Use Of APACHE Research Articles

Evaluating the Use of Apache II Score in Predicting the Severity and Clinical Outcomes of Organophosphorous Poisoning-Original Study

Objectives: To identify predictors of mortality in OPC poisoned patients and also to evaluate the performanceof APACHE II scoring systemfso r predicting severity and the outcome of patients poisoned with OPC who wereadmitted to the ICU.Methods: A single centre observational study conducted in ICU of a tertiary care teaching hospital inchennai,INDIA. Patients are subjected to history questioning, clinical examinations and blood samplingfor complete blood count,renal function test,serum sodium and potassium,arterial blood gas and also vitalparameters including rectal temperature, oxygen saturation, respiratory rate, pulse rate and blood pressurewere recorded.The APACHE score is calculated from the worst values obtained during the first 24 hours of ICUadmission. The 24 hour time window is necessary to allow us to measure all the needed variables to calculate theAPACHE score.Each variable is given the weightage of 0-4. The total score obtained will be in the range of 0-71.Results: 75 patients with confirmed history or documented OPC poisoning were enrolled for study. Thedifference in APACHE II score is statistically significant among the survivors(5.70 ± 3.01) and non survivors(19.57± 3.93) with p value(<0.0001). Other parameters which are shown to be statistically significant [p<0.05] in ourstudy are age, Glasgow coma scale, rectal temperature, respiratory rate, pH, oxygenation, serum urea, serumcreatinine and serum potassium.Conclusion: APACHE II score predicts the severity of acute physiological dysfunction due to multi organinvolvement in OPC poisoning and can be recommended as a useful scoring system in OPC poisonings in ICUsettings.

The simultaneous use of APACHE II and NEWS II clinical scores in postoperative monitoring of the colon and rectum surgical patient

Background: Although highly popular among clinicians and intensive care specialists, the APACHE II and NEWS II clinical scores are not widely documented in the monitoring of complications during the postoperative period of colorectal surgical patients. The rationale behind the present study is to see whether the simultaneous evaluation of a multitude of clinical parameters, as provided by both these scores, could be associated with the development of postoperative septic complications.

Usefulness of APACHE II, SOFA, ISARIC/WHO 4C Mortality Score and CO-RADS for Mortality Prediction of Critically Ill Coronavirus Disease 2019 (Covid-19) Patients

Usefulness of APACHE II, SOFA, ISARIC/WHO 4C Mortality Score and CO-RADS for Mortality Prediction of Critically Ill Coronavirus Disease 2019 (Covid-19) Patients

Comparative study to evaluate use of apache ii and sofa score in sepsis patients in intensive care unit of a tertiary level hospital in western Maharashtra

Background: Intensive care units (ICU) in most settings consume very high cost and sophisticated devices but mortality rates are still very high. There is no specific literature comparing APACHE II score and SOFA score in sepsis patient and this research topic will help to identify the score more appropriate to predict the seriousness, outcome and mortality of patients suffering from sepsis, which has been evaluated in our study. Methodology: This was a single centre hospital based cross sectional, observational, descriptive study conducted in patients in ICUs of our institute. 100 patients over age 16 years old admitted in intensive care unit who have fulfilled the criteria for sepsis were included in our study. Their clinical profile, APACHE II and SOFA scores were evaluated and compared with respect to patients’ outcome in the form of survival. Results: The mean age was 56.71 ± 16.77 years. Majority of patients were males (69%). 52 of patients were survivors (52%) and non-survivor were 48%. The mean SOFA score of survived patients was 3.54 ± 2.57 lower than non-survivor patients of 6.02 ± 3.17.

The Use of APACHE II Scoring System for Predicting Clinical Outcome of Patients Admitted to the Intensive Care Unit: A Report From a Resource-Limited Center

The Use of APACHE II Scoring System for Predicting Clinical Outcome of Patients Admitted to the Intensive Care Unit: A Report From a Resource-Limited Center

The use of APACHE II, SOFA, SAPS 3, C-reactive protein/albumin ratio, and lactate to predict mortality of surgical critically ill patients: A retrospective cohort study: Erratum

The use of APACHE II, SOFA, SAPS 3, C-reactive protein/albumin ratio, and lactate to predict mortality of surgical critically ill patients: A retrospective cohort study: Erratum

A prospective study of prediction of outcomes in perforative peritonitis using apache II scoring system

Background: To predict the risk of mortality and morbidity in patients with perforative peritonitis using APACHE II scoring system. To evaluate the usefulness of APACHE II scoring system as a potential clinical and research tool which could be included as routine part of patient assessment in institution like ours.Methods: This was a prospective, observational study of prediction of outcomes in 80 patients of perforative peritonitis using APACHE II scoring system, conducted during the period of 2 years at our tertiary care institute.Results: Predicted death rate of the study was 17.31% and observed death rate was 25%. However, when observed and predicted death rates were compared in group of patients with APACHE II score of <10, it was over estimating the mortality. In group of patients with APACHE II score 11-20 and >20 it was underestimating the mortality. About 71.2% patients came under APACHE II score <10 with mortality of 3.5%. 23.7% came under group of patients with APACHE II score of 11-20 with mortality of 73.6% and only 5% patients had score >20 with 100% mortality were seen amongst them.Conclusions: In the present study, APACHE II scoring system was found to be accurate predictor of group outcome and can be effectively used in prediction of group outcome in similar population, but does not give sufficient confidence for outcome in an individual patient.

Study of various prognostic factors for sepsis patients requiring intensive medical care with special emphasis on APACHE II score in prognostication

Background: Sepsis has remained a leading cause of bed occupancy and mortality in medical ICU around the world. There is limited epidemiological information from south Asian countries about the prognostic factors for the outcome in such patients which is very important in planning for treatment strategies.Aim: We investigated various prognostic factors for sepsis and also the use of APACHE II scoring system as a prognostic tool.Methodology: We analysed 50 patients with sepsis admitted to medical ICU. All demographic, etiological, clinical and investigatory parameters were recorded and APACHE II score was calculated for all patients on the day of admission. Patients were followed till discharge or death in hospital.Results: Among wide range of primary diseases causing sepsis in our study, tropical sepsis was one of the major contributors which differ from the western studies. Overall mortality was 28% which is comparable to other parts of the world. Demographic profiles including sex, area of residence and socio-economic status except increasing age did not correlate well with mortality in sepsis patients. Central nervous system and respiratory system involvement led to highest mortality (52%). Number of organ systems involved was found to be statistically significant predictive factor for mortality in severe sepsis (p <0.05). Mean APACHE II score of study patients was 22.84 ± 7.57. Severity grading of sepsis as per APACHE II scoring system correlated very well with mortality (p <0.05) but it did not correlate with length of ICU stay.Conclusion: In the era of many complex scoring systems, along with traditional prognostic factors, age old APACHE II scoring system is still a very user-friendly and inexpensive method which can be used at the bedside for mortality prediction in sepsis patients.

Use of APACHE II and SAPS II to predict mortality for hemorrhagic and ischemic stroke patients

We studied the applicability of the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in patients admitted to the intensive care unit (ICU) with acute stroke and compared the results with the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS). We also conducted a comparative study of accuracy for predicting hemorrhagic and ischemic stroke mortality. Between January 2011 and December 2012, ischemic or hemorrhagic stroke patients admitted to the ICU were included in the study. APACHE II and SAPS II-predicted mortalities were compared using a calibration curve, the Hosmer–Lemeshow goodness-of-fit test, and the receiver operating characteristic (ROC) curve, and the results were compared with the GCS and NIHSS. Overall 498 patients were included in this study. The observed mortality was 26.3%, whereas APACHE II and SAPS II-predicted mortalities were 35.12% and 35.34%, respectively. The mean GCS and NIHSS scores were 9.43 and 21.63, respectively. The calibration curve was close to the line of perfect prediction. The ROC curve showed a slightly better prediction of mortality for APACHE II in hemorrhagic stroke patients and SAPS II in ischemic stroke patients. The GCS and NIHSS were inferior in predicting mortality in both patient groups. Although both the APACHE II and SAPS II systems can be used to measure performance in the neurosurgical ICU setting, the accuracy of APACHE II in hemorrhagic stroke patients and SAPS II in ischemic stroke patients was superior.

Digital dark matter and the economic contribution of Apache

Researchers have long hypothesized that research outputs from government, university, and private company R&D contribute to economic growth, but these contributions may be difficult to measure when they take a non-pecuniary form. The growth of networking devices and the Internet in the 1990s and 2000s magnified these challenges, as illustrated by the deployment of the descendent of the NCSA HTTPd server, otherwise known as Apache. This study asks whether this experience could produce measurement issues in standard productivity analysis, specifically, omission and attribution issues, and, if so, whether the magnitude is large enough to matter. The study develops and analyzes a novel data set consisting of a 1% sample of all outward-facing web servers used in the United States. We find that use of Apache potentially accounts for a mismeasurement of somewhere between $2 billion and $12 billion, which equates to between 1.3% and 8.7% of the stock of prepackaged software in private fixed investment in the United States and a very high rate of return to the original federal investment in the Internet. We argue that these findings point to a large potential undercounting of the rate of return from IT spillovers from the invention of the Internet. The findings also suggest a large potential undercounting of “digital dark matter” in general.

English

BACKGROUND: Sepsis with multiple organ dysfunction syndrome (MODS) is a common cause of Intensive Care Unit (ICU) mortality and morbidity. Early initiation of appropriate effective antimicrobial therapy is essential for a favorable outcome in the patient with sepsis. Cultures and serology are available only after 24 to 48 hours. In the crucial hours which determine the prognosis of the patient the physician has to depend on clinical symptoms and demographic data to aid in diagnosis and management. Using scores like APACHE II at the admission and SOFA on admission and also in their due course may help in predicting outcome. Though there are some studies on sepsis in India but use of APACHE II and SOFA scores in India have been rare. OBJECTIVES: To assess morbidity and mortality of patients with multi-organ dysfunction syndrome in sepsis. To prognosticate the patients by using defined scores like SOFA and APACHE II scores. MATERIALS AND METHODS: The study was carried out in the period of November 2010 to September 2012 and 50 patients were included in the study. The detailed history, clinical examination and all the relevant laboratory investigations were done including blood culture. In the present study the conditions were defined according to standard practice and based on relevant literature. All the patients of sepsis admitted to ICU/ emergency ward were prognosticated on the basis of APACHE II score and SOFA score. We have analysed various profiles between two groups; survivor group which include the patients who are successfully discharged after recovery and nonsurvivor group which include the patients who died. RESULTS: The clinical profile of 50 patients with sepsis with MODS was studied. There were 28 males and 22 females in this cohort. In this study, 18 patients died and 32 patients survived with mortality rate of 36%. In this study, though APACHE II score was high among non survivors than survivors (23.28 v/s 18.75), it was of just statistically significantly with P=0.068+. SOFA score has been validated extensively for prognostication. In this study, extensive study of SOFA score was done from day 1 to the last day. The SOFA score on day 1 was high among non survivors and survivors which was statistically significant (10.17 v/s 7.94, p=0.014). However the most significant difference was observed on Day 3. The SOFA score was very high among non survivors as compared to survivors which was statistically very significant.(13.42 v/s 6.84, p<0.001). CONCLUSION: Serial measurement of SOFA score during first week is very useful tool in predicting the outcome especially on the day 3. The trend of SOFA score was progressively declining in survivors while non-survivors had stable higher score during the first week. The APACHE II score on day of admission, though reliable, was not effective in predicting the mortality rate in our set up.

Sa1360 The Use of APACHE IV Compared to APACHE II, Ranson's Criterion and BISAP Score for Predicting Mortality and Complications of Acute Pancreatitis - A Prospective Trial

Sa1360 The Use of APACHE IV Compared to APACHE II, Ranson's Criterion and BISAP Score for Predicting Mortality and Complications of Acute Pancreatitis - A Prospective Trial

Availability Of JobTracker Machine In Hadoop/MapReduce Zookeeper Coordinated Clusters

It is difficult to use the traditional Message Passing Interface (MPI) approach to implement synchronization, coordination, and prevent deadlocks in distributed systems. This difficulty is lessened by the use of Apache's Hadoop/MapReduce and Zookeeper to provide Fault Tolerance in a Homogeneously Distributed Hardware/Software environment. A mathematical model for the availability of the JobTracker in Hadoop/MapReduce using Zookeeper's Leader Election Service is presented in this paper. Although the availability is less than what is expected in f+1 Fault Tolerance systems for crash failures, this approach makes coordination and synchronization easy, reduces the effect of Byzantine faults and provides Fault Tolerance for distributed systems. The results obtained show that the availability changes with change in the number of Zookeeper servers. This model can help determine how many servers are optimal for high availability, from which vendor they must be purchased, and when to use a Zookeeper coordinated Hadoop cluster to perform safety critical tasks.

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.

Outcome prediction in sepsis combined use of genetic polymorphisms – A study in Japanese population

Genetic polymorphisms have recently been found to be related to clinical outcome in septic patients. The present study investigated to evaluate the influence of genetic polymorphisms in Japanese septic patients on clinical outcome and whether use of genetic polymorphisms as predictors would enable more accurate prediction of outcome. Effects of 16 genetic polymorphisms related to pro-inflammatory mediators and conventional demographic/clinical parameters (age, sex, past medical history, and APACHE II score) on ICU mortality as well as disease severity during ICU stay were examined in the septic patients (n=123) admitted to the ICU between October 2001 and November 2007 by multivariable logistic regression analysis. ICU mortality was significantly associated with TNF −308GA, IL1β −31CT/TT, and APACHE II score. Receiver-operating characteristics (ROC) analysis demonstrated that, compared with APACHE II score alone (ROC–AUC=0.68), use of APACHE II score and two genetic parameters (TNF −308 and IL1β −31) enabled more accurate prediction of ICU mortality (ROC–AUC=0.80). Significant association of two genetic polymorphisms, TNF −308 and IL1β −31, with ICU mortality was observed in septic patients. In addition, combined use of these genetic parameters with APACHE II score may enable more accurate prediction of outcome in septic patients.

USE OF APACHE 4 DATA TO INITIATE ROOT CAUSE ANALYSIS

PURPOSE: First item to be able to recognize a possible patient safety concern is data on the expected outcome of a person or group of patients. TeleICU organizations track data based on expected mortality for low risk and high risk patients.

Serum procalcitonin at the time of admission to the ICU as a predictor of short-term mortality

Objective This purpose of this study was to determine if serum procalcitonin (PCT) concentration at the time of admission to the ICU is a predictor of all-cause short-term mortality. Design and methods This prospective cross-sectional study was conducted over a 16-month period with 86 consecutive critically ill patients. The semi-quantitative PCT-Q test was performed and APACHE II scores and C-reactive protein (CRP) concentrations were determined within 24 h of admission. Results PCT-Q test value was a better predictor of all-cause short-term mortality than CRP value or APACHE II score. PCT ≥ 10 ng/mL was highly and independently correlated with mortality. Use of PCT-Q ≥ 10 ng/mL was superior to use of APACHE II ≥ 25 or CRP ≥ 10 mg/dL as a predictor of poor outcome. Conclusions A PCT-Q value ≥ 10 ng/mL obtained at the time of admission to the ICU is a strong predictor of short-term mortality.

Prediction of Mortality after Emergent Transjugular Intrahepatic Portosystemic Shunt Placement: Use of APACHE II, Child-Pugh and MELD Scores in Asian Patients with Refractory Variceal Hemorrhage

ObjectiveThis study was designed to determine if existing methods of grading liver function that have been developed in non-Asian patients with cirrhosis can be used to predict mortality in Asian patients treated for refractory variceal hemorrhage by the use of the transjugular intrahepatic portosystemic shunt (TIPS) procedure.Materials and MethodsData for 107 consecutive patients who underwent an emergency TIPS procedure were retrospectively analyzed. Acute physiology and chronic health evaluation (APACHE II), Child-Pugh and model for end-stage liver disease (MELD) scores were calculated. Survival analyses were performed to evaluate the ability of the various models to predict 30-day, 60-day and 360-day mortality. The ability of stratified APACHE II, Child-Pugh, and MELD scores to predict survival was assessed by the use of Kaplan-Meier analysis with the log-rank test.ResultsNo patient died during the TIPS procedure, but 82 patients died during the follow-up period. Thirty patients died within 30 days after the TIPS procedure; 37 patients died within 60 days and 53 patients died within 360 days. Univariate analysis indicated that hepatorenal syndrome, use of inotropic agents and mechanical ventilation were associated with elevated 30-day mortality (p < 0.05). Multivariate analysis showed that a Child-Pugh score > 11 or an MELD score > 20 predicted increased risk of death at 30, 60 and 360 days (p < 0.05). APACHE II scores could only predict mortality at 360 days (p < 0.05).ConclusionA Child-Pugh score > 11 or an MELD score > 20 are predictive of mortality in Asian patients with refractory variceal hemorrhage treated with the TIPS procedure. An APACHE II score is not predictive of early mortality in this patient population.

Assessment of Prognosis in Acute Liver Failure

Determining prognosis in acute liver failure (ALF) is vital to consideration of transplantation for these critically ill patients. Transplanting a likely survivor may be as unfortunate as not transplanting someone whose outcome is very poor. Prognostic scoring systems have largely failed to accurately portray outcomes, partly because the use of transplantation does not allow the true transplant-free outcome to unfold. The King's College Hospital criteria have not proved accurate enough in predicting outcome for those with moderate illness; sensitivity is reasonable while specificity is poor. Use of APACHE II or MELD systems suffers from similar deficiencies. Use of specialized biomarkers such as Gc protein, alpha-fetoprotein, or troponin shows some promise but has not proven effective to date. Considering etiology and coma grade prior to development of scores based on routine or specialized biomarkers may be important. The rapid evolution of ALF as well as the different etiologies encountered may continue to frustrate our efforts to accurately predict outcomes in ALF.

Role of enteric fever in ileal perforations: An overstated problem in tropics?

To determine the role of enteric fever in ileal perforations. A prospective cohort of 47 patients of ileal perforation was subjected to clinical examination and investigations for APACHE II scoring. Blood, ulcer edge biopsy, mesenteric lymph node and peritoneal aspirate were subjected to culture to determine the predominant aerobic bacterial isolate and its antibiogram. Seven patients (14.9%) required intensive care and seven (14.9%) developed septicaemia. Mortality was 17%. Highest isolation rate was seen in ulcer edge (70.2%) followed by lymph node (66%) culture. The bacterial spectrum was Escherichia coli (23.4%), Enterococcus faecalis (21.3%), Salmonella enterica serovar Typhi (6.3%), Salmonella enterica serovar Paratyphi A (4.2%), etc. Enteric fever organisms are not the predominant causative agents of ileal perforations. Culture of ulcer edge biopsy, lymph node is crucial for aetiological diagnosis. The use of APACHE II triaging and prescription of antimicrobials based on the local pattern of susceptibility profile of the aetiological agent is recommended.