Severity Of Disease Classification System Research Articles

The APACHE II Score as a Predictor of Mortality After Open Heart Surgery.

The Acute Physiology and Chronic Health Evaluation (APACHE) severity of disease classification system, which is one of the most widely used scoring systems to predict mortality, is used for intensive care units (ICU) patients. This study aimed to evaluate the predictive ability of APACHE II for mortality in patients after undergoing cardiac surgery. We studied if APACHE II could successfully predict the outcome in post-cardiac surgery patients. This study involved retrospective data collection of all adult patients who were admitted to Ordu State Hospital cardiovascular surgery ICU following cardiac surgery from August 2013 to December 2015. Area under the receiver operating characteristic (ROC) curve (AUC) values were calculated for the APACHE II model. During the two years of data collection, we included 600 patients with a mean age of 64.77±10.148 years. Of these, 180 (30.0%) were females. The ICU mortality rate was 8.33%, and the mean length of ICU stay was 4.210±6.913 days. The mean pre-operative EuroSCORE was 3.890±2.565, and the mean pre-operative APACHE II score was 6.790±3.617. The AUC values for APACHE II and EuroSCORE were 0.743 and 0.767, respectively. The APACHE II model can be used to predict mortality in a Turkish population of patients who have undergone cardiac surgery.

Module modified acute physiology and chronic health evaluation II: predicting the mortality of neuro-critical disease

Objectives:This study aimed to conduct and assess a module modified acute physiology and chronic health evaluation (MM-APACHE) II model, based on disease categories modified-acute physiology and chronic health evaluation (DCM-APACHE) II model, in predicting mortality more accurately in neuro-intensive care units (N-ICUs).Methods:In total, 1686 patients entered into this prospective study. Acute physiology and chronic health evaluation (APACHE) II scores of all patients on admission and worst 24-, 48-, 72-hour scores were obtained. Neurological diagnosis on admission was classified into five categories: cerebral infarction, intracranial hemorrhage, neurological infection, spinal neuromuscular (SNM) disease, and other neurological diseases. The APACHE II scores of cerebral infarction, intracranial hemorrhage, and neurological infection patients were used for building the MM-APACHE II model.Results:There were 1386 cases for cerebral infarction disease, intracranial hemorrhage disease, and neurological infection disease. The logistic linear regression showed that 72-hour APACHE II score (Wals = 173·04, P < 0·001) and disease classification (Wals = 12·51, P = 0·02) were of importance in forecasting hospital mortality. Module modified acute physiology and chronic health evaluation II model, built on the variables of the 72-hour APACHE II score and disease category, had good discrimination (area under the receiver operating characteristic curve (AU-ROC = 0·830)) and calibration (χ2 = 12·518, P = 0·20), and was better than the Knaus APACHE II model (AU-ROC = 0·778).Discussion:The APACHE II severity of disease classification system cannot provide accurate prognosis for all kinds of the diseases. A MM-APACHE II model can accurately predict hospital mortality for cerebral infarction, intracranial hemorrhage, and neurologic infection patients in N-ICU.

Incidence and outcome of acute lung injury and acute respiratory distress syndrome in the surgical intensive care unit.

Introduction:To determine the incidence and mortality of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in a cohort of patients with risk factors admitted to the Surgical Intensive Care Unit (SICU).Materials and Methods:A prospective observational inception cohort study with no intervention was conducted over 12 months. All patients with at least one known risk factor for ALI/ARDS admitted to the SICU were included in the study. The APACHE II severity of disease classification system scoring was performed within 1 h of admission. The ventilatory parameters and chest radiographs were recorded every 24 h. The P/F ratio, PEEP and Lung Injury Score were calculated each day until the day of discharge from the Intensive Care Unit or for the first 7 days of admission, whichever was shorter.Results:The incidence of ARDS among those who were mechanically ventilated was 11.4%. Sepsis was the most common (34.6%) etiology. Among those with risk factors, the incidence of ARDS was 30% and that of ALI was 32.7%. The mortality in those with ARDS was 41.8%. Those who develop ARDS had higher APACHE II scores, lower pH and higher PaCO2 at admission compared with those who developed ALI or no lung injury.Conclusion:The incidence and mortality of ARDS was similar to other studies. Identifying those with risk factors for ARDS or mortality will enable appropriate interventional measures.

Serum procalcitonin level for the prediction of severity in women with acute pyelonephritis in the ED: value of procalcitonin in acute pyelonephritis

PurposePredicting medical outcomes for acute pyelonephritis (APN) in women is difficult. Delay in diagnosis and treatment often results in rapid progression to circulatory collapse, multiple-organ failure, and death. The aim of this study was to investigate the value of procalcitonin (PCT) level in women with APN at ED. MethodsWe conducted a prospective study of women with APN presenting to the ED. The authors measured inflammatory biomarkers, and the severity of pyelonephritis was assessed by 4 severity of disease classification system and stage of sepsis. We performed an analysis to assess the value of PCT for the prediction of 28-day mortality and disease severity. ResultsA total of 240 female patients with APN are included. Patients were divided into 4 groups on the basis of systemic inflammatory response syndrome criteria, organ dysfunction, and persistent hypotension. The median PCT level was higher in the septic shock group compared with other groups. Of the other inflammatory markers, only white blood cell count was significantly different among the groups, whereas high-sensitivity C-reactive protein level and erythrocyte sedimentation rate revealed no differences. The area under the curve for PCT in predicting 28-day mortality was 0.68. For predicting mortality, a cutoff value of 0.42 ng/mL had a sensitivity of 80% and a specificity of 50%. However, the disease classification systems were demonstrated to be superior to PCT in predicting 28-day mortality. ConclusionsRelative to other classic markers of inflammation, by distinguishing the severity of sepsis related to APN, PCT levels can provide additional aid to clinicians in disease severity classification and their decision of treatment at ED.

Clinical characteristics and outcomes of critically ill obstetric patients: a ten-year review

BACKGROUND AND OBJECTIVES:Pregnancy and delivery can involve complications that necessitate admission to critical care facilities. The objective of our study was to assess the incidence, indications, and outcomes of obstetric patients requiring admission to an intensive care unit (ICU) in a tertiary care hospital, in Saudi Arabia.DESIGN AND SETTING:Retrospective cohort study of consecutive obstetric admissions to the ICU at the King Abdulaziz Medical City over a 10-year period.PATIENTS AND METHODS:We collected baseline demographic data and acute physiology and chronic health evaluation II (APACHE II) scores. ICU mortality was the primary outcome.RESULTS:Over 10 years, 75 obstetric patients were admitted to the ICU, and 59 of these patients (78.6%) were admitted during the antepartum period. The main obstetric indication for ICU admission was pregnancy-induced hypertension (21 patients, 28%) and the leading non-obstetric indication was sepsis (12 patients, 16%). The APACHE II score was 19.59 (15.05). The predicted mortality rate based on the APACHE II score was 21.97%; however, there were only six maternal deaths (8%) among the obstetric patients admitted to the ICU.CONCLUSION:The overall mortality was low. A team approach facilitated the application of optimal care to these patients. Obstetric patients had better outcomes than those predicted by the APACHE II scores. Appropriate antenatal care is important for preventing obstetric complications.

C-reactive protein and delirium in acute ill elderly patients

1. Carpenter I, Bobby J, Kulinskaya E, Seymour G. People admitted to hospital with physical disability have increased length of stay: implications for diagnosis related group re-imbursement in England. Age Ageing 2007; 36: 73–8. 2. Rozzini R, Sabatini T, Trabucchi M. Geriatric wards in acute hospitals. Age Ageing 2005; 34: 195–6. 3. Palmer RM, Landefeld CS, Kresevic DM, Kowal J. A medical unit for the acute care of the elderly. J Am Geriatr Soc 1994; 42: 545–52. 4. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985; 13: 818–29. 5. Mahoney FI, Barthel D. Functional evaluation: the Barthel Index. Md State Med J 1965; 14: 56–61.

Prediction of outcome in acute pancreatitis: A comparative study of APACHE II, clinical assessment and multiple factor scoring systems

The APACHE II severity of disease classification system has been examined prospectively in 160 patients with acute pancreatitis. Using clinical and simple laboratory data APACHE II was able to provide useful discrimination between uncomplicated, complicated and fatal attacks within a few hours of admission. Peak APACHE II scores (recorded during the first 3 days) had a prognostic accuracy similar to the multiple factor scoring systems, but then incurred a similar delay. Patients could be graded according to their risk of death or of developing a major complication; no deaths occurred in patients with a peak APACHE II score less than 10. APACHE II can be repeated daily, uncomplicated attacks demonstrating falling scores in association with clinical improvement, in contrast to the rising scores associated with clinical deterioration in those dying early. APACHE II appears to reflect any continuing disease activity and may prove a useful means of monitoring the course of the illness and response to therapy.

Clinical impact of nosocomial Klebsiella bacteremia in critically ill patients.

In order to determine the clinical impact of Klebsiella bacteremia on critically ill patients, a matched cohort study was conducted between January 1992 and December 2000. During the study period, all intensive care unit (ICU) patients with nosocomial Klebsiella bacteremia were defined as cases (n=52), but two of these patients were excluded from the matched cohort due to incomplete medical records. The remaining 50 patients were matched at a ratio of 1:2 with control patients (n=100) on the basis of the APACHE II severity of disease classification system. Patients with Klebsiella bacteremia experienced acute renal failure and hemodynamic instability more often than controls. They also had a longer ICU stay and longer ventilator dependence. In-hospital mortality rates for cases and controls were nearly equal (36% vs. 37%, respectively; P=0.905). In conclusion, after adjusting accurately for severity of underlying disease and acute illness, no difference in mortality was found between ICU patients with Klebsiella bacteremia and their matched control subjects.

Serum and Other Calcium Fractions in Patients After Severe Musculoskeletal Trauma

Alterations in serum calcium fractions after trauma may be of clinical importance. For investigation of this problem, serum calcium fractions were studied prospectively in 42 patients with severe musculoskeletal injuries. The severity of trauma was assessed with the Apache II severity of disease classification system. Serum ionized calcium, total calcium, pH, albumin, and arterial blood gases were measured daily for the first five days after admission. The fat embolism syndrome developed in eight patients; they were more severely injured than the others, and they had significantly lower levels of serum ionized calcium for all five days of the study. There was a strong negative correlation between the Apache II score and serum ionized calcium. Ionized hypocalcemia has a strong association with development of the complications of severe musculoskeletal trauma, such as the fat embolism syndrome.

Severity of Disease Classification System

Severity of Disease Classification System

APACHE II in Surgical Lung Carcinoma Patients

Recent extensive development of thoracic surgery meets the need to treat elderly patients with a wide variety of pathophysiologic alterations, even if they require continuous medical assistance and high technologic support. Methods in providing such care are still limited by imprecision in evaluation of results; in this setting, a severity of disease classification system is essential to estimate the pretreatment risk of death of elder or chronically ill patients, the appropriate indication to surgical treatments, and the prediction of outcome. We tested hospital admission characteristics and hospital mortality on 59 consecutive high-risk patients from our Surgical Department using the APACHE II severity of disease classification system. Predicted mortality rate for the high-risk patients was 12.44 percent and total mortality ratio (actual deaths/predicted deaths) was 0.94. The APACHE II scoring system showed good correct classification rate, sensitivity, and specificity.

Continuous Enteral Feeding: A Major Cause of Pneumonia among Ventilated Intensive Care Unit Patients

Continuous enteral feeding is widely practiced in intensive care units (ICU). We found that pneumonia developed in 54% of 24 ventilated patients on continuous enteral feeding for more than 3 days. This appeared to affect only patients with a persistently high morning (7:00 am) gastric pH, with 12 of 13 (92%) patients developing pneumonia. In 11 patients the causative organisms were cultured initially from the stomach, oropharynx and trachea before pneumonia supervened. This effect was distinct from that found with the prophylactic use of antacids or H2-receptor antagonists. The mortality (46%) of this group of patients was 1.6 times greater than the expected mortality predicted by the Apache II Severity of Disease Classification System.

Validation of a severity of illness score (APACHE II) in a surgical intensive care unit

The intensive care unit is an important resource for the treatment of patients needing medical and surgical care for complicated diseases. The diversity of diseases and the difference in arrangements between hospitals providing such care have limited the precision of evaluations of intensive care. We have measured the admission characteristics and hospital mortality of 598 consecutive patients admitted to our Surgical Intensive Care Unit (SICU) using a severity of disease classification system (APACHE II) on the first day of admission. Hospital outcome details were available on 87% of the SICU patients. The overall mortality was 21.7%, mean APACHE score for survivors and non-survivors was 14.2 and 22.4, and their risk of death was 21.1% and 54.1%. The APACHE II scoring system provided an excellent means of classification, with a higher sensitivity and specificity.

APACHE II score and mortality in respiratory failure due to cardiogenic pulmonary edema.

We reviewed retrospectively 88 patients to assess whether the APACHE II severity of disease classification system can predict mortality in patients with respiratory failure due to cardiac pulmonary edema. Mean score for survivors was higher than for nonsurvivors (24.5 +/- 6.7 vs. 20.7 +/- 5.7, p less than .01), and increasing APACHE II scores were not associated with increasing mortality. Mortality was 54% for APACHE II scores less than or equal to 18, 43% for scores greater than 18 and less than or equal to 24, 22% for scores greater than 24 and less than or equal to 31, and 25% for scores between 32 and 40. The relationship of APACHE II scores to mortality did not improve when the 25 patients with ICU stays less than 48 h were analyzed; the mean score of survivors in this group was 24.3 +/- 5.2 vs. 18.8 +/- 4.6 for nonsurvivors, p less than .001. The presence of myocardial infarction (MI) was associated with a high mortality. Mortality in the 51 MI patients was 52.9% vs. 13.5% in the 37 patients without MI (p less than .001), but APACHE II scores were similar (22.6 +/- 6.6 and 23.7 +/- 6.4, respectively). The relationship between APACHE II scores and mortality did not improve if patients with and without MI are analyzed separately. For patients with MI, mortality was 78.6% for scores between 12 and 17, 56.2% for scores between 18 and 23, 33.3% for scores between 24 and 29, and 33.3% for scores greater than 29.(ABSTRACT TRUNCATED AT 250 WORDS)

Audit of intensive care: a 30 month experience using the Apache II severity of disease classification system.

608 patients admitted to a general Intensive Care Unit (ICU) over a 30 month period were analyzed according to the Apache II Severity of Disease Classification System on day one of admission. Hospital outcome details were available on 583 patients in the series. The mean Apache II scores for survivors (396) and non-survivors (187) were 13 (SD 7) and 24 (SD 9), and their Risk of Death were 16 (SD 16) and 47 (SD 27) respectively (p(0.001 for both). The majority of deaths (75%: 141/187) in our series came from those with chronic ill health (55%: 103/187), of whom 37% (38/103) were in endstage disease, and those with “old” trauma (18%: 34/187) often with incipient sepsis transferred from other hospitals after a mean delay of 9 days. Our higher than predicted mortality (mortality ratio 1.2) in comparison with centres in the United States of America (US) may be partly explained by the high proportion of our population from these unfavourable groups, by our use of the best Glasgow Coma Scale in the first 24 h following admission, and the major differences between our patient population and that of the US upon which the Apache II was based. The presence of these large unfavourable groups indicates a change in our admission policy is warranted.

One year's experience with the APACHE II severity of disease classification system in a general intensive care unit.

The APACHE II sickness score was applied prospectively for one year in a general intensive care unit in Saudi Arabia. Two hundred and ten patients were studied, 66 of whom died in hospital. The mean APACHE II score of survivors was 11 (SD 7.1) and of non-survivors, 25.3 (SD 8.8). The mean Risk of Death was 13.3% (SD 13.1) for the survivors and 47.2% (SD 25.8) for non-survivors. The differences in APACHE score and Risk of Death between survivors and non-survivors are highly significant (p less than 0.0005 for both). No patient survived who had a Risk of Death greater than 60% and none died with a Risk of Death less than 7%. The sensitivity of the APACHE II system in predictions of death can be improved if the scores on the day of admission and on the 3rd day are taken into account.

Stratification of prognosis in granulocytopenic patients with hematologic malignancies using the APACHE-II severity of illness score.

The APACHE-II (acute physiology and chronic health evaluation) severity of disease classification system was used to stratify prognosis of granulocytopenic patients with hematologic malignancies. A total of 146 admissions were retrospectively reviewed. In 26 ICU admissions, mortality was 69.2%; in 120 admissions to the ward, mortality was 15.8%. The APACHE-II score successfully stratified prognosis in both ward and ICU settings. Respiratory failure and the presence of pneumonia on chest x-ray were identified as poor prognostic factors. ICU patients admitted for monitoring or postoperative care had a better prognosis than those admitted for severe cardiopulmonary compromise. We suggest that the APACHE-II system is useful for stratifying prognosis for clinical research in this group of patients, although it remains to be shown whether it will be useful in predicting the prognosis of individual patients.

USE OF APACHE II SEVERITY OF DISEASE CLASSIFICATION TO IDENTIFY INTENSIVE-CARE-UNIT PATIENTS WHO WOULD NOT BENEFIT FROM TOTAL PARENTERAL NUTRITION

The APACHE II severity of disease classification system was tested for its ability to identify intensive-care-unit (ICU) patients who would not benefit from treatment with total parenteral nutrition (TPN). First, the classification was validated in our patient population by testing it on 210 consecutive ICU admissions. Then a retrospective study was done on 89 ICU patients who had received TPN, to define APACHE II selection criteria. When the APACHE II system was tested prospectively on 26 ICU patients treated with TPN, it predicted correctly, with a specificity of 100%, half of the patients who died.

APACHE II

This paper presents the form and validation results of APACHE II, a severity of disease classification system. APACHE II uses a point score based upon initial values of 12 routine physiologic measurements, age, and previous health status to provide a general measure of severity of disease. An increasing score (range 0 to 71) was closely correlated with the subsequent risk of hospital death for 5815 intensive care admissions from 13 hospitals. This relationship was also found for many common diseases. When APACHE II scores are combined with an accurate description of disease, they can prognostically stratify acutely ill patients and assist investigators comparing the success of new or differing forms of therapy. This scoring index can be used to evaluate the use of hospital resources and compare the efficacy of intensive care in different hospitals or over time.