APACHE II score in massive upper gastrointestinal haemorrhage from peptic ulcer: Prognotic value and potential clinical applications

1989 ◽  
Vol 76 (7) ◽  
pp. 733-736 ◽  
Author(s):  
M. Schein ◽  
G. Gecelter
Keyword(s):  
Peptic Ulcer ◽  
Gastrointestinal Haemorrhage ◽  
Clinical Applications ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Upper Gastrointestinal

scholarly journals Patients With Perforated Peptic Ulcers: Risk Factors for Morbidity and Mortality

2019 ◽  
Vol 103 (11-12) ◽  
pp. 578-584
Author(s):  
Fatih Ciftci ◽  
Fazilet Erözgen
Keyword(s):  
Risk Factors ◽  
Peptic Ulcer ◽  
Postoperative Period ◽  
Perforated Peptic Ulcer ◽  
Apache Ii ◽  
Morbidity And Mortality ◽  
Apache Ii Score ◽  
Peptic Ulcers ◽  
Presentation Time ◽  
Independent Risk Factors

Perforated peptic ulcers continue to be an important problem in surgical practice. In this study, risk factors for peptic ulcer perforation-associated mortality and morbidity were evaluated. This is a retrospective study of patients surgically treated for perforated peptic ulcer over a decade (March 1999–December 2014). Patient age, sex, complaints at presentation, time lapse between onset of complaints and presentation to the hospital, physical findings, comorbidities, laboratory and imaging findings, length of hospitalization, morbidity, and mortality were recorded. The Mannheim peritonitis index (MPI) and Acute Physiology and Chronic Health Evaluation (APACHE) II score were calculated and recorded for each patient on admission to the hospital. Of the 149 patients, mean age was 50.6 ± 19 years (range: 17–86). Of these, 129 (86.5%) were males and 20 (13.4%) females. At least 1 comorbidity was found in 42 (28.1%) of the patients. Complications developed in 36 (24.1%) of the patients during the postoperative period. The most frequent complication was wound site infection. There was mortality in 26 (17.4%) patients and the most frequent cause of mortality was sepsis. Variables that were found to have statistically significant effects on morbidity included age older than 60 years, presence of comorbidities, and MPI (P = 0.029, 0.013, and 0.013, respectively). In a multivariate analysis, age older than 60 years, presence of comorbidities, and MPI were independent risk factors that affected morbidity. In the multivariate logistic regression analysis, age older than 60 years [P = 0.006, odds ratio (OR) = 5.99, confidence interval (CI) = 0.95] and comorbidities (OR = 2.73, CI = 0.95) were independent risk factors that affected morbidity. MPI and APACHE II scoring were both predictive of mortality. Age older than 60, presentation time, and MPI were independent risk factors for mortality. Undelayed diagnosis and appropriate treatment are of the utmost importance when presenting with a perforated peptic ulcer. We believe close observation of high-risk patients during the postoperative period may decrease morbidity and mortality rates.

scholarly journals Management and outcome of patients undergoing surgery after acute upper gastrointestinal haemorrhage

1998 ◽  
Vol 91 (10) ◽  
pp. 518-523 ◽  
Author(s):  
T A Rockall
Keyword(s):  
Peptic Ulcer ◽  
High Risk ◽  
Gastrointestinal Haemorrhage ◽  
Population Based ◽  
Operative Intervention ◽  
Previous Attempt ◽  
Surgical Units ◽  
Risk Patients ◽  
Medical Teams ◽  
Upper Gastrointestinal

Most patients with acute upper gastrointestinal haemorrhage are managed conservatively or with endoscopic intervention but some ultimately require surgery to arrest the haemorrhage. We have conducted a population-based multicentre prospective observational study of management and outcomes. This paper concerns the subgroup of 307 patients who had an operation because of continued or recurrent haemorrhage or high risk of further bleeding. The principal diagnostic group was those with peptic ulcer. Of 2071 patients with peptic ulcer presenting with acute haemorrhage, 251 (12%) had an operative intervention with a mortality of 24%. In the non-operative group mortality was 10%. The operative intervention rate increased with risk score, ranging from 0% in the lowest risk categories to 38% in the highest. Much of the discrepancy between operative and non-operative mortality was explainable by case mix; however, for high-risk cases mortality was significantly higher in the operated group. In 78% of patients who underwent an operation for bleeding peptic ulcer there had been no previous attempt at endoscopic haemostasis. For patients admitted to surgical units, the operative intervention rate was about four times higher than for those admitted under medical teams. In patients with acute upper gastrointestinal haemorrhage operative intervention is infrequent and largely confined to the highest-risk patients. The continuing high mortality in surgically treated patients is therefore to be expected. The reasons for the low use of endoscopic treatment before surgery are not revealed by this study, but wider use of such treatments might further reduce the operative intervention rate. Physicians and surgeons have not yet reached consensus on who needs surgery and when.

scholarly journals Clinical Correlation Analysis of Complications in Elderly Patients with Sequelae of Stroke with Different Barthel Index in Tianjin Emergency Department

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Xingzhen Zheng ◽  
Haidong Wang ◽  
Xiaolin Bian
Keyword(s):  
Emergency Department ◽  
Elderly Patients ◽  
Barthel Index ◽  
Upper Gastrointestinal Bleeding ◽  
Severity Of Illness ◽  
Decubitus Ulcer ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Stroke Patients ◽  
Upper Gastrointestinal

Objective. The Barthel index (BI) is the most commonly used measure of poststroke disability. The purpose of this article is to explore the different complications and severity of the sequelae of elderly stroke patients with different BI in the emergency department, so as to provide a theoretical basis for strengthening the treatment of elderly patients with stroke sequelae. Methods. A retrospective study was adopted, and 1896 patients were divided into two groups according to the BI: 823 patients in the bedridden group ( BI ≤ 40   points ) and 1073 patients in the nonbedridden group ( BI > 40   points ). The type and number of complications and APACHE II score were compared between the two groups. Results. Compared with the two groups, pneumonia, renal insufficiency, respiratory failure, and decubitus ulcer in the bedridden group had a higher incidence, but the incidence of upper gastrointestinal bleeding and fractures in the nonbedridden group was significantly higher ( P < 0.05 ). The APACHE II score of the patients in the bedridden group was higher than that of the nonbedridden group, and they were critical ( P < 0.001 ). And the number of complications was higher than that in the nonbedridden group. Moreover, the BI was negatively correlated with the APACHE-II score and the number of complications, and the APACHE II score was positively correlated with the number of complications ( P < 0.001 ). Conclusion. Different complications and severity of illness occur in elderly patients with sequelae of stroke after different BI in the emergency department.

Das rupturierte infrarenale Aortenaneurysma – eine kritische Analyse

VASA ◽  
1999 ◽  
Vol 28 (1) ◽  
pp. 30-33 ◽  
Author(s):  
Bürger ◽  
Meyer ◽  
Tautenhahn ◽  
Halloul
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Rupture ◽  
Anesthetic Management ◽  
Objective Evaluation ◽  
Left Ventricular ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Infrarenal Aortic Aneurysm ◽  
Emergency Situations ◽  
Probability Of Death

Background: Objective evaluation of the management of patients with ruptured infrarenal aortic aneurysm in emergency situations has been described rarely. Patients and methods: Fifty-two consecutive patients with ruptured infrarenal aortic aneurysm (mean age, 70.3 years; range, 56–89 years; SD 7.8) were admitted between January 1993 and March 1998. Emergency protocols, final reports, and follow-up data were analyzed retrospectively. APACHE II scores at admission and fifth postoperative day were assessed. Results: The time between the appearance of first symptoms and the referral of patients to the hospital was more than 5 hours in 37 patients (71%). Thirty-eight patients (71%) had signs of shock at time of admission. Ultrasound was performed in 81% of patients as the first diagnostic procedure. The most frequent site of aortic rupture was the left retroperitoneum (87%). Intraoperatively, acute left ventricular failure occurred in four patients, and cardiac arrest in two others. The postoperative course was complicated significantly in 34 patients. The overall mortality rate was 36.5% (n = 19). In 35 patients, APACHE II score was assessed, showing a probability of death of more than 40% in five patients and lower than 30% in 17 others. No patient showing probability of death of above 75% at the fifth postoperative day survived (n = 7). Conclusions: Ruptured aortic aneurysm demands surgical intervention. Clinical outcome is also influenced by preclinical and anesthetic management. The severity of disease as well as the patient’s prognosis can be approximated using APACHE II score. Treatment results of heterogenous patient groups can be compared.

scholarly journals Outcome Prediction in Patients with Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation—A Retrospective International Multicenter Study

Membranes ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 170
Author(s):  
Alexander Supady ◽  
Jeff DellaVolpe ◽  
Fabio Silvio Taccone ◽  
Dominik Scharpf ◽  
Matthias Ulmer ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
The United States ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Survival Prediction ◽  
Study Cohort ◽  
Additional Tool ◽  
Saps Ii ◽  
Membrane Oxygenation ◽  
International Multicenter

The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19 acute respiratory distress syndrome (ARDS) is still under debate and conclusive data from large cohorts are scarce. Furthermore, criteria for the selection of patients that benefit most from this highly invasive and resource-demanding therapy are yet to be defined. In this study, we assess survival in an international multicenter cohort of COVID-19 patients treated with V-V ECMO and evaluate the performance of several clinical scores to predict 30-day survival. Methods: This is an investigator-initiated retrospective non-interventional international multicenter registry study (NCT04405973, first registered 28 May 2020). In 127 patients treated with V-V ECMO at 15 centers in Germany, Switzerland, Italy, Belgium, and the United States, we calculated the Sequential Organ Failure Assessment (SOFA) Score, Simplified Acute Physiology Score II (SAPS II), Acute Physiology And Chronic Health Evaluation II (APACHE II) Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score, Predicting Death for Severe ARDS on V‑V ECMO (PRESERVE) Score, and 30-day survival. Results: In our study cohort which enrolled 127 patients, overall 30-day survival was 54%. Median SOFA, SAPS II, APACHE II, RESP, and PRESERVE were 9, 36, 17, 1, and 4, respectively. The prognostic accuracy for all these scores (area under the receiver operating characteristic—AUROC) ranged between 0.548 and 0.605. Conclusions: The use of scores for the prediction of mortality cannot be recommended for treatment decisions in severe COVID-19 ARDS undergoing V-V ECMO; nevertheless, scoring results below or above a specific cut-off value may be considered as an additional tool in the evaluation of prognosis. Survival rates in this cohort of COVID-19 patients treated with V‑V ECMO were slightly lower than those reported in non-COVID-19 ARDS patients treated with V-V ECMO.

scholarly journals Comparison of outcomes of high-flow nasal cannula and noninvasive positive-pressure ventilation in patients with hypoxemia and various APACHE II scores after extubation

2021 ◽  
Vol 15 ◽  
pp. 175346662110042
Author(s):  
Xiaoke Shang ◽  
Yanggan Wang
Keyword(s):  
Positive Pressure Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Abdominal Distension ◽  
Apache Ii ◽  
Positive Pressure ◽  
Apache Ii Score ◽  
Subgroup Ii ◽  
Significant Difference ◽  
Group A ◽  
Group B

Aims: The study aimed to compare and analyze the outcomes of high-flow nasal cannula (HFNC) and noninvasive positive-pressure ventilation (NPPV) in the treatment of patients with acute hypoxemic respiratory failure (AHRF) who had extubation after weaning from mechanical ventilation. Methods: A total 120 patients with AHRF were enrolled into this study. These patients underwent tracheal intubation and mechanical ventilation. They were organized into two groups according to the score of Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II); group A: APACHE II score <12; group B: 12⩽ APACHE II score <24. Group A had 72 patients and patients given HFNC were randomly assigned to subgroup I while patients given NPPV were assigned to subgroup II (36 patients in each subgroup). Group B had 48 patients and patients given HFNC were randomly assigned to subgroup I while patients given NPPV were assigned to subgroup II (24 patients in each subgroup). General information, respiratory parameters, endpoint event, and comorbidities of adverse effect were compared and analyzed between the two subgroups. Results: The incidence of abdominal distension was significantly higher in patients treated with NPPV than in those treated with HFNC in group A (19.44% versus 0, p = 0.005) and group B (25% versus 0, p = 0.009). There was no significant difference between the HFNC- and NPPV-treated patients in blood pH, oxygenation index, partial pressure of carbon dioxide, respiratory rate, and blood lactic acid concentration in either group ( p > 0.05). Occurrence rate of re-intubation within 72 h of extubation was slightly, but not significantly, higher in NPPV-treated patients ( p > 0.05). Conclusion: There was no significant difference between HFNC and NPPV in preventing respiratory failure in patients with AHRF with an APACHE II score <24 after extubation. However, HFNC was superior to NPPV with less incidence of abdominal distension. The reviews of this paper are available via the supplemental material section.

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