Use of APACHE-II as a prognostic score index for non-ICU patients with acute renal failure (ARF)

Nms Fernandes,Pbp Batista,Paulo Giovanni De Albuquerque Suassuna ,Nestor Schor ,Carlos Alberto Balda ,Maysa Seabra Cendoroglo ,Sr Stella

doi:10.1186/cc1373

Abstract

The APACHE-II score has been used as an index of severity of illness for non-ICU patients with ARF in some studies. We sought to investigate the differences between ICU and non-ICU patients, and to determine whether APACHE-II can or cannot be used as a prognostic score index for non-ICU patients and to compare it with the ATN-ISS. To this end, we collected data from 205 ARF patients at the Hospital Sao Paulo - a university based, not-for-profit, tertiary hospital - between February 1997 and November 1997. APACHE-II scores were calculated at the time of hospital admission (AP-1) and time of referral to the nephrologist (AP-2). The ATN-ISS score was also obtained at the time of referral to the nephrologist. The period prevalence of ARF during the study was 1% (205/19524 admissions). There were 98 males and 107 females, with a mean age of 52 ± 18 years, and 70 patients (34%) required dialysis. Sixty-eight patients (33%) were admitted to the ICUs and 137 (67%) were treated in the wards or at the emergency ward. The overall mortality rate was 46%. In multivariate analysis, no differences were found between non-ICU and ICU patients for age, gender or oliguria. However, non-ICU patients had lower frequency of shock (25% versus 57%; P = 0.007) and mechanical ventilation (25% versus 60%; P = 0.007), a lower ATN-ISS (0.41 versus 0.78; P < 0.001), a lower AP1 (16.5 versus 19; P = 0.02) and a lower risk of death as calculated using the AP1 (23% versus 50%; P < 0.001). Non-ICU patients also needed dialysis less often (32% versus 38%; P = 0.003) and had a lower mortality rate (31% versus 78%; P < 0.001), compared to ICU patients. The observed/expected mortality ratio was similar in both groups (1.34 for non-ICU versus 1.56 for ICU patients). The area under the receiver operator curve was similar between ICU and non-ICU patients for AP1 (0.63 versus 0.66; P = 0.78), AP2 (0.71 versus 0.80; P = 0.21) and for the ATN-ISS (0.95 versus 0.96; P = 0.80), suggesting that the APACHE-II collected at hospital admission or at the time of referral to the nephrologist and ATN-ISS can be used as severity of illness scores for non-ICU patients.

Highlights

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Summary

Introduction

Propranolol plasma levels and pharmacokinetics (PK) may be altered by cardiopulmonary bypass (CPB). The objective of our study was to assess the effect of different levels of airway pressure on lung morphology by performing a LRM during the lung CT-scan This way, we could set the best ventilatory strategy for the patient and identify the mechanisms involved during the LRM. The goal of this study was to determine the incidence of thrombocytopenia and the correlation with length of ICU stay, mortality rate, admission severity scores APACHE II and SAPS II, and multiple organ dysfunction scores SOFA and LODS. Multiple organ dysfunction has been recognized as a major factor associated with mortality in patients with acute respiratory failure (ARF). Purpose: The objectives of this study are (1) to describe demographics, clinical features, physiologic parameters, and prognosis of patients on mechanical ventilation admitted to the Intensive Care Unit of Hospital Moinhos de Vento; and (2) to identify predictors of mortality and ventilator time. Percutaneous access is an option in such patients, and the clinical staff can perform it

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