Prediction of the risk of death by APACHE II scoring in critically ill trauma patients without head injury

1996 ◽  
Vol 83 (8) ◽  
pp. 1123-1127 ◽  
Author(s):  
D. J. J. Muckart ◽  
S. Bhagwanjee ◽  
P. A. Neijenhuis
Keyword(s):  
Head Injury ◽  
Critically Ill ◽  
Apache Ii ◽  
Trauma Patients ◽  
Risk Of Death

scholarly journals Influencing Factors and Prevention of Sepsis or Acute Kidney Injury in 85 Patients with Severe Trauma

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Hong Zhang ◽  
Dan Chen ◽  
Lihua Wang ◽  
Bing Li
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Influencing Factors ◽  
Severe Trauma ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Trauma Patients ◽  
Risk Of Death ◽  
Disturbance Of Consciousness ◽  
Prevention And Treatment

Severe trauma can cause systemic reactions, leading to massive bleeding, shock, asphyxia, and disturbance of consciousness. At the same time, patients with severe trauma are at high risk of sepsis and acute renal injury. The occurrence of complications will increase the difficulty of clinical treatment, improve the mortality rate, and bring heavy physical and mental burdens and economic pressure to patients and their families. It is of great clinical significance to understand the high risk factors of sepsis and AKI and actively formulate prevention and treatment measures. In this study, the clinical data of 85 patients with severe trauma were analyzed by univariate and multivariate logistic regression to identify the risk factors leading to sepsis or AKI and analyze the prevention and treatment strategies. The results showed that multiple injuries, APACHE II score on admission, SOFA score on admission, and mechanical ventilation were independent influencing factors of sepsis in patients with severe trauma, while hemorrhagic shock, APACHE II score on admission, CRRT, and sepsis were independent influencing factors of AKI in patients with severe trauma. Severe trauma patients complicated with sepsis or AKI will increase the risk of death. In the course of treatment, prevention and intervention should be given as far as possible to reduce the incidence of complications.

THE APACHE II SCORE IN TRAUMA PATIENTS - A SYSTEMATIC UNDER-ESTIMATION OF RISK OF DEATH

Shock ◽  
1997 ◽  
Vol 7 (Supplement) ◽  
pp. 14-15
Author(s):  
R. Lefering ◽  
H. J. Goller ◽  
B. Böttcher ◽  
E. Neugebauer
Keyword(s):  
Apache Ii ◽  
Apache Ii Score ◽  
Trauma Patients ◽  
Risk Of Death ◽  
Estimation Of Risk

scholarly journals Effect of Nebulized Amphotericin B in Critically ill Patients With Respiratory Candida spp. De-colonization: A Retrospective Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Hangxiang Du ◽  
Limin Wei ◽  
Wenzhe Li ◽  
Bixia Huang ◽  
Yongan Liu ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Control Groups ◽  
Candida Spp ◽  
Risk Of Death ◽  
Alternative Treatment Option ◽  
And Control

The potential relationship among airway Candida spp. de-colonization, nebulized amphotericin B (NAB), and occurrence of ventilator-associated pneumonia (VAP) in patients who are critically ill has not been fully investigated, especially concerning effects on survival. In this observational, retrospective, cohort study in a 22-bed central intensive care unit, we included patients aged >18 years who required mechanical ventilation (MV) for >48 h, with at least two consecutive positive Candida spp. test results. Patients were categorized into NAB and no NAB (control) groups. Propensity matching at 1:1 was performed according to strict standards, and multiple Cox proportional hazard model and multivariate analyses were performed to evaluate the effects of NAB treatment. Throughout an 8-year study period, 526 patients had received MV and had positive respiratory tract Candida spp. cultures. Of these, we included 275 patients and excluded 251 patients. In total, we successfully matched 110 patients from the two groups (each group, n = 55; total population median age, 64 years; Acute Physiology and Chronic Health Evaluation II [APACHE II] score, 25.5; sequential organ failure assessment score, 9). The Candida spp. de-colonization rate was 69.1% in patients treated with NAB. VAP incidence did not differ significantly between the NAB (10.91%) and control (16.36%) groups (P = 0.405). Pseudomonas aeruginosa-related VAP rates differed significantly between the NAB (10.91%) and control (25.45%) groups (P = 0.048). Five (9.1%) patients in the NAB group died during hospitalization compared with 17 (30.9%) controls (P = 0.014). At 28 days, 9 (16.4%) and 16 (29.1%) deaths occurred in the NAB and control groups, respectively, (P = 0.088). The cumulative 90-day mortality rate differed significantly between the two groups (23.6 vs. 43.6%, P = 0.015). Multivariate logistic regression analyses indicated a decreased 90-day mortality in the NAB group (adjusted odds ratio 0.413; 95% confidence interval 0.210–0.812; P = 0.01). In subgroup analyses, the NAB-associated decreased risk of death at 90 days was consistent across subgroups of patients with a Candida score of 2, younger age (<64 years), a higher APACHE II score (≥25), fewer Candida sites (<2), or MV at admission. NAB treatment contributed to Candida spp. airway de-colonization, was associated with a reduced risk of P. aeruginosa-related VAP, and improved 90-day mortality in patients critically ill with Candida spp. tracheobronchial colonization who had received MV for >2 days. NAB may be an alternative treatment option for critically ill patients with VAP.

scholarly journals Does the RIFLE Classification Improve Prognostic Value of the APACHE II Score in Critically Ill Patients?

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Kátia M. Wahrhaftig ◽  
Luis C. L. Correia ◽  
Denise Matias ◽  
Carlos A. M. De Souza
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Prognostic Value ◽  
Kidney Injury ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Mortality ◽  
Risk Of Death ◽  
Rifle Classification ◽  
Critical Patients

Introduction.The RIFLE classification defines three severity criteria for acute kidney injury (AKI): risk, injury, and failure. It was associated with mortality according to the gradation of AKI severity. However, it is not known if the APACHE II score, associated with the RIFLE classification, results in greater discriminatory power in relation to mortality in critical patients.Objective.To analyze whether the RIFLE classification adds value to the performance of APACHE II in predicting mortality in critically ill patients.Methods.An observational prospective cohort of 200 patients admitted to the ICU from July 2010 to July 2011.Results.The age of the sample was 66 (±16.7) years, 53.3% female. ICU mortality was 23.5%. The severity of AKI presented higher risk of death: class risk (RR = 1.89 CI:0.97–3.38, ), grade injury (RR = 3.7 CI:1.71–8.08, ), and class failure (RR = 4.79 CI:2.10–10.6, ). The APACHE II had C-statistics of 0.75, 95% (CI:0.68–0.80, ) and 0.80 (95% CI:0.74 to 0.86, ) after being incorporated into the RIFLE classification in relation to prediction of death. In the comparison between AUROCs, .Conclusion.The severity of AKI, defined by the RIFLE classification, was a risk marker for mortality in critically ill patients, and improved the performance of APACHE II in predicting the mortality in this population.

scholarly journals Application of APACHE II scoring system in assessing prognosis of critically ill surgical and trauma patients

2018 ◽  
Vol 5 (6) ◽  
pp. 2328
Author(s):  
Chandan C. S. ◽  
Mohan Kumar ◽  
Sudarsan S.
Keyword(s):  
Mortality Rate ◽  
Critically Ill ◽  
Statistical Significance ◽  
Scoring Systems ◽  
Apache Ii ◽  
Surgical Patients ◽  
Major Surgery ◽  
Apache Ii Score ◽  
Trauma Patients ◽  
Critical Organ

Background: Surgical patients who become critically ill almost always fall in to one of the three categories: major trauma, major surgery or sepsis. In all three patient categories the patho-physiological processes that make patients ill and lead to cellular injury and organ dysfunction are essentially same, and therefore the way that patients need support of critical organ function are same. Surgical complications remain a frustrating and difficult aspect of operative treatment of patients, regardless of how technically gifted, skilled and capable surgeons. Various critical care and outcome scoring systems are used for outcome assessment of surgical patients. Using scores like APACHE II at the admission and SOFA on admission and also in their due course may help in predicting outcome.Methods: This study included 50 patients studied for a patient for 1 year. The clinical profile of 50 patients with sepsis with MODS was studied. There were 28 males and 22 females in this cohort.Results: In this study, 18 patients died, and 32 patients survived with mortality rate of 36%. In this study also, mean APACHE II score was high among non-survivors than survivors (27.67 v/s 16.00), which score was suggestive of statistical significance (p<0.001). The APACHE II score on day of admission, though reliable, was less effective in predicting the mortality rate in our set up.Conclusions: The APACHE II score on day of admission, though reliable, was less effective than SOFA score in predicting the mortality rate

SIRS SCORE IS SUPERIOR TO APACHE II SCORE IN PREDICTION OF INFECTION IN CRITICALLY ILL TRAUMA PATIENTS.

2005 ◽  
Vol 33 ◽  
pp. A89 ◽  
Author(s):  
Dan Hess ◽  
grant V bochicchio ◽  
Lena Napolitano ◽  
Manjari Joshi ◽  
Kelly Bochicchio ◽  
...  
Keyword(s):  
Critically Ill ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Trauma Patients

Poor Glycemic Control is Associated with Increased Mortality in Critically Ill Trauma Patients

2007 ◽  
Vol 73 (5) ◽  
pp. 454-460 ◽  
Author(s):  
Stephen C. Gale ◽  
Corinna Sicoutris Crnp ◽  
Patrick M. Reilly ◽  
C. William Schwab ◽  
Vicente H. Gracias
Keyword(s):  
Glycemic Control ◽  
Critically Ill ◽  
Poor Glycemic Control ◽  
Apache Ii ◽  
Trauma Patients ◽  
Glucose Levels ◽  
Sliding Scale ◽  
Surgical Icu ◽  
Injured Patients ◽  
Average Glucose

Glycemic control improves outcome in cardiac surgical patients and after myocardial infarction or stroke. Hyperglycemic predicts poor outcome in trauma, but currently no data exist on the effect of glycemic control in critically ill trauma patients. In our intensive care unit (ICU), we use a subcutaneous sliding scale insulin protocol to achieve glucose levels <140 mg/dL. We hypothesized that aggressive glycemic control would be associated with improved outcome in critically ill trauma patients. At our urban Level 1 trauma center, a retrospective study was conducted of all injured patients admitted to the surgical ICU >48 hours during a 6-month period. Data were collected for mechanism of injury, age, diabetic history, Injury Severity Score (ISS), and APACHE II score. All blood glucose levels, by laboratory serum measurement or by point-of-care finger stick, were collected for the entire ICU stay. Outcome data (mortality, ICU and hospital length of stay, ventilator days, and complications) were collected and analyzed. Patients were stratified by their preinjury diabetic history and their level of glucose control (controlled <140 mg/dL vs non-controlled ≥141 mg/dL) and these groups were compared. During the study period, 103 trauma patients were admitted to the surgical ICU >48 hours. Ninety (87.4%) were nondiabetic. Most (83.5%) sustained blunt trauma. The average age was 50 ± 21 years, the average ISS was 22 ± 12, and the average APACHE II was 16 ± 9. The average glucose for the population was 128 ± 25 mg/dL. Glycemic control was not attained in 27 (26.2%) patients; 19 (70.4%) of these were nondiabetic. There were no differences in ISS or APACHE II for controlled versus non-controlled patients. However, non-controlled patients were older. Mortality was 9.09 per cent for the controlled group and was 22.22 per cent for the non-controlled group. Diabetic patients were older and less severely injured than nondiabetics. For nondiabetic patients, mortality was 9.86 per cent in controlled patients and 31.58 per cent in non-controlled patients ( P < 0.05). Also, urinary tract infections were more prevalent and complication rates overall were higher in nondiabetic patients with noncontrolled glucose levels. Nonsurvivors had higher average glucose than survivors ( P < 0.03). Poor glycemic control is associated with increased morbidity and mortality in critically ill trauma patients; this is more pronounced in nondiabetic patients. Age may be a factor in these findings. Subcutaneous sliding scale insulin alone may be inadequate to maintain glycemic control in older critically ill injured patients and in patients with greater physiologic insult. Prospective assessment is needed to further clarify the benefits of aggressive glycemic control, to assess the optimal mode of insulin delivery, and to better define therapeutic goals in critically ill, injured patients.

First reported case of Weissella confusa abundance in the lung microbiota of a critically ill trauma patient with acute respiratory distress syndrome - caution warranted in the use of the Weissella genus as a probiotic

2020 ◽  
Author(s):  
Sandeep Chakraborty
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Distress Syndrome ◽  
Joint Infection ◽  
Starter Cultures ◽  
Trauma Patients ◽  
Virulence Determinants ◽  
Prosthetic Joint

Weissella strains are currently being used for biotechnological and probiotic purposes [1]. While, Weissella hellenica found in flounder intestine had probiotic effects [2], certain species from this genus are opportunistic pathogens in humans. Apart from being implicated in disease in farmed rainbow trout [3], Weissella has been found to cause the following disease in humans.1. endocarditis [4,5]2. bacteraemia [6]3. prosthetic joint infection [7]Whole genome sequences ‘find several virulence determinants such as collagen adhesins, aggregation sub- stances, mucus-binding proteins, and hemolysins in some species’, as well as antibiotic resistance-encoding genes [8]. Caution is warranted in selecting of Weissella strains as starter cultures or probiotics, if at all, since the other option, Lactobacillus, are rarely involved in human disease.Here, the analysis of the lung microbiota in critically ill trauma patients suffering from acute respiratory distress syndrome [9] shows (Accid:ERR1992912) shows complete colonization of Weissella (Fig 1). While, the study mentions ‘significant enrichment of potential pathogens including Streptococcus, Fusobacterium, Prevotella, Haemophilus and Treponema’, there is no reference to the Weissella genus. The percentages of Weissella strains are :confusa=81, soli=7 ,hellenica=5 ,diestrammenae=2. I believe this is the first reported case of Weissella causing ARDS in humans.

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