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1.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(10): 1237-1242, 2021 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-34955135

RESUMO

OBJECTIVE: To study the influence of time-dependent acute physiology and chronic health evaluation II (APACHE II) score on 14-day death risk in patients with severe stroke, and to provide reference for clinical diagnosis and treatment. METHODS: Data of 3 229 patients with severe stroke were enrolled from Medical Information Mart for Intensive Care-III (MIMIC-III). According to the main types of stroke, the patients were divided into subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), ischemic stroke (IS) and other groups. According to age, patients were divided into > 60 years old and ≤ 60 years old subgroups. According to the baseline of sequential organ failure assessment (SOFA) score, they were divided into subgroups of > 3 and ≤ 3. The daily measured values of APACHE II scores in each patient were recorded. And all-cause death within 14 days after admission to intensive care unit (ICU) was used as the outcome index to obtain the survival status and survival time of patients. Joint models for longitudinal and time-to-event data were established to evaluate the effect of APACHE II score measured at multiple time points on the death risk of patients, and a subgroup analysis was performed. RESULTS: Among the joint models, the one which include APACHE II score, and the interaction items between APACHE II and age showed the better fitting. Further analysis showed that APACHE II score was affected by age, gender, hospital admission, baseline SOFA score and smoking history. After controlling for these confounding factors, APACHE II score was significantly associated with 14-day all-cause death in patients with severe stroke [hazard ratio (HR) = 1.48, 95% confidence interval (95%CI) was 1.31-1.66, P < 0.001], which indicated that the risk of death increased by 48% (95%CI was 31%-66%) for each 1-point increase in APACHE II score. Subgroup analysis showed that for different types of severe stroke patients, APACHE II score had a greater impact on the risk of 14-day death in SAH patients (HR = 1.43, 95%CI was 1.10-1.85), but had a smaller impact on ICH and IS groups [HR (95%CI) was 1.37 (1.15-1.64) and 1.35 (1.06-1.71), respectively]. There was no significant difference in APACHE II score on the risk of 14-day death between the patients aged > 60 years old and those aged ≤ 60 years old [HR (95%CI): 1.37 (1.08-1.72) vs. 1.35 (1.07-1.70), respectively]. Compared with patients with SOFA score > 3, APACHE II score had a greater impact on the risk of 14-day death in patients with SOFA score ≤ 3 [HR (95%CI): 1.40 (1.16-1.70) vs. 1.34 (1.16-1.55)]. CONCLUSIONS: Time-dependent APACHE II score is an important indicator to evaluate the risk of death in patients with severe stroke.


Assuntos
Sepse , Acidente Vascular Cerebral , APACHE , Cuidados Críticos , Análise de Dados , Humanos , Unidades de Terapia Intensiva , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico
2.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(11): 1212-1219, 2021 Nov 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34911855

RESUMO

OBJECTIVES: Sepsis associated encephalopathy (SAE) is a common neurological complication of sepsis. Delirium is a common symtom of SAE. The pathophysiology of SAE is still unclear, but several likely mechanisms have been proposed, such as mitochondrial and endothelial dysfunction, neurotransmission disturbances, derangements of calcium homeostasis, cerebral microcirculation dysfunction, and brain hypoperfusion. Near-infrared spectroscopy (NIRS) is a non-invasive measure for regional cerebral oxygen saturation (rSO2), which has attracted more attention these years. Previous studies have reported that abnormal NIRS values were associated with delirium in critically ill patients. Blood pressure management according to NIRS monitoring improved the organ perfusion and prognosis of patients. This study aimed to observe the dynamic changes of rSO2 using NIRS in septic shock patients, and analyze the relationship between them. METHODS: A total of 48 septic patients who admitted to the intensive care unit (ICU) of Xiangya Hospital, Central South University from August 2017 to May 2018, were retrospectively study. Septic shock was diagnosed according to the criteria of sepsis 3.0 defined by the American Association of Critical Care Medicine and the European Society of Critical Care Medicine. NIRS monitoring was performed during the first 6 hours admitted to ICU with sensors placed on the bilateral forehead of patients. The maximum (rSO2max), minimum (rSO2min), mean value, and the variation rate during the first 6 hours of monitor were recorded. The following data were collected upon the first 24 h after admission to the ICU: The baseline data of patients, laboratory examination results (routine blood test, liver and renal function, blood gas analysis, indicators of infection, and coagulation function), scoring system results [Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA)]. Delirium was screened with the Confusion Assessment Method for ICU (CAM-ICU). The length of time on mechanical ventilation (MV), length of ICU-stay, length of hospital-stay, and 28-day mortality were also recorded. The primary outcome was 28-day mortality, and the secondary outcomes were the incidence of delirium, length of ICU-stay, and length of hospital-stay. The differences between survivors and non-survivors, and patients with or without delirium were analyzed, and the risk factors for delirium were assessed. The performance of rSO2-related indexes (rSO2max, rSO2min, the mean value, and the variation rate of rSO2) in predicting 28-day mortality and delirium was analyzed and the cutoff values were determined. RESULTS: The overall 28-day mortality of septic shock patients was 47.92% (23/48), and the incidence of delirium was 18.75% (9/48). The rSO2min was significantly lower in the non-survivors than the survivors (P=0.042). The variation rate of rSO2 was higher in patients with delirium than those without delirium (P=0.006). The independent risk factors for delirium were rSO2max, the level of direct bilirubin (DBIL), and whether achieved the 6-hour bundle. To predict the 28-day mortality of septic shock patients, the area under the receiver operating characteristic curve (AUROC) for rSO2max, rSO2min, the mean value and the variation rate of rSO2 were 0.616, 0.606, 0.623, and 0.504, respectively. To predict the incidence of delirium, AUROC for rSO2max, rSO2min, the mean value and the variation rate of rSO2 were 0.682, 0.617, 0.580, and 0.501, respectively. The best cutoff value for rSO2max in predicting delirium was 77.5% (sensitivity was 0.444, specificity was 0.897). The best cutoff value for rSO2min in predicting delirium was 65.5% (sensitivity was 0.556, specificity was 0.744). CONCLUSIONS: Cerebral anoxia and hyperoxia, as well as the large fluctuation of cerebral oxygen saturation are important factors that affect the outcomes and the incidence of delirium in septic shock patients, which should be paid attention to in clinical practice. Dynamic monitoring of cerebral oxygen saturation and maintain its stability may be of great significance in patients with septic shock.


Assuntos
Sepse , Choque Séptico , APACHE , Humanos , Unidades de Terapia Intensiva , Prognóstico , Estudos Retrospectivos
3.
Tuberk Toraks ; 69(4): 510-519, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34957745

RESUMO

Introduction: Although thorax ultrasound has been used to diagnose pneumonia in recent years, the role of ultrasonic diaphragm evaluation in the prognosis of pneumonia is unknown. This study aimed to assess the impact of diaphragmatic excursion (Dex) measured by ultrasound on the prognosis of severe pneumonia in critical care patients. Materials and Methods: We prospectively recruited patients with severe pneumonia who were admitted to the intensive care unit (ICU) between January 2019 and July 2021. Patients' Dex values, vital signs, clinical features, laboratory parameters, APACHE-II scores on the first admission day of ICU, mortality and respiratory support status at follow-up were recorded. Result: There were 39 patients enrolled in the study. Mean Dex of the study patients was 30.66 ± 12.17 mm. Mean Dex was significantly lower in deceased patients than survivors (18.37 ± 8.12 vs 34.90 ± 10.36 p< 0.001). Dex was lower in patients who required invasive mechanical ventilation than those not (24.90 ± 10.93 vs 34.26 ± 11.70, p= 0.017). The cut-off value of Dex was found 19.0 mm for significantly predicted (p≤ 0.001) survival with the sensitivity of 96.6% and specificity of 70%. Among the study group, diaphragm excursion was negatively correlated with APACHE-II score (r= -0.688, p≤ 0.001) and respiratory rate (r= -0.531, p= 0.001). Conclusions: Dex measured on the day of ICU admission can be used to evaluate the prognosis of patients with severe pneumonia.


Assuntos
Diafragma , Pneumonia , APACHE , Diafragma/diagnóstico por imagem , Humanos , Unidades de Terapia Intensiva , Pneumonia/diagnóstico por imagem , Prognóstico , Curva ROC , Estudos Retrospectivos , Ultrassonografia
4.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(9): 1094-1098, 2021 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-34839868

RESUMO

OBJECTIVE: To observe the changes of regional saturation of cerebral oxygenation (rScO2) and blood neuron specific enolase (NSE) in patients after cardiopulmonary resuscitation (CPR), and to explore its value in evaluating the prognosis of patients' neurological function. METHODS: From January 2012 to December 2020, 97 patients with return of spontaneous circulation (ROSC) after cardiac arrest (CA) treated in the intensive care unit (ICU) of the Second Affiliated Hospital of Soochow University were selected. According to the prognosis, the patients were divided into two groups: good neurological function group [Glasgow-Pittsburgh Cerebral Performance Categories (CPC) 1-2, 20 cases] and neurological dysfunction group (CPC classification 3-5, 77 cases). The clinical data of gender, age, the number of patients with defibrillable rhythm, time of ROSC, the number of CA patients outside the hospital, acute physiology and chronic health evaluation II (APACHE II), Glasgow coma scale (GCS), global non-response scale (FOUR), body temperature, mean arterial pressure (MAP), blood lactic acid (Lac) and GCS at discharge, as well as the length of ICU stay, rScO2 and blood NSE were collected. The differences of rScO2 and NSE between the two groups were compared; and the receiver operator characteristic curve (ROC curve) was drawn to evaluate the value of rScO2 and NSE alone or in combination in predicting the prognosis of patients with ROSC after CA. RESULTS: The rScO2 of good neurological function group was significantly higher than that of neurological dysfunction group at 1, 3, 6, 12, 24 and 48 hours (all P < 0.05). At 24 hours after admission, the rScO2 on the left and right sides of good neurological function group was significantly higher than that in neurological dysfunction group [left: 0.65 (0.59, 0.76) vs. 0.55 (0.44, 0.67), right: 0.62 (0.61, 0.73) vs. 0.50 (0.30, 0.69), both P < 0.05], and NSE was significantly lower than that in the neurological dysfunction group [ng/L: 21.42 (15.38, 29.69) vs. 45.82 (24.05, 291.26), P < 0.05]. ROC curve analysis showed that both rScO2 and NSE alone and combined detection had a certain value in predicting the prognosis of neurological function in patients with ROSC after CA, and the area under the ROC curve (AUC) detected by the combination was the largest, which was higher than the AUC predicted by rScO2 or NSE (0.904 vs. 0.884, 0.792). When the cut-off value of combination was 0.83, the sensitivity and specificity were 75.7% and 100% respectively. CONCLUSIONS: Monitoring rScO2 and NSE can predict the prognosis of neurological function after CPR, especially the combined evaluation of the two indexes, which can greatly improve the accuracy of diagnosis.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , APACHE , Parada Cardíaca/terapia , Humanos , Fosfopiruvato Hidratase , Prognóstico
5.
J Int Med Res ; 49(11): 3000605211059288, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34812075

RESUMO

OBJECTIVE: Cholecystostomy is a palliative treatment for patients unfit to undergo immediate cholecystectomy. Nevertheless, the role of cholecystostomy in the clinical management of such patients remains unclear. The Acute Physiology and Chronic Health Evaluation IV (APACHE IV) scoring system is useful for estimating the hospital mortality of high-risk patients. We evaluated the therapeutic effect of cholecystostomy by the APACHE IV scoring system in patients aged >65 years with acute cholecystitis. METHODS: In total, 597 patients aged >65 years with acute cholecystitis were retrospectively analyzed using APACHE IV scores. RESULTS: The fitness of the APACHE IV score prediction was good, with an area under the receiver operating characteristic curve of 0.894. The chi square independence test indicated that compared with conservative treatment, cholecystostomy may have different effects on mortality for patients whose estimated mortality rate was >10%. Comparison of the estimated mortality of patients before and after cholecystostomy indicated that the estimated mortality was significantly lower after than before puncture, both in the whole patient group and in the group with an estimated mortality of >10%. CONCLUSION: The APACHE IV scoring system showed that cholecystostomy is a safe and effective treatment for elderly high-risk patients with acute cholecystitis.


Assuntos
Colecistite Aguda , Colecistostomia , APACHE , Idoso , Colecistectomia , Colecistite Aguda/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
6.
Medicine (Baltimore) ; 100(41): e27538, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34731152

RESUMO

ABSTRACT: This study was performed to verify whether lactate dehydrogenase to albumin (LDH/ALB) ratio could be used as an independent prognostic factor in patients with severe infection requiring intensive care.We reviewed electronic medical records of patients hospitalized to the intensive care unit via the emergency department with a diagnosis of infection between January 2014 and December 2019. From the collected data, ALB-based ratios (LDH/ALB, blood urea nitrogen to albumin, C-reactive protein to albumin, and lactate to albumin ratios) and some severity scores (modified early warning score, mortality in emergency department sepsis score [MEDS], and Acute Physiology And Chronic Health Evaluation II [APACHE II] score) were calculated. LDH/ALB ratio for predicting the in-hospital mortality was compared with other ALB-based ratios and severity scales by univariable and receiver-operating characteristics curve analysis. Modified severity scores by LDH/ALB ratio and multivariable logistic regression were used to verify the independence and usefulness of the LDH/ALB ratio.The median LDH/ALB ratio was higher in non-survivors than survivors (166.9 [interquartile range: 127.2-233.1] vs 214.7 [interquartile range: 160.2-309.7], P < .001). The area under the receiver-operating characteristics curve of the LDH/ALB ratio (0.642, 95% confidence interval: 0.602-0.681, P < .001) was not lower than that of other ALB-based ratios and severity scores. From multivariable logistic regression, LDH/ALB ratio was independently associated with in-hospital mortality (odds ratio = 1.001, 95% confidence interval: 1.000-1.002, P = .047). Area under the receiver-operating characteristics curves of MEDS and APACHE II scores were improved by modification with LDH/ALB ratio (MEDS: 0.643 vs 0.680, P < .001; APACHE II score: 0.675 vs 0.700, P = .003).LDH/ALB ratio may be useful as the prognostic factor in patients with severe infection requiring intensive care.


Assuntos
Albuminas/análise , Doenças Transmissíveis/sangue , Cuidados Críticos/métodos , Unidades de Terapia Intensiva/estatística & dados numéricos , L-Lactato Desidrogenase/sangue , APACHE , Idoso , Idoso de 80 Anos ou mais , Nitrogênio da Ureia Sanguínea , Proteína C-Reativa/análise , Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/mortalidade , Comorbidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Mortalidade Hospitalar/tendências , Humanos , Ácido Láctico/análise , Masculino , Prognóstico , Estudos Retrospectivos , Sepse/mortalidade , Índice de Gravidade de Doença
7.
Clin Nutr ESPEN ; 45: 486-491, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34620359

RESUMO

BACKGROUND: Intensive care unit (ICU) patients are at particular risk for malnutrition with major impact for outcome and prognosis. Nutrition support teams (NST) have been proposed to improve nutrition care in ICU patients. OBJECTIVE: To assess the effectiveness of an interdisciplinary NST on anthropometry and clinical outcome of ICU patients. METHODS: Before NST implementation, we assessed 120 patients (before NST group; SAPS II score 44 ± 16), afterwards 60 patients (after NST group), of whom 29 received NST guidance (after NST + group; SAPS II 65 ± 19) and 31 not (after NST - group; SAPS II, 54 ± 16). The primary outcome parameter was length of stay in the hospital (hospital-LOS). Severity of disease was assessed by the APACHE II score and the nutritional risk (NUTRIC) score. RESULTS: NST intervention resulted in a more pronounced improvement of disease severity (APACHE II, from 27 ± 8 to 18 ± 6, p < 0.001; NUTRIC, from 7 ± 2 to 4 ± 2, p < 0.001) compared to no NST intervention (APACHE II from 24 ± 7 to 21 ± 7, p < 0.05; NUTRIC from 6 ± 2 to 5 ± 2, p < 0.01). The mean hospital-LOS was not reduced, neither in the NST intervention group nor in the control group without NST intervention. NST intervention failed to improve nutritional status or mortality compared to no NST intervention. CONCLUSION: In our study the NST intervention had a positive effect on disease severity, but failed to improve mortality, hospital-LOS or nutritional status in ICU patients, likely because of a large patient heterogeneity. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02200874).


Assuntos
Estado Terminal , Desnutrição , APACHE , Humanos , Unidades de Terapia Intensiva , Desnutrição/diagnóstico , Desnutrição/terapia , Apoio Nutricional
9.
Medicina (Kaunas) ; 57(10)2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34684169

RESUMO

Background and Objectives: Numerous scoring systems have been introduced into modern medicine. None of the scoring systems assessed both anesthetic and surgical risk of the patient, predict the morbidity, mortality, or the need for postoperative intensive care unit admission. The aim of this study was to compare the anesthetic and surgical scores currently used, for a better evaluation of perioperative risks, morbidity, and mortality. Material and Methods: This is a pilot, prospective, observational study. We enrolled 50 patients scheduled for elective surgery. Anesthetic and surgery risk was assessed using American Society of Anesthesiologists (ASA) scale, Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM), Acute Physiology and Chronic Health Evaluation (APACHE II), and Surgical APGAR Score (SAS) scores. The real and the estimated length of stay (LOS) were registered. Results: We obtained several statistically significant positive correlations: ASA score-P-POSSUM (p < 0.01, r = 0.465); ASA score-SAS, (p < 0.01, r = -0.446); ASA score-APACHE II, (p < 0.01 r = 0.519); predicted LOS and ASA score (p < 0.01, r = 0.676); predicted LOS and p-POSSUM (p < 0.01, r = 0.433); and predicted LOS and APACHE II (p < 0.01, r = 0.454). A significant negative correlation between predicted LOS, real LOS, ASA class, and SAS (p < 0.05) was observed. We found a statistically significant difference between the predicted and actual LOS (p < 001). Conclusions: Anesthetic, surgical, and severity scores, used together, provide clearer information about mortality, morbidity, and LOS. ASA scale, associated with surgical scores and severity scores, presents a better image of the patient's progress in the perioperative period. In our study, APACHE II is the best predictor of mortality, followed by P-POSSUM and SAS. P-POSSUM score and ASA scale may be complementary in terms of preoperative physiological factors, providing valuable information for postoperative outcomes.


Assuntos
Anestesia , APACHE , Anestesia/efeitos adversos , Humanos , Projetos Piloto , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença
10.
Crit Care ; 25(1): 336, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34526076

RESUMO

BACKGROUND: Acute hypoxemic respiratory failure (HRF) is associated with high morbidity and mortality, but its heterogeneity challenges the identification of effective therapies. Defining subphenotypes with distinct prognoses or biologic features can improve therapeutic trials, but prior work has focused on ARDS, which excludes many acute HRF patients. We aimed to characterize persistent and resolving subphenotypes in the broader HRF population. METHODS: In this secondary analysis of 2 independent prospective ICU cohorts, we included adults with acute HRF, defined by invasive mechanical ventilation and PaO2-to-FIO2 ratio ≤ 300 on cohort enrollment (n = 768 in the discovery cohort and n = 1715 in the validation cohort). We classified patients as persistent HRF if still requiring mechanical ventilation with PaO2-to-FIO2 ratio ≤ 300 on day 3 following ICU admission, or resolving HRF if otherwise. We estimated relative risk of 28-day hospital mortality associated with persistent HRF, compared to resolving HRF, using generalized linear models. We also estimated fold difference in circulating biomarkers of inflammation and endothelial activation on cohort enrollment among persistent HRF compared to resolving HRF. Finally, we stratified our analyses by ARDS to understand whether this was driving differences between persistent and resolving HRF. RESULTS: Over 50% developed persistent HRF in both the discovery (n = 386) and validation (n = 1032) cohorts. Persistent HRF was associated with higher risk of death relative to resolving HRF in both the discovery (1.68-fold, 95% CI 1.11, 2.54) and validation cohorts (1.93-fold, 95% CI 1.50, 2.47), after adjustment for age, sex, chronic respiratory illness, and acute illness severity on enrollment (APACHE-III in discovery, APACHE-II in validation). Patients with persistent HRF displayed higher biomarkers of inflammation (interleukin-6, interleukin-8) and endothelial dysfunction (angiopoietin-2) than resolving HRF after adjustment. Only half of persistent HRF patients had ARDS, yet exhibited higher mortality and biomarkers than resolving HRF regardless of whether they qualified for ARDS. CONCLUSION: Patients with persistent HRF are common and have higher mortality and elevated circulating markers of lung injury compared to resolving HRF, and yet only a subset are captured by ARDS definitions. Persistent HRF may represent a clinically important, inclusive target for future therapeutic trials in HRF.


Assuntos
Mortalidade/tendências , Fenótipo , Insuficiência Respiratória/classificação , APACHE , Biomarcadores/análise , Estudos de Coortes , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/mortalidade
11.
Medicine (Baltimore) ; 100(36): e27159, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34516508

RESUMO

ABSTRACT: Severity of illness, age, malnutrition, and infection are the important factors determining intensive care unit (ICU) survival.The aim of the study is to determine the relations between Geriatric Nutritional Risk Index (GNRI), C-reactive protein/albumin (CAR), and prognosis-mortality of geriatric patients (age of ≥65 years) admitted to intensive care unit.The study with 10/15/2020, 697 approval date, and number retrospectively registered. Between January 1, 2018 and December 31, 2019, 413 geriatric patients admitted to ICU. The patients were divided into three groups according to their age.The age group, gender, Charlson comorbidity index, intensive care scores (Acute Physiology And Chronic Health Evaluation II and Sequential Organ Failure Assessment), the infection markers (white blood cell, procalcitonin, CAR levels), malnutrition tools for each patient (body mass index, Nutrition Risk in Critically ill score, and GNRI scores) were analyzed retrospectively. Also length of stay (LOS) ICU, length of stay hospital, and 30-day mortality were recorded.Geriatric patients number of 403 was included in the study. Forty-nine (12.3%) patients had a history of malignancy, 272 (67.5%) patients had Chronic Obstructive Pulmonary Disease comorbidity. There was no difference in mortality between age groups.In patients with mortality, body mass index, had being Chronic Obstructive Pulmonary Disease history, GNRI, length of stay hospital, and albumin were significantly lower; malignancy comorbidity rate, inotrope use, modified Nutrition Risk in Critically ill score, mechanical ventilation duration, LOS ICU, Sequential Organ Failure Assessment, Acute Physiology And Chronic Health Evaluation II, Charlson comorbidity index, C-reactive protein, procalcitonin, and CAR were significantly higher.Both malnutrition and infection affect mortality in geriatric patients in intensive care. The GNRI is better than CAR at predicting mortality.


Assuntos
Infecção Hospitalar/epidemiologia , Idoso Fragilizado , Desnutrição/epidemiologia , Síndrome do Desconforto Respiratório , APACHE , Idoso , Idoso de 80 Anos ou mais , Infecção Hospitalar/etiologia , Infecção Hospitalar/mortalidade , Feminino , Avaliação Geriátrica , Serviços de Saúde para Idosos , Humanos , Unidades de Terapia Intensiva , Masculino , Desnutrição/etiologia , Desnutrição/mortalidade , Avaliação Nutricional , Estado Nutricional , Turquia/epidemiologia
12.
J Assoc Physicians India ; 69(6): 11-12, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34472784

RESUMO

BACKGROUND: Pregnant women in India are at higher risk of dying as compared to middle to high income countries. Deaths can be prevented if risk factors are identified, critical illness is diagnosed early and timely care is provided. The present research was undertaken to study the clinical profile and factors affecting the outcome of pregnant and postpartum patients in the Medical Intensive Care Unit (MICU). METHOD: A total of 75 consecutive patients of age >18 years with confirmed pregnancy or postpartum females within 42 days from date of delivery requiring admission in ICU for at least one organ dysfunction as per APACHE II criteria1 were enrolled in the study. Clinical profiles of patients and outcomes were measured till hospital discharge. RESULTS: Among 75 patients, 18(24%) patients were postpartum while 57(76%) were antepartum.The commonest symptom was fever (64%), followed by breathlessness (62.7%). Respiratory distress (58.7%) was the commonest indication for transfer to MICU. While 60(80%) patients were admitted for medical illnesses in pregnancy, 15(20%) patients were admitted for obstetric complications. Acute infections including malaria, dengue and leptospirosis were the commonest illness diagnosed in 19(25.3%) patients. Severity of illness measured using APACHE II score varied from 4 to 35 points with a mean score of 10.61.Longer duration of symptoms before seeking medical attention, lower pH, lower paO2/FiO2 ratio and serum bicarbonate, a diagnosis of tuberculosis and a higher APACHE II score were associated with a higher mortality. CONCLUSION: With institution of intensive therapy in critically ill maternal patients, 80% of patients could be saved and 61% of fetuses had uneventful outcomes.The prognosis was better for obstetric illnesses than for medical illnesses with only 3 patients dying of obstetric causes whereas 12 patients died of medical illnesses common to the general population. Even though APACHE II score was higher in the group with obstetric conditions (mean=11 vs. 8.1), the mortality was lower.


Assuntos
Unidades de Terapia Intensiva , Complicações na Gravidez , APACHE , Adolescente , Estado Terminal , Feminino , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos
13.
Crit Care ; 25(1): 282, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353352

RESUMO

BACKGROUND/OBJECTIVE: Death in intensive care units (ICUs) may increase bereaved family members' risk for posttraumatic stress disorder (PTSD). However, posttraumatic stress-related symptoms (hereafter as PTSD symptoms) and their precipitating factors were seldom examined among bereaved family members and primarily focused on associations between PTSD symptoms and patient/family characteristics. We aimed to investigate the course and predictors of clinically significant PTSD symptoms among family members of deceased ICU patients by focusing on modifiable quality indicators for end-of-life ICU care. METHOD: In this longitudinal observational study, 319 family members of deceased ICU patients were consecutively recruited from medical ICUs from two Taiwanese medical centers. PTSD symptoms were assessed at 1, 3, 6, and 13 months post-loss using the Impact of Event Scale-Revised (IES-R). Family satisfaction with end-of-life care in ICUs was assessed at 1 month post-loss. End-of-life care received in ICUs was documented over the patient's ICU stay. Predictors for developing clinically significant PTSD symptoms (IES-R score ≥ 33) were identified by multivariate logistic regression with generalized estimating equation modeling. RESULTS: The prevalence of clinically significant PTSD symptoms decreased significantly over time (from 11.0% at 1 month to 1.6% at 13 months post-loss). Longer ICU stays (adjusted odds ratio [95% confidence interval] = 1.036 [1.006, 1.066]), financial insufficiency (3.166 [1.159, 8.647]), and reported use of pain medications (3.408 [1.230, 9.441]) by family members were associated with a higher likelihood of clinically significant PTSD symptoms among family members during bereavement. Stronger perceived social support (0.937 [0.911, 0.965]) and having a Do-Not-Resuscitate (DNR) order issued before the patient's death (0.073 [0.011, 0.490]) were associated with a lower likelihood of clinically significant PTSD symptoms. No significant association was observed for family members' satisfaction with end-of-life care (0.988 [0.944, 1.034]) or decision-making in ICUs (0.980 [0.944, 1.018]). CONCLUSIONS: The likelihood of clinically significant PTSD symptoms among family members decreased significantly over the first bereavement year and was lower when a DNR order was issued before death. Enhancing social support and facilitating a DNR order may reduce the trauma of ICU death of a beloved for family members at risk for developing clinically significant PTSD symptoms.


Assuntos
Atitude Frente a Morte , Família/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , APACHE , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Ansiedade/etiologia , Ansiedade/psicologia , Luto , Depressão/epidemiologia , Depressão/etiologia , Depressão/psicologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Apoio Social , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários
14.
BMC Med Inform Decis Mak ; 21(1): 237, 2021 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362354

RESUMO

BACKGROUND: Prognostication is an essential tool for risk adjustment and decision making in the intensive care units (ICUs). In order to improve patient outcomes, we have been trying to develop a more effective model than Acute Physiology and Chronic Health Evaluation (APACHE) II to measure the severity of the patients in ICUs. The aim of the present study was to provide a mortality prediction model for ICUs patients, and to assess its performance relative to prediction based on the APACHE II scoring system. METHODS: We used the Medical Information Mart for Intensive Care version III (MIMIC-III) database to build our model. After comparing the APACHE II with 6 typical machine learning (ML) methods, the best performing model was screened for external validation on anther independent dataset. Performance measures were calculated using cross-validation to avoid making biased assessments. The primary outcome was hospital mortality. Finally, we used TreeSHAP algorithm to explain the variable relationships in the extreme gradient boosting algorithm (XGBoost) model. RESULTS: We picked out 14 variables with 24,777 cases to form our basic data set. When the variables were the same as those contained in the APACHE II, the accuracy of XGBoost (accuracy: 0.858) was higher than that of APACHE II (accuracy: 0.742) and other algorithms. In addition, it exhibited better calibration properties than other methods, the result in the area under the ROC curve (AUC: 0.76). we then expand the variable set by adding five new variables to improve the performance of our model. The accuracy, precision, recall, F1, and AUC of the XGBoost model increased, and were still higher than other models (0.866, 0.853, 0.870, 0.845, and 0.81, respectively). On the external validation dataset, the AUC was 0.79 and calibration properties were good. CONCLUSIONS: As compared to conventional severity scores APACHE II, our XGBoost proposal offers improved performance for predicting hospital mortality in ICUs patients. Furthermore, the TreeSHAP can help to enhance the understanding of our model by providing detailed insights into the impact of different features on the disease risk. In sum, our model could help clinicians determine prognosis and improve patient outcomes.


Assuntos
Algoritmos , Unidades de Terapia Intensiva , APACHE , Mortalidade Hospitalar , Humanos , Prognóstico , Curva ROC , Índice de Gravidade de Doença
15.
BMC Neurol ; 21(1): 308, 2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-34376174

RESUMO

BACKGROUND: Tuberculous meningitis (TBM) is the most lethal form of tuberculosis worldwide. Data on critically ill TBM patients in the intensive care unit (ICU) of China are lacking. We tried to identify prognostic factors of adult TBM patients admitted to ICU in China. METHODS: We conducted a retrospective study on adult TBM in ICU between January 2008 and April 2018. Factors associated with unfavorable outcomes at 28 days were identified by logistic regression. Factors associated with 1-year mortality were studied by Cox proportional hazards modeling. RESULTS: Eighty adult patients diagnosed with TBM (age 38.5 (18-79) years, 45 (56 %) males) were included in the study. An unfavorable outcome was observed in 39 (49 %) patients and were independently associated with Acute Physiology and Chronic Health Evaluation (APACHE) II > 23 (adjusted odds ratio (aOR) 5.57, 95 % confidence interval (CI) 1.55-19.97), Sequential Organ Failure Assessment (SOFA) > 8 (aOR 9.74, 95 % CI 1.46-64.88), and mechanical ventilation (aOR 18.33, 95 % CI 3.15-106.80). Multivariate Cox regression analysis identified two factors associated with 1-year mortality: APACHE II > 23 (adjusted hazard ratio (aHR) 4.83; 95 % CI 2.21-10.55), and mechanical ventilation (aHR 9.71; 95 % CI 2.31-40.87). CONCLUSIONS: For the most severe adult TBM patients of Medical Research Council (MRC) stage III, common clinical factors aren't effective enough to predict outcomes. Our study demonstrates that the widely used APACHE II and SOFA scores on admission can be used to predict short-term outcomes, while APACHE II could also be used to predict long-term outcomes of adult patients with TBM in ICU.


Assuntos
Tuberculose Meníngea , APACHE , Adulto , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Prognóstico , Estudos Retrospectivos , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/epidemiologia , Tuberculose Meníngea/terapia
16.
Nutrition ; 91-92: 111400, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34388583

RESUMO

OBJECTIVES: This study aimed to compare the serum level of micronutrients with normal amounts, and assess their association with the severity of disease and inflammatory cytokines in patients with coronavirus disease 2019 (COVID-19). METHODS: The present cross-sectional study included 60 patients admitted to the intensive care unit with COVID-19. We recorded data on demographic characteristics, anthropometric information, and medical history. Serum levels of inflammatory markers (erythrocyte sedimentation rate, C-reactive protein, interferon-gamma, tumor necrosis factor-alpha, interleukin-6), vitamins (A, B9, B12, C, D, E), and minerals (magnesium, zinc, iron) were measured. A radiologist assessed the severity of lung involvement according to patient computed tomography scans. The severity of illness was evaluated with the Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) score, oxygen saturation, and body temperature. Independent associations among the serum levels of micronutrients with the severity of COVID-19 were measured. RESULTS: Median patient age was 53.50 years (interquartile range, 12.75 years). Except for vitamin A and zinc, serum levels of other micronutrients were lower than the minimum normal. Patients with APACHE score ≥25 had a higher body mass index (P = 0.044), body temperature (P = 0.003), erythrocyte sedimentation rate (P = 0.008), C-reactive protein (P = 0.003), and lower oxygen saturation (P = 0.005), serum levels of vitamin D (P = < 0.001), and zinc (P = < 0.001) compared with patients with APACHE score <25. We found that lower serum levels of vitamin D, magnesium, and zinc were significantly and independently associated with higher APACHE scores (P = 0.001, 0.028, and < 0.001, respectively) and higher lung involvement (P = 0.002, 0.045, and < 0.001, respectively). CONCLUSIONS: Lower serum levels of vitamin D, zinc, and magnesium were involved in severe COVID-19.


Assuntos
COVID-19 , Micronutrientes , APACHE , Criança , Estudos Transversais , Humanos , SARS-CoV-2
17.
J Pak Med Assoc ; 71(8): 1935-1939, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34418004

RESUMO

Objectives: To compare the diagnostic accuracy of two systems in predicting mortality among patients with acute exacerbation of chronic obstructive pulmonary disease. METHODS: The cross-sectional study was conducted from November 2017 to June 2018 in the Department of Chest Medicine, Jinnah Postgraduate Medical Centre, Karachi, and comprised patients with acute exacerbation of chronic obstructive pulmonary disease. Dyspnoea-eosinopenia-consolidation-acidaemia-atrial fibrillation system was compared with acute physiology and chronic health evaluation II scoring system after mortality scores were calculated for each patient. Data was analysed using SPSS 21. RESULTS: Of the 210 patients, 147(70%) were males and 63(30%) were females. Overall, 59(28.1%) patients died during hospital stay. The mean dyspnoea-eosinopenia-consolidation-acidaemia-atrial fibrillation score was 2.31±0.93 while the mean acute physiology and chronic health evaluation II score was 15.8±7.2. A decision threshold of dyspnoea-eosinopenia-consolidation-acidaemia-atrial fibrillation score >2 had a sensitivity of 84.6% and specificity of 82.3% while acute physiology and chronic health evaluation II score had sensitivity of 53.9% and specificity of 76.5%. CONCLUSIONS: Both scoring systems were found to be good predictors of mortality, but dyspnoea-eosinopenia-consolidationacidaemia-atrial fibrillation score was a simpler and effective clinical tool.


Assuntos
Fibrilação Atrial , Doença Pulmonar Obstrutiva Crônica , APACHE , Estudos Transversais , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Valor Preditivo dos Testes
18.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 803-808, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412748

RESUMO

OBJECTIVE: To investigate the effect of the completion time of initial 30 mL/kg fluid resuscitation on the prognosis of patients with septic shock. METHODS: An observational study was conducted. The inpatients with septic shock admitted to intensive care unit (ICU) of Northern Jiangsu People's Hospital, Affiliated Hospital of Yangzhou University and Jiangdu People's Hospital from October 1st, 2018 to September 30th, 2020 were enrolled. The general data including gender, age, body mass index (BMI), patient source, site of infection, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score and arterial blood lactic acid (Lac) at ICU admission, fluid resuscitation dose, completion time of initial 30 mL/kg fluid resuscitation, mechanical ventilation, incidence of acute kidney injury (AKI), continuous renal replacement therapy (CRRT), length of ICU stay and 28-day mortality. The relationship between the completion time of initial 30 mL/kg fluid resuscitation and ΔSOFA score (the difference between SOFA score 3 hours of fluid resuscitation and initial SOFA score) was analyzed. In addition, according to the completion time (T) of initial 30 mL/kg fluid resuscitation, the patients were divided into T ≤ 1 hour group, 1 hour < T ≤ 2 hours group, 2 hours < T ≤ 3 hours group and T > 3 hours group, and the observation parameters among the groups were compared. RESULTS: (1) A total of 131 patients were enrolled, including 94 males and 37 females with an average age of (68.3±15.0) years old. The median APACHE II score was 27 (21, 34), the median of initial SOFA score was 12 (10, 14), the median of initial Lac was 5.0 (3.4, 7.1) mmol/L, and the most common source of infection was lung, with a total of 87 patients (66.41%). The completion time of initial 30 mL/kg fluid resuscitation and ΔSOFA score fitted the Logistic curve (Y = -1.062 6X2+4.407 9X+0.961 8), which suggested that the early or late completion time of initial fluid resuscitation had adverse effects on the prognosis of patients with septic shock. (2) There was no significant difference in infection site, initial APACHE II score, initial Lac, and initial SOFA score among different completion time of initial 30 mL/kg fluid resuscitation groups. The respiratory support rate, the incidence of AKI and the ratio of CRRT in the T ≤ 1 hour group were significantly higher than those in the 1 hour < T ≤ 2 hours group, 2 hours < T ≤ 3 hours group and T > 3 hours group (respiratory support rate: 78.57% vs. 75.51%, 42.86%, 75.00%; incidence of AKI: 57.14% vs. 20.41%, 21.43%, 50.00%; ratio of CRRT: 35.71% vs. 0%, 7.14%, 16.67%), the differences among the groups were statistically significant (all P < 0.05). The 28-day mortality was the highest in the T ≤ 1 hour group (64.29%), and the lowest in the 1 hour < T ≤ 2 hours group (22.45%), 35.71% in the 2 hours < T ≤ 3 hours group, 33.33% in the T > 3 hours, and the difference among the groups was statistically significant (P < 0.01). CONCLUSIONS: Completion of initial 30 mL/kg fluid resuscitation in 1-2 hours after septic shock may reduce the 28-day mortality and improve organ dysfunction, and initial fluid resuscitation prematurely or too late may increase 28-day mortality. But further research and verification are needed.


Assuntos
Choque Séptico , APACHE , Idoso , Idoso de 80 Anos ou mais , Feminino , Hidratação , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Prognóstico , Choque Séptico/diagnóstico , Choque Séptico/terapia
19.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 876-877, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412761

RESUMO

OBJECTIVE: To establish a high-quality critical illness scoring program by VBA programming. METHODS: The acute physiology and chronic health evaluatin II (APACHE II), Logistic organ dysfunction score (LODS) and sequential organ failure assessment (SOFA) were combined into a program with visual basic for applications (VBA) of Microsoft Excel. Taking the case data published in the literature as an example, the program was applied to SOFA score. First, directly copied the patient's data, such as age, body weight, body temperature, pulse, blood pressure, blood routine, blood biochemistry, blood gas analysis, etc. Then, returned to the program, clicked the "paste data" button, and the data would be automatically filled in, and selected the worst option. Then, the usage of norepinephrine, mechanical ventilation, Glasgow coma scale (GCS) score and 24-hour urine volume were input according to the situation. Finally, clicked the "score" button to get SOFA score. RESULTS: Pasted the data directly into the critical illness scoring program and checked it accordingly. The total time from data input to abtaining scoring result was less than 2 minutes; and the repeatability was strong. CONCLUSIONS: The application of VBA self-programming can quickly and accurately perform critical illness scoring.


Assuntos
Estado Terminal , Escores de Disfunção Orgânica , APACHE , Escala de Coma de Glasgow , Humanos , Prognóstico
20.
BMC Gastroenterol ; 21(1): 331, 2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433425

RESUMO

BACKGROUND: There are few reports about the effect of glucocorticoids in the treatment of acute pancreatitis in humans. This study aims to evaluate the effect of glucocorticoids in the treatment of acute pancreatitis by propensity score matching analysis. RESULTS: Acute pancreatitis patients admitted between 2014 and 2019 were collected from the database and analyzed. Included patients were divided into the glucocorticoids-used group (GC group) and the non-glucocorticoids-used group (NGC group) according to whether glucocorticoids were used. A total of 818 eligible patients were included in the final analysis. Seventy-six patients were treated with glucocorticoids, and 742 patients were treated without glucocorticoids. Before propensity score matching, the triglyceride levels (38.2 ± 18.5 vs. 20.2 ± 16.8, P < 0.05) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (7.1 ± 2.5 vs. 4.5 ± 2.1, P < 0.05) at admission were significantly higher in the GC group than in the NGC group. The incidence of multi-organ failure (33.3% vs. 11.9%, P < 0.05) was significantly higher in the GC group than in the NGC group. Patients in the GC group showed a positive balance of fluid intake and output over 72 h. After 1:1 propensity score matching, 59 patients from each group (GC and NGC) were included in the analysis. There were no significant differences in age, sex, body mass index, triglycerides, or APACHE II scores between the two groups (P > 0.05), and the patients' clinical outcomes were reversed. The proportion of patients with organ failure (40.7% vs. 52.5%, p < 0.05) and multi-organ failure (35.0% vs. 67.7%, P < 0.05) was significantly lower in the GC group than in the NGC group. Furthermore, patients in the GC group had significantly shorter lengths of hospital stay (12.9 ± 5.5 vs. 16.3 ± 7.7, P < 0.05) and costs (25,348.4 ± 2512.6vs. 32,421.7 ± 2813.3, P < 0.05) than those in the NGC group. CONCLUSIONS: This study presents preliminary confirmation of the beneficial effect of glucocorticoids in the treatment of acute pancreatitis. More high-quality prospective studies are needed in the future.


Assuntos
Glucocorticoides , Pancreatite , APACHE , Doença Aguda , Glucocorticoides/uso terapêutico , Humanos , Pancreatite/tratamento farmacológico , Pontuação de Propensão
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