Comparison of Clinical Assessment with APACHE II for Predicting Mortality Risk in Patients Admitted to a Medical Intensive Care Unit

Kruse, James A.; Thill-Baharozian, Mary C.; Carlson, R W

doi:10.1097/00132586-198904000-00032

Cited by 48 publications

(71 citation statements)

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“…In our patient cohort, high levels of IL-18 at admission correlated with increased inhospital mortality. Although our analysis is limited by not measuring cytokines previously associated with mortality (i.e., IL-6, IL-8) (4,39,40), IL-18 level is associated with lactate levels, a clinically established biomarker, and APACHE II scores, a severity indicator, that have both been associated with ICU morbidity and mortality (41)(42)(43). Future studies will be needed to compare the predictive power of multiple biomarkers in tandem.…”

Section: Discussionmentioning

confidence: 99%

Inflammasome-regulated Cytokines Are Critical Mediators of Acute Lung Injury

Dolinay

Kim

Howrylak

et al. 2012

Am J Respir Crit Care Med

490

424

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Rationale: Despite advances in clinical management, there are currently no reliable diagnostic and therapeutic targets for acute respiratory distress syndrome (ARDS). The inflammasome/caspase-1 pathway regulates the maturation and secretion of proinflammatory cytokines (e.g., IL-18). IL-18 is associated with injury in animal models of systemic inflammation. Objectives: We sought to determine the contribution of the inflammasome pathway in experimental acute lung injury and human ARDS. Methods: We performed comprehensive gene expression profiling on peripheral blood from patients with critical illness. Gene expression changes were assessed using real-time polymerase chain reaction, and IL-18 levels were measured in the plasma of the critically ill patients. Wild-type mice or mice genetically deficient in IL-18 or caspase-1 were mechanically ventilated using moderate tidal volume (12 ml/kg). Lung injury parameters were assessed in lung tissue, serum, and bronchoalveolar lavage fluid. Measurements and Main Results: In mice, mechanical ventilation enhanced IL-18 levels in the lung, serum, and bronchoalveolar lavage fluid. IL-18-neutralizing antibody treatment, or genetic deletion of IL-18 or caspase-1, reduced lung injury in response to mechanical ventilation. In human patients with ARDS, inflammasome-related mRNA transcripts (CASP1, IL1B, and IL18) were increased in peripheral blood. In samples from four clinical centers, IL-18 was elevated in the plasma of patients with ARDS (sepsis or trauma-induced ARDS) and served as a novel biomarker of intensive care unit morbidity and mortality. Conclusions: The inflammasome pathway and its downstream cytokines play critical roles in ARDS development.

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Section: Discussionmentioning

confidence: 99%

Inflammasome-regulated Cytokines Are Critical Mediators of Acute Lung Injury

Dolinay

Kim

Howrylak

et al. 2012

Am J Respir Crit Care Med

490

424

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“…If long-term outcome is the desired end point, acute measures, such as admission APS, may have to be substituted for more sensitive indicators of chronic health, such as the Charlson index [25]. Objective assessment of outcome using scoring systems has been shown to be no better, and indeed no worse, than clinical estimates provided by physicians [26,27]. The quest for accurate outcome prediction continues and, because of the high cost of intensive care, remains a worthwhile goal.…”

Section: Discussionmentioning

confidence: 99%

Validation of outcome prediction in elderly patients

Jandziol¹,

Ridley

2000

Anaesthesia

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SummaryWe recently described an equation for predicting the 1-year survival of critically ill patients aged over 70 years. The aim of this study was to check the performance of this equation in a validation group of 555 patients. The required demographic details (age, diagnosis, acute physiology score) of all elderly patients admitted between 1/4/95 and 31/9/96 were recorded and patients were followed for 1 year. One hundred and six patients died on the intensive care unit (19% mortality) and a further 134 died within 1 year (43% total 1-year mortality). The performance of the predictive equation was modest; the goodness-of-®t p-value was 0.04 and the area under the receiver operating characteristic curve was 0.75. For both groups, the combined 1-year survival of all critically ill elderly patients was 55% but the outcome of patients aged over 85 years remains poor (37%).

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“…An acceptable level of accuracy for individual clinical decision-making has not been established. Clinical assessment of risk of death has been shown to be more accurate than APACHE I1 in surgical intensive care patients [7] and of the same order of accuracy in medical intensive care patients as APACHE I1 admission scoring [8]. Prognostic scoring systems continue to be developed and their unbiased and reproducible prediction of individual mortality may soon surpass clinical assessment.…”

Section: Discussionmentioning

confidence: 99%