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Objective: Several predictive scoring systems measuring disease severity are used to predict outcomes, typically mortality, of critically ill patients in the intensive care unit (ICU). Two common validated predictive scoring systems include acute physiology and chronic health evaluation II (APACHE II) and modified sequential organ failure assessment score (mSOFA). To compare performance of APACHE II and mSOFA score in critically ill patients regarding the outcomes in the form of morbidity and mortality in ICU. Methods: This prospective observational clinical study was conducted on 100 patients over 6 months. For each patient, APACHE II score on day of admission and serial mSOFA scores on day 0, 3, 7 and 10 were calculated and compared. Results: The age of the non-survivors was significantly older than survivors was (57.1±11.76 and 54.28±15.16). [In our study we found that the mean length of ICU stay of non-survivors was (5.41±4.81) & survivors(8.63± 4.81) days.] In our study mortality rate was 40%.The APACHE II score with cut-off point of 23 demonstrated a sensitivity rate of 98.33% & specificity rate of 17.5%, accuracy of 66.00%. Serial mSOFA scores with cut-off of 11 on day0, day3, day7 better differentiated survivors from non-survivors with 98.3% sensitivity, 27.5% specificity and 70% accuracy. Conclusion: Both APACHE II and mSOFA scores can help ICU physicians as a significant predictive marker for mortality in critically ill patients. The serial measurement of mSOFA score in the first week is a better mortality predictor tool than APACHE II score in critically ill patients.
ABSTRACT
Resumen: Introducción: La obesidad es una enfermedad con impacto negativo en la sobrevida; se hace referencia al término «paradoja de la obesidad¼ utilizado como un efecto protector en la mortalidad. Objetivo: Determinar si la obesidad es un factor de protección en el paciente crítico. Material y métodos: Se realizó un estudio de cohorte. Se obtuvo información de expedientes de Unidad de Cuidados Intensivos (UCI) del Hospital Regional Monterrey del Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE) Monterrey durante 2018. Se hizo análisis bivariado para asociación χ2 y U de Mann-Whitney para correlación fórmula de Pearson y análisis de supervivencia con curva de Kaplan-Meier. Resultados: Se analizaron 151 expedientes de pacientes, 73 obesos y 78 no obesos, se observó que la obesidad es un factor protector para mortalidad (p = 0.044, OR 0.431 (IC 0.187-0.992). El IMC no se correlaciona con el Acute physiology and chronic health evaluation (APACHE) II (p = 0.066); sin embargo, con un impacto en la curva de supervivencia (p = 0.42). Conclusiones: Se detecta la obesidad como factor protector; sin embargo, su asociación con enfermedades crónicas degenerativas, estancia prolongada en UCI y sus complicaciones no dejan de tener impacto negativo en la supervivencia fuera de la unidad.
Abstract: Introduction: Obesity is a disease with a negative impact on survival; the prognosis of these patients is has controversial results. The term «obesity paradox¼ refers as a protective effect on mortality. Objective: To determine whether obesity is a protective factor in the critically ill patient. Material y methods: A cohort study was conducted. Data was obtained from ICU records of the ISSSTE Monterrey Regional Hospital during 2018, bivariate analysis was performed for χ2 and Mann Whitney's U association, for Pearson's formula correlation and survival analysis with Kaplan-Meier curve. Results: 151 records of 73 obese and 78 non-obese patients were analyzed, it was observed that obesity is a protective factor for mortality (p = 0.044, OR 0.431(IC 0.187-0.992), BMI does not correlate with APACHE II (p = 0.066), however, an impact on the survival curve was observed (p = 0.42). Conclusions: According to the results obtained, it matches with the term «obesity paradox¼, however, its association with chronic degenerative diseases, prolonged stay in the ICU and its complications do not cease to have a negative impact on survival outside the unit.
Resumo: Introdução: A obesidade é uma doença com impacto negativo na sobrevida; O termo «paradoxo da obesidade¼ refere-se a um efeito protetor sobre a mortalidade. Objetivo: Determinar se a obesidade é um fator protetor em pacientes críticos. Material e métodos: Foi realizado um estudo de coorte. As informações foram obtidas dos registros da UTI do ISSSTE Monterrey Regional Hospital durante o ano de 2018, foi realizada análise bivariada para associação χ2 eU Mann-Whitney, para correlação da fórmula de Pearson e análise de sobrevida com curva de Kaplan-Meier. Resultados: Foram analisados 151 prontuários de 73 pacientes obesos e 78 não obesos, observou-se que a obesidade é fator protetor para mortalidade (p = 0.044, OR 0.431(IC 0.187-0.992), IMC não se correlaciona com APACHE II (p = 0.066), porém, com impacto na curva de sobrevida (p = 0.42). Conclusões: A obesidade é encontrada como fator de proteção, porém, sua associação com doenças crônico-degenerativas, permanência prolongada na UTI e suas complicações não deixam de ter impacto negativo na sobrevida fora da unidade.
ABSTRACT
Background: Acute pancreatitis is a common disease with wide clinical variation and its incidence is increasing. Acute pancreatitis may vary in severity, from mild self-limiting pancreatic inflammation to pancreatic necrosis with life-threatening sequelae. The severity of acute pancreatitis is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis. Aim of the study: To compare the efficacy of Ranson scoring with APACHE II scoring system in predicting the severity of acute pancreatitis. Materials and methods: The present study was a prospective study of 33 cases of Acute pancreatitis admitted in Rajiv Gandhi Government General Hospital, Chennai, during the study period of July 2014 to September 2014. 33 cases for the purpose of the study were selected on the basis of the nonprobability (purposive) sampling method. multiple clinical and laboratory variables of both Ranson and APACHE II scoring system and the final score of the patient from both the scoring systems are assessed to know their efficacy in predicting the severity of the disease (higher the score more severe the disease). Results: Overall, 8(24.2%) patients suffered from severe pancreatitis and 25(75.7%) had mild acute pancreatitis of which all 8 had severe attack as per APACHE II score (>8) and only 3 of these were considered severe by Ranson score (>3). The systemic complications were a multiorgan failure in 2(6.06%), respiratory 1(3.03%) and renal 1(3.03%) all seen in patients with the severe score as per APACHE II. Umarani Subramaniam, Ahila Muthuselvi, Kesavan. A comparative study between APACHE II and Ranson scoring systems in predicting the severity of acute pancreatitis. IAIM, 2019; 6(4): 55-59. Page 56 Conclusion: The early diagnosis and precise scoring of disease severity are important goals in the initial evaluation and management of pancreatitis. Pancreatitis not only must be differentiated from a myriad of other potential diagnoses, but patients must also be stratified to identify those with severe disease and to guide appropriate therapy.