ICU Scoring Systems Research Articles

Methylene blue dosing strategies in critically ill adults with shock-A retrospective cohort study.

Shock increases mortality in the critically ill and the mainstay of therapy is the administration of vasopressor agents to achieve hemodynamic targets. In the past, studies have found that the NO-pathway antagonist methylene blue improves hemodynamics. However, the optimal dosing strategy remains elusive. Therefore, we investigated the hemodynamic and ICU outcome parameters of three different dosing strategies for methylene blue. We performed a retrospective cohort study of patients in shock treated with methylene blue. Shock was defined as norepinephrine dose >0.1 μg/kg/min and serum lactate level >2 mmol/l at the start of methylene blue administration. Different demographic variables, ICU treatment, and outcome parameters were evaluated. To compare the differences in the administration of vasopressors or inotropes, the vasoactive inotropic score (VIS) was calculated at different time points after starting the administration of methylene blue. Response to methylene blue or mortality at 28 days were assessed. 262 patients from July 2014 to October 2019 received methylene blue. 209 patients met the inclusion criteria. Three different dosing strategies were identified: bolus injection followed by continuous infusion (n = 111), bolus injection only (no continuous infusion; n = 59) or continuous infusion only (no bolus prior; n = 39). The groups did not differ in demographics, ICU scoring system, or comorbidities. In all groups, VIS decreased over time, indicating improved hemodynamics. Cardiogenic shock and higher doses of norepinephrine increased the chance of responding to methylene blue, while bolus only decreased the chance of responding to methylene blue treatment. 28-day mortality increased with higher SAPSII scores and higher serum lactate levels, while bolus injection followed by continuous infusion decreased 28-day mortality. No severe side effects were noted. In this cohort, methylene blue as a bolus injection followed by continuous infusion was associated with a reduced 28-day mortality in patients with shock. Prospective studies are needed to systematically evaluate the role of methylene blue in the treatment of shock.

Evaluation of Cardiac Troponin I as a Predictor of Outcome ofSepsis in Critically Ill Patients

AbstractBackground: Sepsis and septic shock are the most commoncauses of morbidity and mortality in Intensive Care Units inthe United States. The cardiovascular abnormalities associatedwith septic shock, in large part, account for the life-threateningnature of the syndrome. Cardiac troponin I (cTnI) has beenshown to be an indicator of myocardial injury and is anaccepted prognostic factor of Myocardial Infarction (MI).Aim of Study: To study the prognostic value of cTnI onmortality and adverse complications in patients with sepsisand septic shock. And to study the relation of cTnI with ICUscoring system (SOFA).Patients and Methods: This is a comparative cross sec-tional study, was conducted at Intensive Care Unit (ICU) atAin Shams University Hospitals and El-Matria TeachingHospital, on 70 patients with suspected infection who wereaged between 18 and 60 years old, over the period of sixmonths from November 2019 to April 2020.Results: Finally, as regard relation between outcome and1st sample cTnI in each group; the study on the hand revealedthat there was no statistical significant difference betweenoutcome and 1st sample cTnI in Group with positive cTnI,Group II with non-elevated cardiac troponin I.Conclusion: Based on our results we recommend forfurther studies in larger patients and longer period of follow-up to emphasize our conclusion. Sepsis patients with highcTnI levels are usually more critically ill while had the samechance to adverse outcome and less mortality and cTnI level is not a predicator of mortality, further studies in larger patient populations must establish whether elevated troponin may be used as an independent mortality risk factor for intensive care patients without ACS.

Mortality prediction by SOFA score in ICU-patients after cardiac surgery; comparison with traditional prognostic\u2013models

BackgroundThere are many prognostic models and scoring systems in use to predict mortality in ICU patients. The only general ICU scoring system developed and validated for patients after cardiac surgery is the APACHE-IV model. This is, however, a labor-intensive scoring system requiring a lot of data and could therefore be prone to error. The SOFA score on the other hand is a simpler system, has been widely used in ICUs and could be a good alternative.The goal of the study was to compare the SOFA score with the APACHE-IV and other ICU prediction models.MethodsWe investigated, in a large cohort of cardiac surgery patients admitted to Dutch ICUs, how well the SOFA score from the first 24 h after admission, predict hospital and ICU mortality in comparison with other recalibrated general ICU scoring systems. Measures of discrimination, accuracy, and calibration (area under the receiver operating characteristic curve (AUC), Brier score, R2, and Ĉ-statistic) were calculated using bootstrapping. The cohort consisted of 36,632 Patients from the Dutch National Intensive Care Evaluation (NICE) registry having had a cardiac surgery procedure for which ICU admission was necessary between January 1st, 2006 and June 31st, 2018.ResultsDiscrimination of the SOFA-, APACHE-IV-, APACHE-II-, SAPS-II-, MPM24-II - models to predict hospital mortality was good with an AUC of respectively: 0.809, 0.851, 0.830, 0.850, 0.801. Discrimination of the SOFA-, APACHE-IV-, APACHE-II-, SAPS-II-, MPM24-II - models to predict ICU mortality was slightly better with AUCs of respectively: 0.809, 0.906, 0.892, 0.919, 0.862. Calibration of the models was generally poor.ConclusionAlthough the SOFA score had a good discriminatory power for hospital- and ICU mortality the discriminatory power of the APACHE-IV and SAPS-II was better. The SOFA score should not be preferred as mortality prediction model above traditional prognostic ICU-models.

Comparison of Mortality Prediction, of APACHE II, SAPS II and SOFA ICU Scoring Systems in Patients with Severe Sepsis and Septic Shock in ICU of A Tertiary Care Hospital

Comparison of Mortality Prediction, of APACHE II, SAPS II and SOFA ICU Scoring Systems in Patients with Severe Sepsis and Septic Shock in ICU of A Tertiary Care Hospital

THAI-ICU score as a simplified severity score for critically ill patients in a resource limited setting: Result from SEA-AKI study group

PurposeTo create a simplified ICU scoring system to predict mortality in critically ill patients that can be feasibly applied in resource limited setting with good performance of predicting hospital mortality. Materials and methodsA retrospective study from prospective cohort was created consisting of adult patients who were admitted to an ICU of 17 centers across Thailand from 2013 to 2015. A development cohort (n = 3503) and a validation cohort (n = 1909) were randomly selected from the available enrollment data. ResultsIn the development cohort, the predictors of the simplified score 6 variable model were low Glasgow coma score (GCS), low mean arterial pressure or need vasopressor, positive net-fluid balance, tachypnea, thrombocytopenia, and high blood urea nitrogen.In the validation study of THAI-ICU, AUC (95%CI) was 0.81(0.78–0.83). At the optimum cutoff value of 9; the sensitivity, specificity, positive likelihood ratio were 72%, 73%, and 2.72 respectively. The Hosmer-Lemeshow - C statistic was 13.5 (p = .2) and the Brier score 95% CI was 0.16 (0.15, 0.17). ConclusionsThe THAI-ICU score is a new simplified severity score for predicting hospital mortality. The simplicity of the score will increase the possibility to apply in resource limited settings.

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Comparison of the Mortality Prediction of Different ICU Scoring Systems (APACHE II and III, SAPS II, and SOFA) in Acute Respiratory Distress Syndrome Patients

Comparison of the Mortality Prediction of Different ICU Scoring Systems (APACHE II and III, SAPS II, and SOFA) in Acute Respiratory Distress Syndrome Patients

Extracellular histone H3 levels are inversely correlated with antithrombin levels and platelet counts and are associated with mortality in sepsis patients

ObjectiveSepsis is a leading cause of death worldwide. Extracellular histones are cytotoxic compounds mediating death in murine sepsis and circulating nucleosome levels predict mortality in human inflammation and sepsis. Whether or not circulating extracellular histone H3 correlates with other plasma parameters and/or ICU scoring systems has not been completely established, nor if levels of circulating extracellular histones can be used as predictive markers for clinical outcome in sepsis. MethodsWe measured plasma histone H3 (H3) levels in the plasma of 43 sepsis patients who were admitted to the Intensive Care Unit and determined their correlation with disease severity, organ failure, mortality and coagulation- and tissue homeostasis parameters including LDH levels, thrombin potential (ETP), prothrombin levels, antithrombin levels and platelet counts. ResultsMedian H3 levels of sepsis patients at the ICU were significantly increased in non-survivors as compared to survivors with levels found being 3.15μg/ml versus 0.57μg/ml respectively, P=0.04. H3 levels are positively correlated with lactate dehydrogenase (LDH) activity (Spearman’s rho=0.49, P<0.001), and negatively correlated with antithrombin levels (rho=−0.34, P=0.027) and platelet counts (rho=−0.33, P=0.031). ConclusionsWe conclude that circulating H3 levels correlate with mortality in sepsis patients and inversely correlate with antithrombin levels and platelet counts.

Comparison of the mortality prediction of different ICU scoring systems (APACHE II and III, SAPS II, and SOFA) in a single-center ICU subpopulation with acute respiratory distress syndrome

BackgroundScoring systems can be used to define critically ill patients, estimate their prognosis, help in clinical decision making, guide the allocation of resources and estimate the quality of care in the ICU. PurposeThis study compared the predictive accuracy of four predictive scoring systems in the ICU. MethodsA prospective cohort study including consecutively admitted 110 adult ICU patients (88 males) with ARDS from Saudi German Hospital, Madinah, was performed from June 2013 to January 2015. The median age of the patients was 38years, the median duration of illness before ICU admission was 6days, and the median duration of ICU admission was 27days. The APACHE II, APACHE III, SAPS II, and SOFA scores were calculated based on the worst values during the first 24h of admission. ResultsThe actual mortality rate (27.3%) was higher than the estimated mortality rates, with the highest predicted rate of 11.3% obtained using the APACHE II. All four severity scores were significantly associated with mortality (F=62.772, p=0.000) and explained 83% of its variability (R2=0.834). However, after adjustment, only the APACHE III scoring system was a significant predictor (Beta=−0.753, p=0.000). Three scoring systems were significantly associated with mortality (F=42.055, p=0.000) and explained almost 70% of its variability (R2=0.712), but after adjustment, only the APACHE II was a significant predictor (Beta=−0.631, p=0.041). The combination of the severity score and mortality prediction was a significant predictor of mortality (Beta=−1.397, p=0.000 and Beta=0.517, p=0.036, respectively). ConclusionThe accuracy of the studied scoring systems for predicting ICU mortality in ARDS patients is limited. The performance of the APACHE II/III scoring systems was superior to that of other systems in terms of predicting the severity and mortality, and the combination of scores improved the performance. There is a need to develop ARDS-specific scoring systems. Until a new system is developed, it is better to use the updated versions of the APACHE scoring system or a combination of all ICU scoring systems.

SOFA vs APACHE II as ICU scoring system for sepsis: A dilemma

Prolactinoma is classified as microprolactinoma when it measures In case of microprolactinoma, the risk of complications are low hence it is recommended to keep a close follow up of patient without any need for intervention. In case of macroprolactinoma it is recommended to use barrier contraception to prevent pregnancy for at least 6-12 months after detection and starting treatment to allow proper shrinkage of the tumor with dopamine agonist. Once pregnancy is confirmed -In those with low risk features, dopamine agonist is stopped and a close follow up is advised. In those with high risk features, it is recommended to continue the dopamine agonist therapy with a close follow up. Postpartum period generally doesn’t pose much threat to prolactinoma and treatment may be discontinued if patient wishes to breast feed her infant.

SOFA vs APACHE II as ICU scoring system for sepsis: A dilemma

SOFA vs APACHE II as ICU scoring system for sepsis: A dilemma

ICU scoring system, SAPS 3

The scoring systems used widely in the field of intensive care are prognostic models that estimate the in hospital mortalityrate. Many clinicians utilize these systems to measure the severity of illness, predict patient prognosis, and gatherinformation for clinical research. We introduce the SAPS (Simplified Acute Physiology Score) 3 system that one of thesescoring system.

ICU severity of illness scores: APACHE, SAPS and MPM.

This review aims to evaluate the latest versions of the Acute Physiology and Chronic Health Evaluation, Simplified Acute Physiology Score and Mortality Probability Model scores, make comparisons and describe their strengths and limitations. Additionally, we provide critical analysis and recommendations for the use of these scoring systems in different scenarios. The last generation of ICU scoring systems (Acute Physiology and Chronic Health Evaluation IV, Mortality Probability Model 0-III (MPM0-III) and Simplified Acute Physiology Score 3) was widely validated in different regions of the world and in distinct settings comprising general ICU patients as well as specific subgroups such as critically ill cancer patients, cardiovascular, surgical, acute kidney injury requiring renal replacement therapy and those in need of extra-corporeal membrane oxygen. Conflicting results are reported, and in general the scores presented a good discrimination despite a worse calibration as compared with the ones described in the original studies that generated them. Nonetheless, such calibration is often improved when customizations are performed both at ICU and region or country level. ICU scoring systems provide a valuable framework to characterize patients' severity of illness for the evaluation of ICU performance, for quality improvement initiatives and for benchmarking purposes. However, to ensure the best accuracy, constant updates as well as regional customizations are required.

ICU Scoring Systems

Department of Anesthesiology, University of Rochester School of Medicine, Rochester, NY RAND Health, RANDBoston, MA Department of Surgery, University of Vermont College of Medicine, Burlington, VT * See also p. 544. Supported, in part, by Department of Anesthesiology at the University of Rochester School of Medicine. The authors have disclosed that they do not have any potential conflicts of interest.

Comparison of Different ICU Scoring System to Predict Primary and Secondary Outcomes in Out of Hospital and In-House Cardiac Arrest Patients

Comparison of Different ICU Scoring System to Predict Primary and Secondary Outcomes in Out of Hospital and In-House Cardiac Arrest Patients

Abstract P269: Comparison of Usefulness of Apache II and SAPS II in Stroke Patients

Objective: APACHE II and SAPS II are widely used for grading the derangement in the physiological homeostasis of individual patients as well as for prognostic calculations. But these mortality prediction systems are not made for specific patients group but for general ICU group. We studied the applicability of SAPS II and APACHE II in patients admitted to neurosurgical intensive care unit with high proportion of typical cerebral stroke and compared the accuracy of prediction between hemorrhagic and ischemic stroke. Methods: From January 2008 to December 2008, ischemic or hemorrhagic stroke patients, who admitted to neurosurgical ICU, were included into the study. Data collection was done during first 24 hrs of the stay. These data calculated as described in the original articles and predicted mortality was obtained. APACHE II and SAPS II predicted mortalities were compared each other by Calibration curve, Lemeshow-Hosmer goodness for fit test, ROC curve. We compared the results of APACHE II and SAPS II between hemorrhagic and ischemic stroke. Results: During January 2008 to December 2008, 672 patients were admitted to neurosurgical ICU. Observed mortality was 15.7% whereas APACHE II and SAPS II predicted mortalities were 27% and 30.2%. Calibration curve was close to the line of perfect prediction. SAPS II was not statistically significant in Lemeshow-Hosmer test, but slightly favor in area under ROC curve. Conclusion: ICU scoring systems are becoming increasingly important tools to improve resource allocation and to assist in clinical decision making. The ideal scoring system should be able to predict outcome upon admission to the ICU. The severity scores, however, are not accurate enough to be used in the routine management of these patients. In our study APACHE II and SAPS II systems can be used to measure performance in the neurosurgical ICU setting, but not in individual patient.

ICU scoring systems: which one to use in patients with sepsis?

Disease-severity scoring systems have been developed for stratification of ICU patients. These systems have been tested and validated in various general medical and surgical ICU patients. However, the validity and efficacy of these systems, especially the newer generation, has not been assessed in patients with sepsis, which is the commonest indication for admission to a medical ICU. Hence, we conducted this study to assess the performance of various ICU scoring systems - Acute Physiology and Chronic Health Evaluation (APACHE) II, III, IV; Simplified Acute Physiology Score (SAPS) II, III; Mortality Prediction Model (MPM) II0, III0; and Sequential Organ Failure Assessment (SOFA) scores - in septic patients admitted to a medical ICU.

ICU scoring systems: which one to use in oncology patients?

ICU scoring systems: which one to use in oncology patients?

Revisiting the validity of APACHE II in the trauma ICU: Improved risk stratification in critically injured adults

Background Quality and benchmarking initiatives highlight the need for accurate stratified risk adjustment. The stratification of trauma patients has relied on scores specific to trauma populations. While the Acute Physiologic and Chronic Health Evaluation (APACHE) II score has been considered “invalid” in the trauma population, we hypothesized that APAHCE II would more accurately predict outcomes in critically injured patients in whom commonly used trauma scores have inherent limitations. Methods A prospective cohort of critically injured patients was enrolled. Severity scores and their sub-components were collected, and in-hospital mortality was assessed. The area under the receiver operating characteristic (AUROC) curve was used to determine the predictive value of each score. Logistic regression estimated the odds of death associated with incremental changes in severity scores and their subcomponents. Results 1019 patients were available for analysis. APACHE II was the best predictor of mortality (AUROC 0.77 versus AUROC 0.54 for ISS and 0.64 for TRISS). A unit increase in APACHE II was associated with an OR of death of 1.18 (95% CI 1.14–1.22). The components of APACHE II that contributed the most to its accuracy included temperature, serum creatinine and the Glasgow Coma Scale (GCS). Conclusion Critically injured patients have physiologic derangements not accurately accounted for by commonly used trauma scores. In this subset a more general ICU scoring system is useful for risk adjustment for research, administrative and quality improvement purposes.

Which ICU-scoring system may be useful for risk estimation in patients with penetrating injuries treated in Intensive Therapy Units?

Owczuk, R.1; Wujtewicz, M. A.1; Zawadzka-Kaczmarek, K.2; Sawicka, W.1; Wenski, W.3; Sasiuk, W.4; Wujtewicz, M.1Author Information