Acute Physiology and Chronic Health Evaluation (APACHE) II Score – the Clinical Predictor in Neurosurgical Intensive Care Unit

Akavipat, Phuping

doi:10.20471/acc.2019.58.01.07

Cited by 44 publications

(47 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Consequently, there is an urgent demand for better identification of variables for high-risk patients. At present, the determination of ICU patient risk mainly relies on clinical judgment and severity scores (such as APACHE scores), which incorporate patients' previous health statuses, along with clinical and laboratory variables, which track the function of multiple organ systems [13][14][15][16]. In recent decades, our knowledge of the biochemical processes underlying critical illness has considerably improved.…”

Section: Discussionmentioning

confidence: 99%

The associations between cytokine levels and clinical outcomes in critically ill patients after surgery: a retrospective cohort study

Yan¹,

Wang²,

Hu³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The associations of serum cytokine levels and critically ill patient outcomes after surgery remain unclear. The use of cytokine markers to predict outcomes in critically ill patients is controversial. Objective To determine the levels of IL-1β, IL-2, IL-6, IL-8, IL-10, TNF-α and procalcitonin in critical surgical ICU (SICU) patients and evaluate their associations with patient outcome and clinical significance. Methods This was a retrospective cohort study of consecutive patients admitted to the SICU in Zhongshan Hospital, Fudan University. The program ran from January 1, 2018, to June 30, 2019. The levels of IL-1β, IL-2, IL-6, IL-8, IL-10, TNF-α and procalcitonin were detected, and their relationship with patient outcomes was investigated. The primary outcome was in-hospital mortality, compared by a multivariable logistic regression analysis among the survivors and nonsurvivors. Results Overall, 5,257 patients were included in this study for their first SICU admission; 5,099 patients survived, 158 patients died, and the mortality rate was 3.0% (158/5,257). Univariate and multivariate analyses showed that nonsurvivors had increased levels of IL-1β (OR = 1.855, P = 0.000) and IL-2 (OR = 1.51, P = 0.000) compared with survivors. In addition, 196 patients (3.7%) were readmitted to the SICU, and data from 187 patients were collected. Of these, 161 patients survived, and 26 patients died; the mortality rate was 13.9% (26/187), which was much higher than that of the first round of patients. The level of IL-2 significantly influenced SICU readmission (OR = 3.921, P = 0.000). For the third round of SICU admission, 10 patients were included, 7 patients survived, and 3 patients died; the mortality rate was 30.0% (3/10). Furthermore, older age, longer time of SICU stay, and higher rate of mechanical ventilation and CRRT were associated with patient death. Conclusions High levels of cytokines may be risk factors for mortality and SICU readmission in critically ill patients who receive surgery. Further work is still needed to determine which unmeasured characteristics and therapies may contribute to the increased risk observed.

show abstract

Section: Discussionmentioning

confidence: 99%

The associations between cytokine levels and clinical outcomes in critically ill patients after surgery: a retrospective cohort study

Yan¹,

Wang²,

Hu³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Consequently, there is an urgent demand for better identi cation of variables for high-risk patients. At present, the determination of ICU patient risk mainly relies on clinical judgment and severity scores (such as APACHE scores), which incorporate patients' previous health statuses, along with clinical and laboratory variables, which track the function of multiple organ systems [13][14][15][16]. In recent decades, our knowledge of the biochemical processes underlying critical illness has considerably improved.…”

Section: Discussionmentioning

confidence: 99%

Inflammation Cytokine Expression and Association With Clinical Outcomes in Critically Ill Patients After Major Surgery: A Retrospective Cohort Study

Yan¹,

Wang²,

Yan³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The associations of serum cytokine levels and critically ill patient outcomes after major surgery remain unclear. The use of cytokine markers to predict outcomes in critically ill patients is controversial.Objective To determine the levels of IL-1β, IL-2, IL-6, IL-8, IL-10, TNF-α and procalcitonin in critical surgical ICU(SICU) patients and evaluate their associations with patient outcome and clinical significance.Methods This was a retrospective cohort study of consecutive patients admitted to the SICU in Zhongshan Hospital, Fudan University. The program ran from January 1, 2018, to June 30, 2019. The levels of IL-1β, IL-2, IL-6, IL-8, IL-10, TNF-α and procalcitonin were detected, and their relationship with patient outcomes was investigated.The primary outcome was in-hospital mortality, compared by a multivariable logistic regression analysis among the survivors and nonsurvivors.Results Overall, 5,257 patients were included in this study for their first SICU admission; 5,099 patients survived, 158 patients died, and the mortality rate was 3.0%(158/5,257). Univariate and multivariate analyses showed that nonsurvivors had increased levels of IL-1(OR=1.855, P=0.000) and IL-2(OR=1.51, P=0.000) compared with survivors. In addition, 196 patients(3.7%) were readmitted to the SICU, and data from 187 patients were collected. Of these, 161 patients survived, and 26 patients died; the mortality rate was 13.9%(26/187), which was much higher than that of the first round of patients. The level of IL-2 significantly influenced SICU readmission(OR=3.921, P=0.000).For the third round of SICU admission, 10 patients were included, 7 patients survived, and 3 patients died; the mortality rate was 30.0%(3/10). Furthermore, older age, longer time of SICU stay, and higher rate of mechanical ventilation and CRRT were associated with patient death.Conclusions High levels of cytokines may be risk factors for mortality and SICU readmission in critically ill patients who receive major surgery. Further work is still needed to determine which unmeasured characteristics and therapies may contribute to the increased risk observed.

show abstract

“…Information was gathered by a medical student who was not involved in the assessment or treatment of the patients studied. Patients' age, gender, discharge disposition, comorbidities, primary and secondary diagnoses, admission and discharge date to the MSU, EARS score, acuity score (ranges from 1 to 5, where more critical the patient's condition, the higher the level of acuity, level 1 being the highest and level 5 the lowest), and APACHE II score [11] are recorded ( Table 1). The patients' primary and secondary diagnoses were further sorted into categories for analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Summary variables and calculation methods for Acute Physiology and Chronic Health Evaluation (APACHE) II score adopted from Akavipat et al[11] …”

mentioning

confidence: 99%

Outcomes of Emergency Medical Patients Admitted to a Medical Surveillance Unit: a Retrospective Cross-Sectional Study

Vantomme

Siddiqui

Cossette

et al. 2020

SN Compr. Clin. Med.

View full text Add to dashboard Cite

High-acuity patients occasionally require advanced resources and monitoring, but do not qualify for intensive care admission in large intensive care unit (ICU). For these patients, intermediate care units (IMCUs) can provide adequate care. IMCUs lessen the patient burden for both the general ward and the ICU, allowing for more free beds in the ICU and ward. The main purpose of this study was to explore typical patient characteristics/demographics of patients admitted to an IMCU from the emergency room (ER) and mortality rate. This study is a retrospective cross-sectional study of a medical surveillance unit (MSU), which is an IMCU located in Pasqua Hospital, Regina. All patients admitted to the MSU from the ER in 2017 and 2018 were included in the study. This study retrospectively reviewed 715 patients in total. Patients' age, sex, discharge disposition, comorbidities, primary and secondary diagnoses, admission and discharge date to/from the MSU, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, early assessment and response system (EARS) score, and acuity score were recorded. A total of 715 patient charts were reviewed for this study, with 323 patients in 2017 and 392 patients in 2018. Approximately a third of the study participants were diabetic, and half were hypertensive. Male sex had higher comorbidities including asthma or cerebrovascular accidents, and women had been diagnosed with coronary heart disease or liver disease. Both male and female were equally affected by substance use. 25.6% of the study population were smokers, 15.5% were intravenous drugs, and 16.8% were suffering with alcohol use disorder. Respiratory diseases account for a quarter of all primary diagnoses made in the MSU. Overall mortality rate was 5.9%. The APACHE II, EARS, and acuity scores were significantly different between deceased and alive patients (p < 0.001, p < 0.007, and p < 0.001, respectively). Half of the patients were discharged to home and a quarter were transferred to the ward. Nearly two-third of the study population was not readmitted to hospital within 30 days. This is one of the first studies to describe IMCU patients characteristics transferred from the ER in Canada. The APACHE II, EARS, and acuity scores were found significantly different between deceased and alive patients. These scores could therefore be used to develop tools that can identify high-risk patients for equitable allocation of healthcare resources to reduce mortality. Keywords Medical surveillance unit. Quality of care. Intermediate care unit. Modified early warning score This article is part of the Topical Collection on Medicine

show abstract

Acute Physiology and Chronic Health Evaluation (APACHE) II Score – the Clinical Predictor in Neurosurgical Intensive Care Unit

Cited by 44 publications

References 25 publications

The associations between cytokine levels and clinical outcomes in critically ill patients after surgery: a retrospective cohort study

The associations between cytokine levels and clinical outcomes in critically ill patients after surgery: a retrospective cohort study

Inflammation Cytokine Expression and Association With Clinical Outcomes in Critically Ill Patients After Major Surgery: A Retrospective Cohort Study

Outcomes of Emergency Medical Patients Admitted to a Medical Surveillance Unit: a Retrospective Cross-Sectional Study

Contact Info

Product

Resources

About