non-survivors. Given the existing limitations, future research may identify assessment tools more relevant to discriminating survival outcomes for critically ill patients in the perioperative environment.
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Affiliation(s)
- Curtis C Copeland
- U.S. Air Force School of Aerospace Medicine, Center for the Sustainment of Trauma and Readiness Skills, Baltimore, United States; University of Maryland School of Medicine, Department of Anesthesiology, R Adams Cowley Shock Trauma Center, US Air Force C-STARS Baltimore, 22 S. Greene Street, T4M14, Baltimore, MD 21201, United States; David Geffen School of Medicine, Ronald Reagan Medical Center, UCLA, 757 Westwood Plz. Suite 3325, Los Angeles, CA 90095, United States.
| | - Andrew Young
- David Geffen School of Medicine, Ronald Reagan Medical Center, UCLA, 757 Westwood Plz. Suite 3325, Los Angeles, CA 90095, United States
| | - Tristan Grogan
- David Geffen School of Medicine, Ronald Reagan Medical Center, UCLA, 757 Westwood Plz. Suite 3325, Los Angeles, CA 90095, United States
| | - Eilon Gabel
- David Geffen School of Medicine, Ronald Reagan Medical Center, UCLA, 757 Westwood Plz. Suite 3325, Los Angeles, CA 90095, United States
| | - Anahat Dhillon
- David Geffen School of Medicine, Ronald Reagan Medical Center, UCLA, 757 Westwood Plz. Suite 3325, Los Angeles, CA 90095, United States
| | - Vadim Gudzenko
- David Geffen School of Medicine, Ronald Reagan Medical Center, UCLA, 757 Westwood Plz. Suite 3325, Los Angeles, CA 90095, United States
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Safari S, Shojaee M, Rahmati F, Barartloo A, Hahshemi B, Forouzanfar MM, Mohammadi E. Accuracy of SOFA score in prediction of 30-day outcome of critically ill patients. Turk J Emerg Med 2016; 16:146-150. [PMID: 27995206 PMCID: PMC5154578 DOI: 10.1016/j.tjem.2016.09.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/09/2016] [Accepted: 09/26/2016] [Indexed: 11/16/2022] Open
Abstract
Objectives Researchers have attempted to design various scoring systems to determine the severity and predict the outcome of critically ill patients. The present study aimed to evaluate the accuracy of SOFA score in predicting 1-month outcome of these patients in emergency department. Methods The present study is a prospective cross-sectional study of >18 year old non-trauma critically ill patients presented to EDs of 3 hospitals, Tehran, Iran, during October 2014 to October 2015. Baseline characteristics, SOFA score variables, and 1-month outcome of patients were recorded and screening performance characteristics of the score were calculated using STATA 11 software. Results 140 patients with the mean age of 68.36 ± 18.62 years (18–95) were included (53.5% male). The most common complaints were decrease in level of consciousness (76.43%) and sepsis (60.0%), were the most frequent final diagnoses. Mean SOFA score of the patients was 7.13 ± 2.36 (minimum 2 and maximum 16). 72 (51.43%) patients died during the following 30 days and 16 (11.43%) patients were affected with multiple organ failure. Area under the ROC curve of SOFA score in predicting mortality of studied patients was 0.73 (95%CI: 0.65–0.81) (Fig. 2). Table 2 depicts screening performance characteristics of this scale in prediction of 1-month mortality in the best cut-off point of ≥7. At this cut-off point, sensitivity and specificity of SOFA in predicting 1-month mortality were 75% and 63.23%, respectively. Conclusion Findings of the present study showed that SOFA scoring system has fair accuracy in predicting 1-month mortality of critically ill patients. However, until a more reliable scoring system is developed, SOFA might be useful for narrative prediction of patient outcome considering its acceptable likelihood ratios.
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Affiliation(s)
- Saeed Safari
- Emergency Department, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Shojaee
- Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Rahmati
- Emergency Department, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Barartloo
- Emergency Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrooz Hahshemi
- Emergency Department, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Forouzanfar
- Emergency Department, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Mohammadi
- Emergency Department, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Tomulić Brusich K, Acan I, Višković Filipčić N. Ventilator-Associated Pneumonia: Comparing Cadaveric Liver Transplant and Non-Transplant Surgical Patients. Acta Clin Croat 2016; 55:360-369. [PMID: 29045094 DOI: 10.20471/acc.2016.55.03.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Ventilator-associated pneumonia is a frequent complication in intensive care surgical patients, particularly those with high severity scores on admission. We studied the incidence and clinical outcome of ventilator-associated pneumonia among patients undergoing major general surgery
procedures and those undergoing cadaveric liver transplantation in our hospital. Patients with the intensive care unit stay longer than four days having undergone surgery or transplantation and mechanically ventilated for more than 48 hours were included in the study. Ventilator-associated pneumonia
diagnosis was based on a combination of radiological signs (progressive infiltrate on chest radiograph), clinical signs (fever >38.3 °C, leukocytes >12×10(9)/mL) and microbiological data (positive culture from tracheal aspiration >10(5) or bronchoalveolar lavage >104 colonies/mL). Medical records of
1037 patients were reviewed and 157 patients were found to have been mechanically ventilated for more than 48 hours: 62 transplanted and 95 non-transplanted. Only 39 (24.84%) patients matched the criteria for ventilator-associated pneumonia. There were no differences in sex, age, duration of
mechanical ventilation, length of stay or outcome between the two groups. However, the main difference was the mean severity score on admission (Simplified Acute Physiology Score II) which was higher among non-transplant patients (42±16 vs. 31±9; p=0.03). Gram-negative bacteria were the
leading causative agents (82.03%) and were multidrug-resistant. In the intensive care surgical population, transplantation per se does not seem to increase patient risk for either ventilator-associated pneumonia acquisition or worse outcomes.
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Affiliation(s)
| | - Ivana Acan
- Department of Anesthesiology and Intensive Care, Merkur University Hospital, Zagreb, Croatia
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Hernández-Tejedor A, Cabré-Pericas L, Martín-Delgado MC, Leal-Micharet AM, Algora-Weber A; EPIPUSE study group. Evolution and prognosis of long intensive care unit stay patients suffering a deterioration: A multicenter study. J Crit Care 2015; 30:654.e1-7. [PMID: 25656920 DOI: 10.1016/j.jcrc.2015.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/31/2014] [Accepted: 01/12/2015] [Indexed: 12/28/2022]
Abstract
PURPOSE The prognosis of a patient who deteriorates during a prolonged intensive care unit (ICU) stay is difficult to predict. We analyze the prognostic value of the serialized Sequential Organ Failure Assessment (SOFA) score and other variables in the early days after a complication and to build a new predictive score. MATERIALS AND METHODS EPIPUSE (Evolución y pronóstico de los pacientes con ingreso prolongado en UCI que sufren un empeoramiento, Evolution and prognosis of long intensive care unit stay patients suffering a deterioration) study is a prospective, observational study during a 3-month recruitment period in 75 Spanish ICUs. We focused on patients admitted in the ICU for 7 days or more with complications of adverse events that involve organ dysfunction impairment. Demographics, clinical variables, and serialized SOFA after a supervening clinical deterioration were recorded. Univariate and multivariate analyses were performed, and a predictive model was created with the most discriminating variables. RESULTS We included 589 patients who experienced 777 cases of severe complication or adverse event. The entire sample was randomly divided into 2 subsamples, one for development purposes (528 cases) and the other for validation (249 cases). The predictive model maximizing specificity is calculated by minimum SOFA + 2 * cardiovascular risk factors + 2 * history of any oncologic disease or immunosuppressive treatment + 3 * dependence for basic activities of daily living. The area under the receiver operating characteristic curve is 0.82. A 14-point cutoff has a positive predictive value of 100% (92.7%-100%) and negative predictive value of 51% (46.4%-55.5%) for death. CONCLUSIONS EPIPUSE model can predict mortality with a specificity and positive predictive value of 99% in some groups of patients.
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Boone MD, Celi LA, Ho BG, Pencina M, Curry MP, Lior Y, Talmor D, Novack V. Model for End-Stage Liver Disease score predicts mortality in critically ill cirrhotic patients. J Crit Care 2014; 29:881.e7-13. [PMID: 24974049 DOI: 10.1016/j.jcrc.2014.05.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/27/2014] [Accepted: 05/22/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Cirrhosis is a common condition that complicates the management of patients who require critical care. There is interest in identifying scoring systems that may be used to predict outcome because of the poor odds for recovery despite high-intensity care. We sought to evaluate how Model for End-Stage Liver Disease (MELD), an organ-specific scoring system, compares with other severity of illness scoring systems in predicting short- and long-term mortality for critically ill cirrhotic patients. MATERIALS AND METHODS This was a retrospective cohort study involving seven intensive care units (ICUs) in a tertiary care, academic medical center. Adult patients with cirrhosis who were admitted to an ICU between 2001 and 2008 were evaluated. Severity of illness scores (MELD and Sequential Organ Failure Assessment [SOFA]) were calculated on admission and at 24 and 48 hours. The primary end points were 28-day and 1-year all-cause mortality. RESULTS Of 19742 ICU hospitalizations, 848 had cirrhosis. Relevant data were available for 521 patients (73%). Of these cases, 353 patients (69.5%) were admitted to medical ICU (MICU), and the other 155 (30.5%), to surgical unit. Alcohol abuse and hepatitis C were the most common reasons for cirrhosis. Patients who died within 28 days were more likely to receive mechanical ventilation, pressors, and renal replacement therapy. Among 353 medical admissions, both MELD and SOFA were found to be significantly associated with both 28-day and 1-year mortality. Among the 155 surgical admissions, both scores were found to be not significant for 28-day mortality but were significant for 1 year. CONCLUSIONS Our results demonstrate that the prognostic ability of a variety of scoring systems strongly depends on the patient population. In the MICU population, each model (MELD + SOFA, MELD, and SOFA) demonstrates excellent discrimination for 28-day and 1-year mortality. However, these scoring systems did not predict 28-day mortality in the surgical ICU group but were significant for 1-year mortality. This suggests that patients admitted to a surgical ICU will behave similarly to their MICU cohort if they survive the perioperative period.
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Affiliation(s)
- M Dustin Boone
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
| | - Leo A Celi
- Department of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard-Massachusetts Institute of Technology Division of Health Science Technology, Cambridge, MA
| | - Ben G Ho
- Harvard-Massachusetts Institute of Technology Division of Health Science Technology, Cambridge, MA
| | - Michael Pencina
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA
| | - Michael P Curry
- Department of Medicine, Division of Hepatology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA
| | - Yotam Lior
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Victor Novack
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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