Usefulness of Severity-of-Illness Scores Based on Admission Data Only in Nosocomial Infection Surveillance Systems

2007 ◽  
Vol 28 (4) ◽  
pp. 453-458 ◽  
Author(s):  
Petra Gastmeier ◽  
Karin Menzel ◽  
Dorit Sohr ◽  
Henning Rüden
Keyword(s):  
Nosocomial Infection ◽  
Scoring System ◽  
Reference Data ◽  
Severity Of Illness ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Fisher Exact Test ◽  
Surveillance Systems ◽  
Exact Test ◽  
Device Use

Background.Surveillance of nosocomial infection (NI) and the use of reference data for comparison is recommended to improve the quality of patient care. In addition to standardization according to device use, another stratification of reference data according to patients' severity-of-illness scores is often required for benchmarking in intensive care units (ICUs).Objective.To determine whether severity-of-illness scores on admission to the ICU are sufficient data for predicting the development of NI.Methods.This study was performed in an interdisciplinary ICU at a teaching hospital. Two scores were studied: the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system and the Therapeutic Intervention Scoring System (TISS). The patient's clinical condition was evaluated on admission and reevaluated daily during the period before the development of NI. In addition, we recorded the number of intubations for every patient-day, the age and sex of the patients, and their history of operations. The Fisher exact test and the stepwise multiple logistic regression model were applied to identify significant predictors of NI.Results.During a 12-month period, 270 patients with ICU stays of more than 24 hours were included in the study. Sixty-nine NIs were identified (incidence, 25.6 cases per 100 patients [95% confidence interval, 19.9-32.3]). A mean APACHE II score and a mean TISS score above the median for these scores, duration of ventilation above the median in the period before the development of NI, and patient age were significantly associated with the development of NI; the score data on admission provided a clearly poorer prediction.Conclusion.The APACHE II and TISS scores on admission are not useful predictors for NI in ICUs.

scholarly journals The Characteristics of Mortality Predictor Scoring for Sepsis Patients in Haji Adam Malik Hospital

2021 ◽  
Vol 8 (10) ◽  
pp. 339-344
Author(s):  
Abdul Halim Harahap ◽  
Franciscus Ginting ◽  
Lenni Evalena Sihotang
Keyword(s):  
Sofa Score ◽  
Scoring System ◽  
Scoring Systems ◽  
Developed Countries ◽  
Apache Ii ◽  
Apache Ii Score ◽  
P Value ◽  
Cross Sectional ◽  
Cross Sectional Design ◽  
Score Apache

Introduction: Sepsis is a leading cause of death in the Intensive Care Unit (ICU) in developed countries and its incidence is increasing. Many scoring systems are used to assess the severity of disease in patients admitted to the ICU. SOFA score to assess the degree of organ dysfunction in septic patients. The Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system is most often used for patients admitted to the ICU. CCI scoring system to assess the effect of comorbid disease in critically ill patients on mortality. The study aimed to describe the characteristics of the use of scoring to predict patients’ mortality admitted to Haji Adam Malik Hospital. Methods: This is an observational study with a cross-sectional design. A total of 299 study subjects met the inclusion criteria and exclusion criteria, three types of scoring, namely SOFA score, APACHE II score, and CCI score were used to assess the prognosis of septic patients. Data analysis was performed using SPSS. P-value <0.05 was considered statistically significant. Results: A total of 252 people (84.3%) of sepsis patients died. The mean age of the septic patients who died was 54.25 years. The SOFA score ranged from 0-24, the median SOFA score in deceased sepsis patients was 5.0. The APACHE II score ranged from 0-71, the median APACHE II score in deceased sepsis patients was 23.0. The CCI score ranged from 0-37, the median CCI score in deceased sepsis patients was 5.0. Conclusion: Higher scores are associated with an increased probability of death in septic patients. Keywords: Sepsis; mortality predictor; SOFA score; APACHE II score, CCI score.

scholarly journals CORRELATION BETWEEN LEVEL OF SOLUBLE FAS AND DEGREE OF SEPSIS SEVERITY BASED ON APACHE II SCORE

2018 ◽  
Vol 24 (3) ◽  
pp. 231
Author(s):  
Pauline Hadisiswoyo ◽  
Endang Retnowati ◽  
Erwin Astha Triyono
Keyword(s):  
Prediction Model ◽  
Scoring System ◽  
Linear Regression Analysis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Sepsis Severity ◽  
Cross Sectional ◽  
Chronic Health ◽  
Soluble Fas ◽  
Positive Correlations

A widely used scoring system to assess the severity of sepsis is Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II scoring system, however there are some disadvantages in using this. Other parameters are needed to predict severity and outcome of sepsis. Proinflammatory cytokines and Fas receptors are increased in sepsis and their concentration elevations are correlated with disease severity. An increase of soluble Fas level will follow increasing Fas receptors. This study aimed to prove any correlation between the level of soluble Fas and degree of sepsis severity based on APACHE II score. A cross-sectional observational study was conducted in January-June 2015 on 30 septic patients. APACHE II scores were calculated from the patients’physiological data, age, and chronic health problem status. Levels of soluble Fas were measured using the ELISA method (Human FAS/ CD95 (Factor-Related Apoptosis) ELISA Kit, Elabscience Biotechnology). Levels of soluble Fas ranged between 1,049-2,783 pg/mL (1,855.7 ± 477.27 pg/mL). APACHE II scores varied between 4-29 (17.2 ± 5.82). Significant positive correlations between levels of soluble Fas and APACHE II score (r=0.347, p=0.03) were found. A prediction model of soluble Fas levels based on APACHE II score was made. Linear regression analysis produced a prediction model of soluble Fas levels based on APACHE II score, in which soluble Fas level= 1,365.8 + 28.485 x APACHE II score.  

Oral Health Status and Development of Ventilator-Associated Pneumonia: A Descriptive Study

2006 ◽  
Vol 15 (5) ◽  
pp. 453-460 ◽  
Author(s):  
Cindy L. Munro ◽  
Mary Jo Grap ◽  
R.K. Elswick ◽  
Jessica McKinney ◽  
Curtis N. Sessler ◽  
...  
Keyword(s):  
Health Status ◽  
Oral Health ◽  
Dental Plaque ◽  
Severity Of Illness ◽  
Oral Health Status ◽  
Microbial Colonization ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Ventilator Associated Pneumonia ◽  
Time Correlations

• Background Ventilator-associated pneumonia is a significant cause of morbidity and mortality and may be influenced by oral health. • Objective To describe the relationship between ventilator-associated pneumonia and oral health status, changes in oral health status during the first 7 days after intubation, and microbial colonization of the oropharynx and trachea. • Methods A total of 66 patients were enrolled within 24 hours of intubation and were followed up for up to 7 days. Data on oral health measures and the Clinical Pulmonary Infection Score (CPIS) were collected at baseline, day 4 (n = 37), and day 7 (n = 21). A regression model was used to predict risk of pneumonia at day 4. • ResultsDental plaque and oral organisms increased over time. Correlations were significant for baseline and day 4 dental plaque (P &lt; .001), baseline salivary lactoferrin and day 4 plaque (P = .01), and lower salivary volume and higher day 4 CPIS (P = .02). Potential pathogens were identified in oral cultures for 6 patients before or at the same time as the appearance of the organisms in tracheal aspirates. Correlations were significant with day 4 CPIS for score on the Acute Physiology and Chronic Health Evaluation (APACHE) II (P = .007), day 4 salivary volume (P = .02), interaction of APACHE II score and day 1 CPIS (P&lt;.001), and interaction of day 1 CPIS and plaque (P=.01). • Conclusions Higher dental plaque scores confer greater risk for ventilator-associated pneumonia, particularly for patients with greater severity of illness. Salivary volume and lactoferrin may affect the risk.

scholarly journals Assessment of Outcome over a 10-year Period of Patients Admitted to a Multidisciplinary Adult Intensive Care Unit with Haematological and Solid Tumours

2005 ◽  
Vol 33 (1) ◽  
pp. 26-35 ◽  
Author(s):  
J. L. Moran ◽  
P. J. Solomon ◽  
P. J. Williams
Keyword(s):  
Mechanical Ventilation ◽  
Cox Model ◽  
Severity Of Illness ◽  
Cohort Effect ◽  
Solid Tumours ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Adult Intensive Care Unit ◽  
Icu Admission ◽  
Over Time

The risk factors for time to mortality, censored at 30 days, of patients admitted to an adult teaching hospital ICU with haematological and solid malignancies were assessed in a retrospective cohort study. Patients, demographics and daily ICU patient data, from admission to day 8, were identified from a prospective computerized database and casenote review in consecutive admissions to ICU with haematological and solid tumours over a 10-year period (1989–99). The cohort, 108 ICU admissions in 89 patients was of mean age (±SD) 55±14 years; 43% were female. Patient diagnoses were leukaemia (35%), lymphoma (38%) and solid tumours (27%). Median time from hospital to ICU admission was five days (range 0–67). On ICU admission, 50% had septic shock and first day APACHE II score was 28±9. Forty-six per cent of patients were ventilated. ICU and 30-day mortality were 39% and 54% respectively. Multivariate Cox model predictors (P<0.05), using only ICU admission day data were: Charlson comorbidity index (CCI), time to ICU admission (days) and mechanical ventilation. For daily data (admission through day 8), predictors were: cohort effect (2nd vs 1st five-year period); CCI; time to ICU admission (days); APACHE II score and mechanical ventilation. Outcomes were considered appropriate for severity of illness and demonstrated improvement over time. Ventilation was an independent outcome determinant. Controlling for other factors, mortality has improved over time (1st vs 2nd five year period). Analysis restricted to admission data alone may be insensitive to particular covariate effects.

Controlling for Severity of Illness in Assessment of the Association Between Antimicrobial-Resistant Infection and Mortality: Impact of Calculation of Acute Physiology and Chronic Health Evaluation (APACHE) II Scores at Different Time Points

2007 ◽  
Vol 28 (7) ◽  
pp. 832-836 ◽  
Author(s):  
Keith W. Hamilton ◽  
Warren B. Bilker ◽  
Ebbing Lautenbach
Keyword(s):  
Severity Of Illness ◽  
Chronic Health Evaluation ◽  
Apache Ii ◽  
Fluoroquinolone Resistance ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Time Points ◽  
Resistant Infection ◽  
Multivariable Models ◽  
Culture Specimen

Background.In studies of the association between antibiotic-resistant infection and mortality, the importance of controlling for the underlying severity of illness is well recognized. However, it is unclear when the severity of illness should be assessed. Controlling for severity of illness on the day the culture specimen is obtained may underestimate the true association between resistance and mortality.Objective.TO assess the impact of calculating the Acute Physiology and Chronic Health Evaluation (APACHE) II score at different time points on the association between antimicrobial resistance and mortality.Methods.We used an existing data set from a study that investigated the association between fluoroquinolone resistance and mortality. The APACHE II score was calculated at 3 time points: the day the culture specimen was obtained, 1 day before the culture specimen was obtained, and 2 days before the culture specimen was obtained. Separate multivariable models were constructed using the 3 different APACHE II scores. These models were compared qualitatively.Results.Of 91 total subjects, 51 were infected with a fluoroquinolone-resistant strain and 40 with a fluoroquinolone-susceptible strain. The median APACHE II score for all subjects was 13 (95% confidence interval [CI], 11-15) when calculated on the day the culture specimen was obtained, 12 (95% CI, 11-13) when calculated 1 day before, and 11 (95% CI, 10-13) when calculated 2 days before the culture specimen was obtained. Of 91 subjects, 12 (13.2%) died. The 3 multivariable models (each with the APACHE II score calculated on a different day) were not substantively different; the adjusted odds ratio for the association between fluoroquinolone-resistant infection and mortality varied only from 1.38 to 1.65 in the 3 models.Conclusions.APACHE II scores calculated at different time points relative to obtainment of the culture specimen did not differ substantively. Furthermore, when the adjusted association between fluoroquinolone resistance and mortality was assessed, there were no substantive differences across multivariable models that incorporated APACHE II scores calculated at different time points.

scholarly journals Why the surgical patients are so critical in their intensive care unit arrival?

2013 ◽  
Vol 28 (suppl 1) ◽  
pp. 48-53 ◽  
Author(s):  
Anibal Basile-Filho ◽  
Mayra Gonçalves Menegueti ◽  
Maria Auxiliadora-Martins ◽  
Edson Antonio Nicolini
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Negative Impact ◽  
Survival Rates ◽  
Severity Of Illness ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Death Risk ◽  
Icu Transfer ◽  
The Impact

PURPOSE: To assess the ability of the Acute Physiology and Chronic Health Evaluation II (APACHE II) to stratify the severity of illness and the impact of delay transfer to an Intensive Care Unit (ICU) on the mortality of surgical critically ill patients. METHODS: Five hundred and twenty-nine patients (60.3% males and 39.7% females; mean age of 52.8 ± 18.5 years) admitted to the ICU were retrospectively studied. The patients were divided into survivors (n=365) and nonsurvivors (n=164). APACHE II and death risk were analysed by generation of receiver operating characteristic (ROC) curves. The interval time between referral and ICU arrival was also registered. The level of significance was 0.05. RESULTS: The mean APACHE II and death risk was 19.9 ± 9.6 and 37.7 ± 28.9%, respectively. The area under the ROC curve for APACHE II and death risk was 0.825 (CI = 0.765-0.875) and 0.803 (CI = 0.741-0.856). The overall mortality (31%) increased progressively with the delay time to ICU transfer, as also evidencied by the APACHE II score and death risk. CONCLUSION: This investigation shows that the longer patients wait for ICU transfer the higher is their criticallity upon ICU arrival, with an obvious negative impact on survival rates.

scholarly journals Homeopathy and the COVID-19 pandemic: quasi-experimental observational study

2021 ◽  
Vol 20 (1) ◽  
pp. 09-10
Author(s):  
Carla Holandino ◽  
Adriana Passos Oliveira ◽  
Edgard Costa Vilhena ◽  
Twoany Rebecca Pedroza Sanches ◽  
Fábio de Almeida Bolognani ◽  
...  
Keyword(s):  
Severity Of Illness ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Significance Level ◽  
Exact Test ◽  
Health Authorities ◽  
Significant Difference ◽  
High Death ◽  
Quasi Experimental ◽  
Observational Cohort

Background: the number of cases of Covid-19 reached more than 11 million people in Brazil, but mostly in Caxias city (Rio de Janeiro) high death rates are very worrysome. In this scenario, homeopathy therapy, along with sanitary and therapeutic measures, should be recommended by health authorities. Aims: to evaluate the use of homeopathic complex (Bryonia alba, China officinalis and Metallum album 30cH), concerning the severity of the illness, during the coronavirus pandemic. Methodology: the complex was administrated at multiple families from Caxias, with (FW) and without (FWO) symptoms similar to COVID-19’s, therefore qualifying the project as a quasi-experimental longitudinal observational cohort study (applied in 51 families or 128 people). With this, the influence of homeopathic intervention in sick (FW) and health (FWO) groups was estimated. All volunteers used three drops of the medicine, once a day, per 60 days. The medicine was prepared accordingly to the Brazilian Homeopathic Pharmacopoeia1. The follow-up was carried out within seven days, which resulted in a total of 8 weeks, since the first interview. The data was organized and statistically analyzed with a 5% significance level, for categorical variables, by Fisher Exact test, in Excel sheet and SPSS 17.0 platform. The ethical committee approved this project under the code: CAAE 31601020.3.0000.5243. Results and Discussion: the preliminary results showed the absence of deaths in both groups (FW and FWO), without any statistically significant difference related to the severity of illness. Most of the families (98.03%) were thrilled to contribute in this particular homeopathic research and reported to have had general health symptoms’ improvements (84.31%). Despite the previous comorbidities presented in 52.9% of the families and considering that Covid-19 infected 0.020% of them, only 0.098% looked for medical assistance and none needed hospitalization. Conclusion: no differences between previous sick and health groups were detected after homeopathy intervention.

scholarly journals Role of acute physiology and chronic health evaluation II scoring system in risk stratification and management of small bowel perforations

2020 ◽  
Vol 7 (6) ◽  
pp. 1776
Author(s):  
Sanjana Kumar ◽  
Jainendra K. Arora ◽  
Sunil Kumar Jain
Keyword(s):  
Small Bowel ◽  
Mortality Rate ◽  
Scoring System ◽  
Chronic Health Evaluation ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Double Blind ◽  
Chronic Health ◽  
Significant Difference

Background: Despite the surgical treatment, sophisticated intensive care units, latest generation antibiotics and a better understanding of pathophysiology, the morbidity and mortality rate of perforation peritonitis are still high. Patients are usually managed by subjective decision of surgeon based on which mortality is very high.Methods: This was a double-blind observational study conducted over a period of 18 months on 50 patients with small bowel perforations. Based on the acute physiology and chronic health evaluation (APACHE) II score at presentation, patients were triaged into 3 groups: group 1 (score ≤10), group 2 (score 11 to 20) and group 3 (score >20). Study population was managed by the subjective decision of the operating surgeon who was blinded off the APACHE II score of patients. Hence removing the possibility of bias and observing a correlation between surgical outcome and APACHE II score of the patient.Results: Patients with higher APACHE II score (>10) were more likely to undergo exteriorization of bowel. Length of hospital stay was also found to be increased with an increase in score. APACHE II score of 10 was found to predict mortality with significant difference between 2 groups. Below this score the mortality was 0% and above this score the mortality rate rose to 31.25%.Conclusions: APACHE II can be used as a reliable and uniform scoring system as its assessment at presentation in patients of small bowel perforations provides an insight to their surgical management as well as predicting overall outcome. 

scholarly journals A multicenter comparison of dialysis membranes in the treatment of acute renal failure requiring dialysis.

1998 ◽  
Vol 9 (2) ◽  
pp. 257-266
Author(s):  
J Himmelfarb ◽  
N Tolkoff Rubin ◽  
P Chandran ◽  
R A Parker ◽  
R L Wingard ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Complement Activation ◽  
Severity Of Illness ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Dialysis Membrane ◽  
Significant Difference ◽  
Initiation Of Dialysis ◽  
Discharge From Hospital

The mortality of patients with acute renal failure (ARF) remains high, and in several large studies approaches 60%. This mortality is particularly high in patients with ARF who require dialysis and has not changed substantially over several years, despite the introduction of major advances in monitoring and treatment. Increasing prevalence of comorbidities has been suggested as the major factor in this persistently high mortality. This study investigates the potential role of the dialysis membrane on patient outcome in a prospective multicenter study of 153 patients with ARF requiring dialysis. The membrane assignment was made in alternating order and was limited to membranes with low complement activation (Biocompatible [BCM]) and cellulosic, high complement activation (Bioincompatible [BICM]). Both types of membranes were low-flux membranes. Patients were dialyzed with the assigned membrane until recovery, discharge from hospital, or death. The severity of illness of each patient was assessed using the APACHE II score at the time of initiation of dialysis. A logistic regression analysis was used to adjust for the APACHE II score. The results of the study showed a statistically significant difference in survival (57% in patients on BCM, 46% in patients on BICM; P = 0.03) and in recovery of renal function (64% in patients on BICM and 43% in patients on BICM; P = 0.001). These differences were particularly marked in the patients who were nonoliguric (>400 ml/d of urine output) at initiation of the study. In the subset of patients who were nonoliguric at the start of dialysis, a larger fraction (70%) became oliguric after initiating dialysis on a BICM membrane, in contrast to 44% who were initiated on a BCM membrane (P = 0.03). It is concluded that the biocompatibility of the dialysis membrane plays a role in the outcome of patients with ARF, particularly those who are nonoliguric at the time of initiation of dialysis.

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