Application of Different Scoring Systems and Their Value in Pediatric
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Central Venous Oxygen Saturation As a Surrogate Marker for Outcome in Critically Ill Patients-A Prospective Observational Cohort Study
Research Article J Anest & Inten Care Med Volume 6 Issue 5 - May 2018 Copyright © All rights are reserved by Kasimahanti Rajesh DOI: 10.19080/JAICM.2018.06.555698 Central Venous Oxygen Saturation as a Surrogate Marker for Outcome in Critically ill Patients-A Prospective Observational Cohort Study Sandeep Gajbe1, Sona Dave1 and Rajesh Kasimahanti2* 1Department of Anesthesia, Nair Hospital, India 2Department of Critical Care Medicine, Yashoda Hospitals, India Submission: May 21, 2018; Published: May 29, 2018 *Corresponding author: Rajesh Kasimahanti, Department of Critical Care Medicine, Yashoda Hospitals, Secunderabad, Pin: 500003, India, Email: Abstract Background and Aims: Mixed venous oxygen saturation aids in assessing tissue oxygenation. However considering the invasiveness of the (ScvO ) and their comparison with the outcome as measured by APACHE II score in critically ill patient treated by early goal directed therapy. procedure2 the need to find a surrogate marker. The aim of the study was to observe the measured values of central venous oxygen saturation Material and Methods: A prospective observational cohort study which included 100 adult patients on prolonged ventilator support (>24 hours) in a tertiary intensive care who received early goal directed therapy were included in the study. Intermittent ScvO2 measurement was compared with the outcome as measured by APACHE II score. APACHE II scoring was done only once on admission of patient.The clinical end point of study was survival or death of patient. Results and Conclusion: The mean arterial pressure, central venous pressure, PaO2 and urine output were higher amongst the survivors compared to nonsurvivors. The mean ScvO2 in nonsurvivors and survivors was 53.34 ± 4.08 and 73.33 ± 5.03 respectively. -
And Early Treatment-Related Factors on Mortality in ICU Patients With
Ohki et al. Journal of Intensive Care (2020) 8:30 https://doi.org/10.1186/s40560-020-00450-7 RESEARCH Open Access Impact of host- and early treatment-related factors on mortality in ICU patients with candidemia: a bicentric retrospective observational study Shingo Ohki1, Nobuaki Shime1* , Tadashi Kosaka2 and Naohisa Fujita3 Abstract Background: Candidemia is one of the most life-threatening infections among critically ill patients in the intensive care unit. However, the number of studies on the impact of host- and early treatment-related factors on mortality in this cohort is limited. The aim of this study was to investigate the relationship between clinically relevant factors, including early treatment (appropriate antifungal therapy and/or central venous catheter removal) and mortality in intensive care unit patients with candidemia. Methods: We performed a retrospective observational study in two Japanese University hospitals between January 2007 and December 2016. Adult intensive care unit patients with candidemia who met the following inclusion criteria: (1) ≥ 18 years old; (2) admitted in intensive care unit at the time of onset; and (3) central venous catheter in situ at the time of onset were included. We performed univariate and multivariate logistic regression analysis to identify factors associated with 30-day crude mortality. Results: A total of 68 patients met the inclusion criteria, 47 (69%) of whom were males. The median age was 68.0 (interquartile range, 61.0–76.0) years. The most common causative Candida species was Candida albicans (40 [59%] patients). With respect to the source of infection, central venous catheter-related candidemia was the most frequent (30 [44%] patients). -
Sequential Organ Failure Assessment (SOFA) Score
CalculatedPOWERED BY Decisions Clinical Decision Support for Emergency Medicine Practice Subscribers Sequential Organ Failure Assessment (SOFA) Score Introduction: The SOFA score predicts mortality risk for patients in the intensive care unit based on lab results and clinical data. Click the thumbnail above to access the calculator. Points & Pearls • The Sequential Organ Failure Assessment namically or to determine the success or failure of (SOFA) is a mortality prediction score that is an intervention in the ICU. based on the degree of dysfunction of 6 organ systems. • The score is calculated at admission and every Why to Use 24 hours until discharge, using the worst param- The SOFA score can be used to determine the eters measured during the prior 24 hours. level of organ dysfunction and mortality risk in • The scores can be used in several ways, including: ICU patients. » As individual scores for each organ to deter- mine the progression of organ dysfunction. » As a sum of scores on a single intensive care When to Use unit (ICU) day. • The SOFA can be used on all patients who » As a sum of the worst scores during the ICU are admitted to an ICU. stay. • It is not clear whether the SOFA is reliable for • The SOFA score stratifies mortality risk in ICU patients who were transferred from another patients without restricting the data used to ICU. admission values. Critical Actions Instructions Clinical prediction scores such as the SOFA and the Calculate the SOFA score using the worst value Acute Physiologic Assessment and Chronic Health for each variable in the preceding 24-hour Evaluation (APACHE II) can be measured on all period. -
Sepsis-Related Organ Failure Assessment Score Is a Strong Predictor of Survival in Acute-On-Chronic Liver Failure
DANISH MEDICAL JOURNAL Sepsis-related Organ Failure Assessment Score is a strong predictor of survival in acute-on-chronic liver failure Frederik Cold1, Frank Vinholt Schiødt1, Frank Christian Pott2, Nina Strandkjær2 & Erik Christensen1 ABSTRACT vival of patients with ACLF is more effectively calcu- INTRODUCTION: The mortality of patients with an exacer lated by using ICU-specific scoring systems than scores ORIGINAL ARTICLE bation of decompensated liver cirrhosis is high even if focusing only on liver function [1, 6], great efforts have 1) Centre of Abdominal treated in the intensive care unit (ICU), and the criteria for been made to develop new scoring systems to assist the Disease K, Section of Medical Gastroentero- referral to ICU are not well defined. The objective of this clinicians. The most recent score is the Chronic Liver logy and Hepatology, study was to identify variables associated with mortality. Failure-Sequential Organ Failure Assessment (CLIF- Bispebjerg Hospital METHODS: A singlecentre retrospective cohort analysis SOFA) scoring system [1, 7]. 2) Department of was conducted in a universityaffiliated ICU. A total of 53 Despite progress in the prediction of mortality in Anaesthesia and Intensive Care adult patients with decompensated alcoholic liver cirrhosis the ICU [2, 4, 6, 8], the criteria for transfer to the ICU were admitted from January 2012 to June 2015. Variables Medicine, Bispebjerg may still be improved. Hospital, Denmark associated with survival were identified using Cox The aim of this study was to investigate the survival regression analysis. of patients with ACLF referred to the ICU and to iden- Dan Med J RESULTS: The tenday, 30day, 90day, and oneyear tify those variables that hold the best prognostic infor- 2019;66(8):A5557 mortality were 36%, 57%, 66%, and 80%, respectively. -
A New Prognostication Rule by APACHE II Score and Serum
Giamarellos-Bourboulis et al. Critical Care 2012, 16:R149 http://ccforum.com/content/16/4/R149 RESEARCH Open Access Risk assessment in sepsis: a new prognostication rule by APACHE II score and serum soluble urokinase plasminogen activator receptor Evangelos J Giamarellos-Bourboulis1*, Anna Norrby-Teglund2, Vassiliki Mylona3, Athina Savva1, Iraklis Tsangaris4, Ioanna Dimopoulou4, Maria Mouktaroudi1, Maria Raftogiannis1, Marianna Georgitsi1, Anna Linnér2, George Adamis5, Anastasia Antonopoulou1,4, Efterpi Apostolidou6, Michael Chrisofos7, Chrisostomos Katsenos8, Ioannis Koutelidakis9, Katerina Kotzampassi10, George Koratzanis3, Marina Koupetori11, Ioannis Kritselis12, Korina Lymberopoulou3, Konstantinos Mandragos8, Androniki Marioli3, Jonas Sundén-Cullberg2, Anna Mega13, Athanassios Prekates14, Christina Routsi15, Charalambos Gogos16, Carl-Johan Treutiger2, Apostolos Armaganidis4 and George Dimopoulos4 Abstract Introduction: Early risk assessment is the mainstay of management of patients with sepsis. APACHE II is the gold standard prognostic stratification system. A prediction rule that aimed to improve prognostication by APACHE II with the application of serum suPAR (soluble urokinase plasminogen activator receptor) is developed. Methods: A prospective study cohort enrolled 1914 patients with sepsis including 62.2% with sepsis and 37.8% with severe sepsis/septic shock. Serum suPAR was measured in samples drawn after diagnosis by an enzyme- immunoabsorbent assay; in 367 patients sequential measurements were performed. After ROC analysis and multivariate logistic regression analysis a prediction rule for risk was developed. The rule was validated in a double- blind fashion by an independent confirmation cohort of 196 sepsis patients, predominantly severe sepsis/septic shock patients, from Sweden. Results: Serum suPAR remained stable within survivors and non-survivors for 10 days. Regression analysis showed that APACHE II ≥17 and suPAR ≥12 ng/ml were independently associated with unfavorable outcome. -
Prediction of Median Survival Time in Sepsis Patients by the SOFA Score
Burns & Trauma, 2020, 8, tkz006 doi: 10.1093/burnst/tkz006 Research Article Research Article Prediction of median survival time in sepsis patients by the SOFA score combined with different predictors Wen Li1, Meiping Wang1,2, Bo Zhu1, Yibing Zhu1,3,* and Xiuming Xi1,* 1Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University. 20A Fuxingmenwai Street, Xicheng District, Beijing 100038, China, 2Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China and 3Department of Statistics, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China *Correspondence. Xiuming Xi, Email: [email protected]; Yibing Zhu, Email: [email protected] Received 30 July 2019; Revised 21 August 2019; Editorial decision 27 November 2019 Abstract Background: Sepsis is the leading cause of intensive care unit (ICU) admission. The purpose of this study was to explore the prognostic value of the Sequential Organ Failure Assessment (SOFA) score, the Acute Physiological and Chronic Health Evaluation II (APACHE II) score, and procalcitonin (PCT), albumin (ALB), and lactate (LAC) levels in patients with sepsis. Methods: Consecutive adult patients with suspected or documented sepsis at ICU admission were recruited. Their basic vital signs and related auxiliary examinations to determine their PCT and ALB levels and APACHE II score were recorded at ICU admission, and their LAC levels and SOFA scores were recorded for one week after admission. The influence of these variables on hospital mortality was evaluated. Logistic regression was used to derive the Sepsis Hospital Mortality Score (SHMS), a prediction equation describing the relationship between predictors and hospital mortality. -
Jama Raschke 2021 Ld 210012
Letters 6. Haute Autorité de Santé (HAS). Stratégie de vaccination contre le SARS-CoV-2: vaccination des personnes ayant un antécédent de Covid-19 Table. Clinical Characteristics of 675 Study Patients [SARS-CoV-2 vaccination strategy: vaccination of people with a history of Characteristics No. (%)a Covid-19]. Published February 11, 2021. Accessed February 13, 2021. https:// Age, median (IQR), y 63 (53-72) www.has-sante.fr/upload/docs/application/pdf/2021-02/strategie_de_ vaccination_contre_le_sars-cov-2___vaccination_des_personnes_ayant_un_ Age group, y antecedent_de_covid-19_-_synthese.pdf 18-44 92 (14) 45-64 267 (40) Discriminant Accuracy of the SOFA Score 65-74 199 (29) for Determining the Probable Mortality 75-84 102 (15) of Patients With COVID-19 Pneumonia Requiring ≥85 15 (2) Mechanical Ventilation Sex The COVID-19 pandemic has raised concern regarding the ca- Female 270 (40) pacity to provide care for a surge of critically ill patients that Male 405 (60) might require excluding patients with a low probability of short- Race/ethnicityb 1 term survival from receiving mechanical ventilation. A sur- Non-Hispanic White 259 (38) vey identified 26 unique COVID-19 triage policies, of which 20 Hispanic 286 (42) used some form of the Sequential Organ Failure Assessment Native American 68 (10) (SOFA) score.2 Black 28 (4) However, studies performed in 2016 and 2017 have shown Body mass index, median (IQR)c 33 (29-39) only moderate discriminant accuracy of the SOFA score for pre- Medications dicting survival in intensive care unit (ICU) patients with sep- Dexamethasone 255 (36) sis and an area under the receiver operating characteristic curve Remdesivir 326 (48) (AUROC) of 0.74 to 0.75.3,4 We hypothesized that the SOFA Anticoagulants 607 (90) score might be less accurate in patients requiring mechanical Norepinephrine 33 (5) ventilation for COVID-19 pneumonia because such patients generally have severe single-organ dysfunction and less varia- Comorbidities tion in SOFA scores. -
A Discussion of Sepsis Severity Scoring Systems in Severe Complicated
Tolonen et al. World Journal of Emergency Surgery (2018) 13:17 https://doi.org/10.1186/s13017-018-0177-2 RESEARCH ARTICLE Open Access Getting the invite list right: a discussion of sepsis severity scoring systems in severe complicated intra-abdominal sepsis and randomized trial inclusion criteria Matti Tolonen1, Federico Coccolini2, Luca Ansaloni3, Massimo Sartelli4, Derek J. Roberts5, Jessica L. McKee6, Ari Leppaniemi1, Christopher J. Doig7, Fausto Catena8, Timothy Fabian9, Craig N. Jenne10, Osvaldo Chiara11, Paul Kubes12,13, Yoram Kluger14, Gustavo P. Fraga15, Bruno M. Pereira16, Jose J. Diaz17, Michael Sugrue18, Ernest E. Moore19,JiananRen20,ChadG.Ball21,RaulCoimbra22,23, Elijah Dixon24,WalterBiffl25, Anthony MacLean26, Paul B. McBeth5,10,27, Juan G. Posadas-Calleja10, Salomone Di Saverio28, Jimmy Xiao6, Andrew W. Kirkpatrick5,10,27,29* , From the Closed Or Open after Laparotomy (COOL) for Source Control in Severe Complicated Intra-Abdominal Sepsis Investigators Abstract Background: Severe complicated intra-abdominal sepsis (SCIAS) is a worldwide challenge with increasing incidence. Open abdomen management with enhanced clearance of fluid and biomediators from the peritoneum is a potential therapy requiring prospective evaluation. Given the complexity of powering multi-center trials, it is essential to recruit an inception cohort sick enough to benefit from the intervention; otherwise, no effect of a potentially beneficial therapy may be apparent. An evaluation of abilities of recognized predictive systems to recognize SCIAS patients was conducted using an existing intra-abdominal sepsis (IAS) database. Methods: All consecutive adult patients with a diffuse secondary peritonitis between 2012 and 2013 were collected from a quaternary care hospital in Finland, excluding appendicitis/cholecystitis. From this retrospectively collected database, a target population (93) of those with either ICU admission or mortality were selected. -
Regional Variability of Admission Prevalence and Mortality of Pediatric Critical Illness in Latvia
Anesth Crit Care 2019; 1 (1): 015-022 DOI: 10.26502/acc.003 Research Article Regional Variability of Admission Prevalence and Mortality of Pediatric Critical Illness in Latvia Linda Setlere1,2, Ivars Vegeris2,3, Margita Stale4, Reinis Balmaks1,2 1Faculty of Medicine, Riga Stradins University, Latvia 2Intensive Care Unit, Children’s Clinical University Hospital, Riga, Latvia 3Department of Doctoral Studies, Riga Stradins University, Latvia 4The Centre for Disease Prevention and Control of Latvia, Riga *Corresponding Author: Dr. Reinis Balmaks, Departments of Clinical Skills and Medical Technologies and Pediatrics, Riga Stradins University, 26a Anninmuizas Blvd, Riga, LV-1067, Latvia, Tel: +37167061579; E-mail: [email protected] Received: 03 May 2019; Accepted: 09 May 2019; Published: 17 May 2019 Abstract Objectives: There is only one pediatric intensive care unit (PICU) in Latvia, where all critically ill children <18 years are admitted from all regions of Latvia. The aim of this study is to ascertain regional differences in mortality and morbidity of critically ill children over a 5-year period. Materials and Methods: Descriptive retrospective study of children who were admitted to the PICU in Latvia from January 2012 to December 2016. Data on episodes were obtained from the Children's Clinical University Hospital electronic health records. Pediatric Index of Mortality (PIM2) was used for risk adjustment and calculation of standardized mortality ratio (SMR). The data were compared among the six regions of Latvia - Kurzeme, Latgale, Pieriga, Riga, Vidzeme, and Zemgale. Results: The analysis included 3651 intensive care episodes. The highest PICU admission prevalence was in Riga and the lowest in Latgale - 2.3 and 1.7 admissions per 1000 children per year, respectively. -
Sepsis-3 Definitions. What Are They, and How Should We Use Them?
Sepsis-3 definitions. What are they, and how should we use them? William T. Browne, MD, FCCM October 28, 2016 ACCP/SCCM Consensus Definitions • SIRS (Systemic Inflammatory Response Syndrome) – Temperature > 38° C or < 36° C – Heart rate > 90 – Respiratory rate > 20 or pCO2 < 32 mm Hg – WBC > 12,000 or < 4,000 or > 10% bands • Any two of the criteria needed for SIRS diagnosis ACCP/SCCM Consensus Definitions • Sepsis – Must have diagnosis of SIRS – Clinical evidence of infection • bacteremia • infiltrate on CXR • abscess on imaging study ACCP/SCCM Consensus Definitions • Severe sepsis – must have diagnosis of sepsis – evidence of organ dysfunction • Organ dysfunction – increase in BUN/creatinine – elevated LFTs – hypoxia – elevated serum lactate ACCP/SCCM Consensus Definitions • Septic shock – must have findings of severe sepsis – hypotension after adequate fluid resuscitation – systolic BP 40 mm Hg below baseline – may not have hypotension if receiving pressor agents Was this a useful bedside tool? Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection Under these new definitions Sepsis(new) = Severe Sepsis(old) Key concepts of sepsis (1) • Sepsis is the primary cause of death from infection, especially if not recognized and treated promptly. Its recognition mandates urgent attention • Sepsis is a syndrome shaped by pathogen factors and host factors (eg, sex, race and other genetic determinants, age, comorbidities, environment) with characteristics that evolve over time. What differentiates sepsis from infection is an aberrant or dysregulated host response and the presence of organ dysfunction. Key concepts of sepsis (2) • Sepsis-induced organ dysfunction may be occult; therefore, its presence should be considered in any patient presenting with infection. -
Risk Factors for Mortality in Severe Multiply Injury Patients with Acute Hypoxemic Respiratory Failure
Eur opean Rev iew for Med ical and Pharmacol ogical Sci ences 2015; 19: 3693-3700 Risk factors for mortality in severe multiply injury patients with acute hypoxemic respiratory failure Y.-D. CHEN, X.-L. FENG, L. DENG, P. ZHOU, J.-D. WANG, B. CAI, H. JIANG, Y. DONG, X.-H. ZHANG Department of Emergency ICU, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Institute for Disaster and Emergency Medicine Research, Sichuan Provincial People’s Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan, China Youdai Chen and Xuanlin Feng contributed equally Abstract. – OBJECTIVE: To investigate the CONCLUSIONS: Traumatic AHRF patients re - risk factors related to mortality in severe poly - quiring ventilation support show a high rate of trauma patients with acute hypoxemic respira - early mortality. Greater vigilance for high tory failure (AHRF). APACHE II score, short time interval between PATIENTS AND METHODS: From December injury and ventilation, low pH in traumatic 2011 to December 2014, we identified and intu - AHRF patients is required. bated 524 traumatic AHRF patients in a level 1 trauma centers. Amongst those, we enrolled Key Words: seventy-six severe traumatic AHRF patients Multiple injury, Mortality, Ventilation, Acute hypoxemic with an injury severity score (ISS) over 16 and respiratory failure. need for over 24 hour intra-tracheal mechanical ventilation for our study. Patients were followed daily to collect data about demographics, injury characteristic, diagnostic, treatment, respirato - Abbreviations ry parameters, major complications, duration of mechanical ventilation, length of stay, preva - MODS = Multiple Organ Dysfunction Syndrome; APACHE lence of major complications and 28-days mor - II = Acute Physiology And Chronic Health Evaluation score tality. -
Correlation of Quick SOFA Score and Procalcitonin with Mortality in the Emergency Department
Journal of Advances in Medicine and Medical Research 32(6): 64-69, 2020; Article no.JAMMR.56300 ISSN: 2456-8899 (Past name: British Journal of Medicine and Medical Research, Past ISSN: 2231-0614, NLM ID: 101570965) Correlation of Quick SOFA Score and Procalcitonin with Mortality in the Emergency Department Mandip Singh Bhatia1*, Ritu Attri2, Kumar Rajni Kant3 and Saurabh C. Sharda1 1Department of Internal Medicine, PGIMER, Chandigarh, India. 2Department of Internal Medicine, Government Medical College, Patiala, India. 3Anaesthesia and Critical Care, SGHS Hospital, Mohali, India. Authors’ contributions This work was carried out in collaboration among all authors. Authors MSB and RA designed the study, performed the statistical analysis, wrote the protocol and wrote the first draft of the manuscript. Authors KRK and SCS managed the analyses of the study. Author SCS managed the literature searches. All authors read and approved the final manuscript. Article Information DOI: 10.9734/JAMMR/2020/v32i630434 Editor(s): (1) Dr. Rameshwari Thakur, Muzaffarnagar Medical College, India. Reviewers: (1) Dinesh Yadav, Madhav Hospital, India. (2) Apeksha Niraula, Nepal. (3) Marcel Cerqueira Cesar Machado, University of São Paulo, Brazil. Complete Peer review History: http://www.sdiarticle4.com/review-history/56300 Received 25 February 2020 Accepted 01 May 2020 Original Research Article Published 08 May 2020 ABSTRACT Introduction: Sepsis is defined as life-threatening organ dysfunction caused by the dysregulated host response to infection with high mortality. Early diagnosis and treatment can decrease mortality. Methods: We studied 2031 patients presenting to an emergency department with fever or suspected infection to find the correlation between q SOFA SCORE and procalcitonin levels with mortality.