Desempeño de PSI/PORT y SOFA para predicción de ventilación mecánica invasiva en neumonía por SARS-CoV-2 / Performance of PSI/PORT and SOFA in predicting mechanical invasive ventilation in SARS-CoV-2 pneumonia / Desempenho de PSI/PORT e SOFA para prever ventilação mecânica invasiva na pneumonia por SARS-CoV-2

Resumen Introducción: Son escasas las publicaciones sobre aplicación de escalas pronósticas para predecir el uso de ventilación mecánica invasiva (VMI) en neumonía por SARS-CoV-2. El objetivo del estudio fue evaluar el desempeño de las escalas PSI/PORT y SOFA para predecir el uso de VMI en pacientes con neumonía por SARS-CoV-2. Material y métodos: Estudio retrospectivo que incluyó pacientes hospitalizados con neumonía por SARS-CoV-2 del 01 de abril al 31 de mayo de 2020. Se realizó análisis de curvas ROC, calculando el área bajo la curva de las escalas PSI/PORT y SOFA, así como sensibilidad, especificidad y valores predictivos. Resultados: Se incluyó a 151 pacientes, con edad de 52 años (IQR 45-64); 69.5% eran hombres. Del total, 102 pacientes necesitaron VMI (67.5%). Las áreas bajo las curvas ROC para predecir VMI fueron: SOFA 0.71 (IC 95% 0.64-0.78) y PSI/PORT 0.78 (IC 95% 0.71-0.85). Al compararlas, no hubo significancia estadística (p = 0.08). Conclusiones: Las escalas SOFA y PSI/PORT pueden infraestimar la necesidad de VMI en la neumonía por SARS-CoV-2. En nuestro estudio, SOFA y PSI/PORT no tuvieron un buen desempeño para predecir el uso de VMI en pacientes hospitalizados con neumonía por SARS-CoV-2.

Abstract Introduction: There are few publications on the application of prognostic scales to predict the use of invasive mechanical ventilation (IMV) in SARS-CoV-2 pneumonia. Therefore, the study's objective was to evaluate the performance of PSI/PORT and SOFA in predicting the use of IMV in patients with SARS-CoV-2 pneumonia. Material and methods: A retrospective study that included hospitalized patients with SARS-CoV-2 pneumonia from April 01, 2020, to May 31, 2020. Analysis of ROC curves was performed, calculating the area under the curve for PSI/PORT and SOFA scores, as well as sensitivity, specificity, and predictive values. Results: 151 patients were included, aged 52 years (IQR 45-64); 69.5% were men. Of the total, 102 patients required IMV (67.5%). Area under the curve to predict IMV were: SOFA 0.71 (95% CI 0.64-0.78) and PSI/PORT 0.78 (95% CI 0.71-0.85). When comparing them, there was no statistical significance (p = 0.08). Conclusions: In patients with SARS-CoV-2 infection, SOFA and PSI/PORT may underestimate the need for IMV. In our study, SOFA and PSI/PORT score performed fair in predicting IMV use in hospitalized patients with SARS-CoV-2 pneumonia.

Resumo Introdução: Existem poucas publicações sobre a aplicação de escalas prognósticas para prever o uso de ventilação mecânica invasiva (VMI) na pneumonia por SARS-CoV-2. O objetivo do estudo foi avaliar o desempenho do PSI/PORT e SOFA para prever o uso de IMV em pacientes com pneumonia por SARS-CoV-2. Material e métodos: Estudo retrospectivo que incluiu pacientes internados com pneumonia por SARS-CoV-2 entre 1o de abril de 2020 e 31 de maio de 2020. Foi realizada análise da curva ROC, calculando a área sob a curva PSI/PORT e SOFA, bem como a sensibilidade, especificidade e valores preditivos. Resultados: Foram incluídos 151 pacientes, com idade de 52 anos (IQR 45-64); 69.5% eram homens. Do total, 102 pacientes necessitaram de VMI (67.5%). As áreas sob as curvas ROC para predizer VMI foram: SOFA 0.71 (IC 95% 0.64-0.78) e PSI/PORT 0.78 (IC 95% 0.71-0.85). Ao compará-los, não houve significância estatística (p = 0.08). Conclusões: SOFA e PSI/PORT podem subestimar a necessidade de VMI na pneumonia por SARS-CoV-2. Em nosso estudo, SOFA e PSI/PORT não tiveram bom desempenho na previsão do uso de VMI em pacientes hospitalizados com pneumonia por SARS-CoV-2.

Effect of the timing of peripancreatic fluid drainage on prognosis in patients with severe acute pancreatitis: a two-center clinical retrospective study / 中华急诊医学杂志

Objective:To evaluate the effect of the timing of peripancreatic drainage on the survival outcome of patients with severe acute pancreatitis (SAP).Methods:This retrospective study included 271 patients with SAP admitted to two tertiary hospitals from January 2015 to December 2019. The Acute Physiology and Chronic Health EvaluationⅡ score (APACHEⅡ), Sequential Organ Failure Assessment score (SOFA), computed tomography (CT) grade, peripancreatic drainage situations, and survival outcome of patients were recorded. Patients were divided into the early and non-early peripancreatic catheter drainage groups (EPCD and non-EPCD). The data were analyzed using the Cox proportional hazard model for propensity score matching (PSM) and stratification.Results:After PSM, the 30-day and 90-day risk of death between the EPCD and non-EPCD groups were significantly different (0.134, 95% CI: 0.029-0.576, P=0.007; 0.166, 95% CI: 0.044-0.631, P=0.008, respectively). Furthermore, stratified analysis revealed significant differences in 30-day and 90-day risk of death between the EPCD and non-EPCD groups when the SOFA score was≥4 or the APACHEⅡ score was ≥8. Conclusions:For patients with SAP with SOFA score ≥4 or APACHEⅡ score≥8, early peripancreatic drainage can reduce the risk of death, but CT grading is not helpful for the decision-making of drainage timing in patients with SAP.

Utilidad pronóstica de la escala qSOFA en pacientes ingresados en un servicio de Medicina Interna por enfermedades infecciosas / Prognostic utility of the qSOFA scale in patients admitted to an Internal Medicine service due to infectious diseases

INTRODUCCIÓN: La sepsis es una entidad grave siendo su sospecha y tratamiento precoces claves para el pronóstico. OBJETIVO: Analizar la utilidad pronóstica de la escala qSOFA en pacientes que ingresan por infección en un servicio de Medicina Interna. PACIENTES Y MÉTODOS: Estudio descriptivo, tranversal, de los pacientes ingresados con infección en el Hospital General de Castellón (España) de noviembre de 2017 a febrero de 2018. Criterio de inclusión: pacientes admitidos por la sospecha de un proceso infeccioso. Variable principal dependiente: mortalidad. Variable principal independiente: qSOFA. Variables secundarias: tiempo hasta primera valoración médica y hasta inicio de antibioterapia empírica en Urgencias (minutos), características demográficas del paciente, analíticas y evolutivas. RESULTADOS: Se analizó un total de 311 pacientes, 145 varones, edad media 78 años (DE 16,23). Setenta y cinco (24%) presentaron qSOFA ≥ 2. Se observó una mayor mortalidad en aquellos pacientes con qSOFA ≥ 2 (36 vs 11%, p = 0,00). CONCLUSIÓN: En pacientes admitidos con enfermedades infecciosas, un valor de qSOFA > = 2 se asoció a mayor mortalidad. Se requieren futuros estudios para comprobar su potencial utilidad diagnóstica.

BACKGROUND: Sepsis is a serious entity. Diagnosis and early treatment is important for the prognosis. AIM: To analyze the prognostic utility of the qSOFA scale as a predictor of mortality in patients admitted by infection in an Internal Medicine Service and describe its demographic characteristics and possible association with mortalilty. METHODS: Descriptive and cross-sectional study of patients admitted with diagnosis of acute infection at the General Hospital of Castellon (Spain) from November 2017 to February 2018. Inclusion criteria: patients admitted on suspicion of an infectious process. Main dependent variable: mortality. Independent main variable: qSOFA scale. Secondary variables: time until the first medical evaluation and the start of empirical antibiotic therapy, demographic characteristics of the patient, analytics and evolutional. RESULTS: A total of 311 patients were analyzed, 145 men with an average age of 78 (DE 16,23). Seventy five presented qSOFA ≥ 2. Higher mortality was observed in those patients with qSOFA ≥ 2 (36% vs 11%, p = 0.00). CONCLUSION: In patients admitted with infectious diseases, a qSOFA value > = 2 was associated with higher mortality. Future studies are required to verify its potential diagnostic utility.

Assessment of pSOFA-L score in predicting the clinical outcome of critically ill children

Background: Recently Pediatric Sequential Organ Failure Assessment (pSOFA) score was adapted and validated in critically ill children to predict the clinical outcome. This study was aimed to evaluate the lactate level association with the outcome and thereby formulating pSOFA-L score to predict the clinical outcome better in critically ill children.Methods: This hospital based prospective, observational, analytical study was conducted in the Department of Paediatrics, A. J Hospital, Mangalore, Karnataka. Requirement of oxygen, inotrope support and other parameters were studied and compared the score with clinical outcome. A total of 75 cases were studied.Results: In this study total of 51 children had high serum lactate levels (68%). Out of 28 expired children 23 children had higher serum lactate levels that accounts for about 82.14% which is statistically significant (p<0.001). ROC curve of pSOFA-L score in predicting the mortality yielded AUC: 0.92 and cut off value: 10.5 which is statistically significant (p<0.001). In the present study mortality rate was 26.09% in children whose pSOFA-L score was less than 9 and mortality rate of 38.89% and 50.00% in children whose pSOFA-L score was 9 to 11 and more than 11 respectively.Conclusions: In this study increase in pSOFA-L score is associated with high mortality and poor outcome. The findings of the present study validate and emphasize that, pSOFA-L score helps in accurate prediction of mortality of critically ill children.

C-reactive protein/albumin ratio as a predictor of 28 day mortality in patients with sepsis

Background: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis remains a major cause of morbidity and mortality worldwide. Important biomarkers that can be used as prognostic markers in sepsis are C Reactive Protein (CRP) and serum Albumin levels. CRP levels markedly elevate in response to infection whereas albumin levels decrease in response to acute phase infection. We want to ascertain the value of CRP/albumin ratio as an independent predictor of 28-day mortality in sepsis patients.Methods: A prospective study was conducted including 150 patients satisfying the criteria for sepsis according to SOFA score of more than 2. Initial CRP/Albumin ratio was assessed to determine its significance in assessing the 28-day mortality, primary end point of our study. Secondary end points assessed were length of ICU stay, need for inotropic support, need for ventilator support and renal replacement therapy.Results: In the analysis of CRP/Albumin ratio as a predictor of 28-day mortality, patients were followed up from day of admission till 28 days to assess primary outcome. Among study subjects survivors were 92 in whom mean CRP/ALB ratio was 0.1197 and non survivors were 58 patients with mean CRP/ALB ratio was 0.0426. p-value <0.001, there was statistically significant difference found between survivor and Non-Survivor with respect to CRP/Albumin ratio. In assessing secondary outcome statistically significant association was found for need for ventilator and inotropic support, whereas it was insignificant in assessing need for dialysis and length of ICU stay.Conclusions: CRP/albumin ratio, which indicates the extent of residual inflammation, could be used as a prognostic marker in predicting mortality in patients with sepsis and septic shock.

Prevalence and Correlation of Intra-abdominal Hypertension with Incidence of Acute Kidney Injury in ICU Patients: A Cohort Study from A Tertiary Care Centre

Introduction: Intra-abdominal hypertension (IAH), asustained and repeated steady state rise in intra-abdominalpressure (IAP) above 12 mmHg, was reported as a hiddencause contributing to morbidity and mortality in criticallyill patients. This study was aimed to find out the possiblerelationship between IAH and acute kidney injury (AKI) inICU patients.Material and methods: Prospective cohort study wasconducted among patients admitted in medical and surgicalICU. Consecutive patients coming under the inclusioncriteria were selected and IAH was measured using pressuretransducer technique. IAP was measured at the time ofadmission, at 24 hours, 48hours and also at the end of 72hours.Other parameters were collected based on a standard proformaprepared.Results: Eighty patients were included in our study, of which24 patients had IAH. Mean age in patients with IAH wasobtained as 63.08 ± 12.37 years with a male predominance.Maximum patients were belonging to age group of 61-70yrs (25%), 9 patients were below 40 yrs and 14 patientswere above 81yrs. Mean IAP was calculated to be 11.65 ±3.15. Only 9 patients were in grade IV (11.3%). Risk factorsassociated were found to be ascites, upper GI bleed andmetabolic encephalopathy. IAH and AKI were found to besignificantly correlated (odds ratio=2.666 with CI 0.98-7.25).Conclusion: Rising intra-abdominal pressure is found to havehigher incidence of renal failure than those with establishedIAH. IAH has been found to be a clinically significant riskfactor for development of AKI in ICU patients.

Comparison of two simplified SOFA scores for predicting the prognosis of patients with sepsis / 解放军医学杂志

Objective To compare the prognostic value of electronic SOFA (eSOFA) scores and simplified SOFA (sSOFA) scores in evaluating the prognosis of patients with sepsis. Methods A retrospective analysis was conducted of clinical data of 245 patients with sepsis admitted to the Department of Emergency and Critical Care Medicine, Shanghai Pudong Hospital from August 2016 to August 2019. Clinical end points were survival status 28 days after hospital admission. eSOFA score, sSOFA score, qSOFA score and SOFA score were evaluated to predict patient prognosis using the area under the receiver operating characteristic curve (AUC). Results AUC of eSOFA score, sSOFA score, qSOFA score and SOFA score for predicting the prognosis of the patients was 0.757 (95% CI 0.686-0.828), 0.721 (95% CI 0.665-0.787), 0.662 (95% CI 0.586-0.738), 0.806 (95% CI 0.747-0.866, respectively. The eSOFA score was superior to the sSOFA score (Z=2.317, P=0.021) in terms of AUC. Conclusions The eSOFA and sSOFA scores have predictive value for the prognosis of sepsis, and eSOFA score is better than sSOFA score.

Sensibilidad y especificidad de los puntajes Evaluación de Insuficiencia Orgánica Secuencial Rápida vs Síndrome de Respuesta Inflamatoria Sistémica en la predicción de mortalidad intrahospitalaria / Quick sequential organ failure assessment vs systemic inflammatory response syndrome scores sensitivity and specificity for predicting in-hospital mortality

Resumen: OBJETIVO: Comparar la capacidad predictiva de mortalidad intrahospitalaria de los puntajes Evaluación de Insuficiencia Orgánica Secuencia Rápida (qSOFA) y Síndrome de Respuesta Inflamatoria Sistémica (SIRS) en pacientes adultos ingresados con diagnóstico de infección. MATERIAL Y MÉTODO: Estudio descriptivo, transversal, con diseño no experimental, efectuado de enero a julio de 2017 en pacientes adultos ingresados con infección de origen diferente al Hospital General del Sur Dr. Pedro Iturbe de la ciudad de Maracaibo, Venezuela, seleccionados mediante un muestreo no probabilístico intencional. A los pacientes se les cuantificaron los puntajes qSOFA y SIRS, se compararon las características al ingreso, días de hospitalización y mortalidad intrahospitalaria en los dos grupos. RESULTADOS: Se incluyeron 60 sujetos, 51.6% eran hombres; el foco infeccioso más frecuente fue el urinario con 43.3%, la administración de agentes vasoactivos fue necesaria en 40% de los pacientes, mientras que la mortalidad intrahospitalaria ocurrió en 45% de los casos. El puntaje qSOFA se asoció con mayor porcentaje de mortalidad intrahospitalaria en comparación con el puntaje SIRS, también mostró mayor capacidad predictiva con sensibilidad de 96%, especificidad de 33%, valor predictivo positivo de 54%, valor predictivo negativo de 92%, razón de verosimilitud positiva de 1.4, razón de verosimilitud negativa de 0.1 y área bajo la curva de 0.77 (0.65-0.89). CONCLUSIÓN: El puntaje qSOFA tiene mayor sensibilidad y especificidad de mortalidad intrahospitalaria en comparación con el SIRS.

Abstract: OBJECTIVE: To compare in-hospital mortality predictive capacity of quick Sequential Organ Failure Assessment (qSOFA) and Systemic Inflammatory Response Syndrome (SIRS) in adult patients admitted with suspected infection. MATERIAL AND METHOD: A descriptive, cross-sectional study was carried out from January to July 2017 with a non-experimental design in adult patients admitted with infection of different source to the Hospital General del Sur Dr. Pedro Iturbe from Maracaibo city, Venezuela, selected by an intentional sampling. We quantified the qSOFA and SIRS scores, comparing the characteristics of admission, days of stay and in-hospital mortality in the two groups. RESULTS: There were included 60 subjects, 51.6% were men; the most frequent infectious source was the urinary tract with 43.3%, the use of vasoactive agents was necessary in 40% of the patients, while in-hospital mortality occurred in 45% of cases. The quick SOFA score was associated with a greater percentage of in-hospital mortality compared to the SIRS score, also exhibiting a greater predictive capacity with sensitivity of 96%, specificity of 33%, positive predictive value of 54%, negative predictive value of 92%, positive likelihood ratio: 1.4, negative likelihood ratio: 0.1 and area under the curve of 0.77 (0.65-0.89). CONCLUSION: The quick SOFA score showed greater sensitivity and specificity for in-hospital mortality compared to the SIRS.

Efecto del protocolo de Rivers en la mejora de la hemodinamia y oxigenación en pacientes con shock séptico por neumonía grave del Hospital III EsSalud Chimbote / Effect of Rivers Protocol in improving hemodynamics and oxygenation in patients with septic shock due to severe pneumonia in EsSalud III Hospital in Chimbote

Objetivos: Determinar la relación entre la aplicación del protocolo de Rivers y la mejora hemodinámica y oxigenatoria en pacientes con shock séptico por neumonía grave atendidos en el Hospital III EsSalud Chimbote durante el periodo julio a diciembre 2018. Materiales y métodos: Ensayo no controlado que incluyó a 30 pacientes con shock séptico por neumonía a quienes se aplicó el protocolo de Rivers, y se evaluó si efecto en indicadores hemodinámicos y oxigenatorios, según puntuación SOFA. Se aplicó la prueba de Wilcoxon para determinar el efecto de la aplicación del protocolo Rivers. Resultados: El score SOFA antes de aplicar el protocolo de Rivers presentó en la evaluación hemodinámica una mediana de 2,5 y de 2,0 al final (p < 0,01). Respecto a la evaluación oxigenatoria, la mediana inicial fue 2,5 y de 1,0 al final (p < 0,01). Se encontró que, luego de la aplicación del protocolo de Rivers, 21 de 30 pacientes presentaron mejoría en la hemodinamia y 27 de 30 pacientes presentaron mejoría oxigenatoria. Conclusiones: El presente estudio recomienda considerar la aplicación del protocolo de Rivers en pacientes con shock séptico por neumonía grave, con el fin de mejorar la hemodinamia y oxigenación.

Objectives: To determine the relationship between the use of Rivers Protocol and hemodynamics and oxygenation status improvement in patients with septic shock due to severe pneumonia seen at EsSalud III Hospital in Chimbote from July to December 2018. Materials and Methods: This is a non-controlled trial which included 30 patients with septic shock due to severe pneumonia. The Rivers Protocol was administered, and its effect was assessed with respect to hemodynamic and oxygenation patterns, according to the SOFA score. The Wilcoxon test was used for determining the effect of using the Rivers Protocol. Results: SOFA scores for the hemodynamics assessment had an initial median 2.5 and 2.0 at the end (p<0.01). With respect to the oxygenation assessment, the initial median was 2.5, and it was 1.0 at the end (p<0.01). It was found that after administering the Rivers Protocol, 21 of 30 patients improved their hemodynamic status, and 27 of 30 patients improved their oxygenation status. Conclusions: This study recommends considering the use of Rivers Protocol in patients with septic shock due to severe pneumonia, aiming to improve both their hemodynamics and oxygenation status.

Study of serum HDL-cholesterol levels in sepsis patients and its prognostic significance

Background: Sepsis is the second leading cause of mortality in the ICU. Despite advances in aggressive management, sepsis continues to have a high mortality rate, hence a prognostic marker is essential. Recently HDL-cholesterol was found to be have significant association between mortality and its levels. Hence, this study is being conducted to assess the association between sepsis and HDL-C levels.Methods: It is a prospective study conducted in MGMCRI involving 100 sepsis patients. Among them 66 people survived, and 34 people expired. Serum HDL-cholesterol levels and variables required for SOFA score are measured at two intervals, one during admission and on day 5 of admission. The correlation between SOFA scores and HDL-C levels were assessed.Results: Among non-survivors SOFA score was found to be high and low in the survived patients. Similarly, HDL-C values, were high in survived patients and low in dead patients. The correlation between SOFA scores and HDL in both survivors and non survivors, both at the time of admission and at day 5 were found to be statistically significantly correlated.Conclusions: This study proves the significant relationship between the HDL values and the SOFA scores. Hence, HDL-cholesterol levels can be used to measure the prognosis and therapeutic efficacy in cases of sepsis. Rising values of HDL cholesterol favour improvement in clinical condition and falling values imply worsening and there by providing a prognostic indicator.

The application of post cardiovascular surgery SOFA score in hospital mortality in severe patients / 中华胸心血管外科杂志

Objective@#Establish the post cardiovascular surgery SOFA score(pcvsSOFA)based on the Sequential Organ Failure Assessment(SOFA)score to evaluate the severity and prognosis of patients after cardiovascular surgery.@*Methods@#3 872 consecutive patients who underwent cardiovascular surgery and stayed in ICU more than 24 hours between July 2015 and December 2017 were retrospectively analyzed to establish a derivation cohort. Univariable and multivariable logistic regression were used to identify the predictors in the pcvsSOFA. And the validity of the new model was evaluated in the derivation cohort and validation cohort.@*Results@#Respiratory system score, coagulation system score, nervous system score and renal system score on the first day of ICU, Emergency surgery and re-surgery were risk factors and established the pcvsSOFA. The total score of pcvsSOFA was 20 point and was divided into four classes, namely class Ⅰ(pcvsSOFA-score: 1-5), class Ⅱ(pcvsSOFA-score: 6-10), class Ⅲ(pcvsSOFA-score: 11-15) and class Ⅳ(pcvsSOFA-score: 16-20)with their corresponding predicted mortality 0.9%(n=2 317), 5.7%(n=1 367), 26.8%(n=184), and 64.2%(n=4) in the derivation cohort. The area under the receiver operating characteristics curve(AUC)was 0.864(95%CI: 0.837-0.892), and the integrated discriminant improvement(IDI) was 0.035.In the validation cohort, AUC(pcvsSOFA)= 0.832(95%CI: 0.735-0.928), IDI=0.211. The AUC of SOFA, APACHE Ⅱ and SAPS Ⅱ was 0.771, 0.793 and 0.721 respectively.@*Conclusion@#Compared with the SOFA score, pcvsSOFA could be a better tool to assess the prognosis of critical patients in the early postoperative stage.

The application of post cardiovascular surgery SOFA score in hospital mortality in severe patients / 中华胸心血管外科杂志

Objective Establish the post cardiovascular surgery SOFA score( pcvsSOFA) based on the Sequential Organ Failure Assessment( SOFA) score to evaluate the severity and prognosis of patients after cardiovascular surgery. Methods 3872 consecutive patients who underwent cardiovascular surgery and stayed in ICU more than 24 hours between July 2015 and December 2017 were retrospectively analyzed to establish a derivation cohort. Univariable and multivariable logistic regression were used to identify the predictors in the pcvsSOFA. And the validity of the new model was evaluated in the derivation cohort and validation cohort. Results Respiratory system score, coagulation system score, nervous system score and renal system score on the first day of ICU, Emergency surgery and re-surgery were risk factors and established the pcvsSOFA. The total score of pcvsSOFA was 20 point and was divided into four classes, namely class Ⅰ( pcvsSOFA-score:1-5 ) , class Ⅱ( pcvsSOFA-score:6-10 ) , class Ⅲ( pcvsSOFA-score:11-15 ) and class Ⅳ( pcvsSOFA-score:16-20 ) with their corresponding predicted mortality0.9％(n=2317),5.7％(n=1367),26.8％(n=184),and64.2％(n=4) inthederivationcohort. Thearea under the receiver operating characteristics curve(AUC)was 0. 864(95％CI:0. 837-0. 892), and the integrated discriminant improvement(IDI) was 0. 035. In the validation cohort, AUC(pcvsSOFA) = 0. 832(95％CI:0. 735-0. 928), IDI=0. 211. The AUC of SOFA, APACHE Ⅱ and SAPS Ⅱ was 0. 771, 0. 793 and 0. 721 respectively. Conclusion Compared with the SOFA score, pcvsSOFA could be a better tool to assess the prognosis of critical patients in the early postoperative stage.

Prognostic value of APACHE Ⅱ,SOFA score and blood lactic acid changes in heat stroke patients combined with MODS / 中国职业医学

OBJECTIVE: To evaluate the prognostic value of acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), sequential organ failure assessment(SOFA) score and the blood lactic acid in heat stroke patients combined with multiple organ dysfunction syndrome(MODS). METHODS: A judge sampling method was used to select 42 cases of heat stroke patients combined with MODS as study subjects. They were divided into survival group(23 cases) and death group(19 cases) according to prognosis. The APACHEⅡ, SOFA score and blood lactate level after admission to intensive care unit(ICU) were detected. The prognostic value of each index was analyzed according to receiver operating characteristic curve(ROC) curve. RESULTS: At the 48 th hour after admission to ICU, the APACHEⅡ and SOFA scores of the patients in the death group were higher than those in the survival group(P<0.05). At the 6 th hour after admission to ICU, the blood lactate level in the death group increased compare with that in the survival group(P<0.05). APACHEⅡ or SOFA scores at 48 hours, and the blood lactate levels at the 1 st, 2 nd, and 6 th hours after admission to ICU were all positively correlated with prognosis(P<0.05). ROC curve analysis showed that APACHEⅡ and SOFA scores at 48 hours, and the blood lactate levels at the 1 st, 2 nd, and 3 rd hours after admission to ICU could be used to evaluate the prognosis(P<0.01). CONCLUSION: The dynamic monitoring of APACHEⅡ, SOFA score and the blood lactic acid have important clinical significance on the prognosis of heat stroke patients with MODS.

A study on outcome of malaria and acute gastroenteritis induced acute kidney injury requiring hemodialysis

Background: Acute kidney injury previously known as acute renal failure, is characterized by the sudden impairment of kidney function resulting in the retention of nitrogenous and other waste products normally cleared by the kidneys. Acute Kidney Injury is usually manifested as multiorgan failure syndrome and extracorporeal support may also target fluid overload and heart failure, extracorporeal CO2 removal for combined kidney and lung support, albumin dialysis for liver support. Haemodialysis is more effective than peritoneal dialysis for management of Acute Kidney injury as Peritoneal dialysis is associated with clearance limitation and difficulties with fluid removal and is thus rarely used in adults in developed countries.Methods: The study was conducted in the Department of Medicine, Pt. J.N.M. Medical College and Dr. B.R.A.M. Hospital, Raipur (CG), India, from 2010 to 2012. All patients of both the sexes who were diagnosed as a case of Acute Kidney Injury due to Acute Gastroenteritis and Malaria and who were advised for Hemodialysis were included in the study. In our study, 32 patients of Acute Kidney Injury were included. The criteria used for AKI in the study was RIFLE criteria. Hemodialysis was done in all the cases. Quantitative variables are reported as means±SD and qualitative variables as percentage. Factor(s) determining outcome of AKI were tested by univariate analysis using “fisher’s exact test”. All variables with a P value <0.05 in the univariate analysis were defined statistically significant.Results: Out of 32 patients of Acute Kidney Injury in our study, 50% (n=16) were of Malaria associated AKI cases and other 50% (n=16) patients were of Acute Gastroenteritis associated AKI in which 87.5% males,12.5% Females were of Malaria and 75% male,25% Female were in AGE associated AKI. Maximum number of patients presented with features of AKI within first 3days of disease onset i.e. 56.25% (n=9) of malaria patients and 68.75% (n=11) of AGE patients. Mortality due to MOD was more common in Malaria patients as compared to AGE patients. AGE associated AKI patients had different level of deranged SOFA score.Conclusions: Acute kidney injury due to acute gastroenteritis differs from other causes of AKI by frequent occurrence of hypokalemia. Early diagnosis and prompt management can restore the kidney function.

The values of SOFA score, qSOFA score and SIRS criteria in predicting the prognosis of adult patients with suspect infection / 中华急诊医学杂志

Objective To investigate the clinical values of SOFA score,qSOFA score and SIRS criteria in predicting the prognosis of patients with suspected infection in the emergency department.Methods From January 2015 to April 2017,487 patients aged over 18 years were suspected to be infected and admitted to hospital.SOFA,qSOFA,and SIRS scores were calculated.The mortality and the requirement of ICU treatment were used as prognostic factors for evaluating the validity of each score.The prognostic value of each scoring system was evaluated by the area under the receiver operating characteristic curve (AUROC).Results In 487 patients,the hospital mortality rate was 4.9％,and requirement of ICU treatment rate was 17％.SOFA score predicting hospital mortality and requirement of ICU treatment (AUROC 0.905) were superior to other scores (qSOFA-WBC:AUROC 0.778,qSOFA:AUROC 0.769,SIRS:AUROC 0.64).Compared with the SIRS criteria,patients with a score of ＞1 had higher qSOFA scores (94.47％),but lower sensitivity (44.86％);although SIRS criteria had a higher sensitivity (77.57％),they were less specific (42.63％).When qSOFA was added to the condition of leukocyte abnormalities (＜4× 109/L or ＞ 10× 109/L),the prognosis was improved and the sensitivity and specificity for prognosis were 73.83％ and 71.84％ (qSOFA-WBC score,＞1),respectively.In patients with qSOFA-WBC score,only 6 patients (negative predictive value of 94.2％) died or required ICU treatment.Conclusion The SOFA score is superior to qSOFA and SIRS in predicting the prognosis of patients with suspect infection,and qSOFA-WBC is superior to qSOFA and SIRS in predicting low risk.

The association between feeding intolerance and clinical outcome in critically ill patients admitted to ICU: a multi-center prospective, observational study / 中华急诊医学杂志

Objective To investigate the prevalence of feeding intolerance (FI),and to explore the FI within 7 days of ICU admission in association with clinical outcome in critically ill patients.Methods The adult patients from 14 general ICUs in Zhejiang Province with an expected admission to ICU for at least 24h were recruited from March 2014 to August 2014,and all clinical,laboratory,and survival data were prospectively collected.The AGI (acute gastrointestinal injury) grade was daily assessed based on gastrointestinal (GI) symptoms,feeding details and organ dysfunction within the first week of ICU stay.The intra-abdominal pressures (IAP) was measured using AbViser device.Results Of 550 patients enrolled,418 were assessed in GI symptoms and feeding details within 7 days of ICU stay.The mean age and SOFA score were (65.1 ± 18.3) years and (8.96 ±4.10),respectively.Of them,355 patients (84.9％) were under mechanical ventilation support,and 37 (8.85％) received renal replacement therapy.The mean length of time for enteral feeding was (30.8 ±26.2) h,and the prevalence of FI on the 3rd and 7th day of ICU stay accounted for 39.2％ and 25.4％,respectively.Compared to those with FI within 7 days of ICU stay,the patients without FI had higher rate of successively weaning from mechanical ventilation (21.3％ vs.5.7％,P =0.003) and higher rate of withdrawal of vasoactive medication (45.5％ vs.20.0％,P =0.037),as well as lower mortality rate of 28-day (24.4％ vs.38.7％,P =0.004) and 60-day (29.6％ vs.44.3％,P =0.005).In multivariate Cox regression model with adjustment for age,sex,participant center,serum creatinine and lactate,AGI grade on the first day of ICU stay,and comorbidities,the FI within 7 days of ICU stay (x2 ≥ 7.24,P ＜ 0.01) remained to be independent predictors for 60-day mortality.After further adjusted for SOFA score,the FI within 7 days of ICU stay (HR =1.71,95％ CI:1.18-2.49;P =0.006) and AGI grade on the first day of ICU stay (HR =1.33,95 ％ CI:1.07-1.65;P =0.009) could provide independent prognostic values of 60-day mortality.Conclusions There is high rate of FI occurred within 7 days of ICU stay,and is significantly associated with worse outcome.In addition,this study also provides evidence to further support that measurement of gastrointestinal dysfunction could increase value of SOFA score in outcome prediction for the risk of 60-day mortality.

Predictive value of AGI grading system introduced into SOFA score in patients with severe acute pancreatitis / 中华急诊医学杂志

Objective To study the predictive value of acute gastrointestinal injury (AGI) grading system introduced into Sequential Organ Failure Assessment (SOFA) score in patients with severe acute pancreatitis (SAP) in order to provide a reliable clinical tool for the evaluation of prognosis of SAP.Methods Patients with acute pancreatitis admitted to ICU from July 2012 to July 2014 were enrolled for study.The criteria of exclusion were the age below 18 years old,pregnancy,or patients without consent to the treatment.A total of 63 patients with 37 males and 26 females aged (47 ± 15.3) years were included.The data of their acute physiology and chronic health evaluation (APACHE) Ⅱ score,the highest SOFA score and AGI grade within the first week,and the 28-day mortality rate were collected.Patients without AGI were defined as zero point,and AGI grade Ⅰ-Ⅳ were defined as 1-4 points.The receiver operating characteristic curve (ROC) was used to evaluate the value of APACHE Ⅱ score,SOFA score,and SOFA + AGI score in predicting the prognosis of SAP.The areas under ROC curve (AUC) of the APACHE Ⅱ score,SOFA score,and SOFA + AGI score were compared with MedCalc software,and P value less than 0.01 was considered to be statistical significance.Results (1) The 28-day mortality of the 63 patients with SAP was 20.6％ (13/63),in which 50 patients in the survival group,13 patients in the death group.The APACHEⅡ scores of two groups were (15.62 ± 4.33 vs.12.10 ± 3.74,P=0.0048),the SOFA scores were (14.77 ± 3.09 vs.9.24 ± 2.88,P ＜0.01),and the SOFA + AGI scores were (18.77 ±3.09 vs.10.74 ± 3.17,P＜0.01).(2) The AUC of APACHEⅡ score was0.748 ± 0.084 (95％ CI:0.622-0.849),the AUC of SOFA score was 0.902 ± 0.059 (95％ CI:0.801-0.962),and the AUC of SOFA +AGI score was 0.963 ± 0.037 (95％ CI,0.882-0.994);There was no significant difference in AUC between APACHE Ⅱ score and SOFA score (P =0.10),and there was statistical significance between the AUC of APACHE Ⅱ score and that of SOFA + AGI score (P =0.013),and the difference in AUC between SOFA score and SOFA + AGI score was statistically significant (P =0.008).The Youden index and the positive likelihood ratio of SOFA + AGI score system were the greatest to be 0.863 and 15.38,respectively.Conclusions SOFA scoring system has better predictive value in patients with SAP when AGI grading system was introduced into it.

Weighted index of comorbidities evaluates the impact of underlying diseases on hospital mortality of pneumonia patients / 中华急诊医学杂志

Objective To estimate the validity of Charlson' s weighted index of comorbidities (WIC) used to predicting 28-day mortality among ICU pneumonia patients with underlying diseases.Methods Aretrospective analysis of 160 adult patients with pneumonia admitted to a multi-discipline ICU of Shanghai Changzheng hospital between October 2010 and February 2012 was carried out.Clinical data were collected including age,gender,community acquired pneumonia (CAP) or hospital acquired pneumonia (HAP),underlying diseases,severity-of-sepsis,and 28-day mortality.WIC scores,acute physiology and chronic health evaluation (APACHE) Ⅱ,and sepsis related organ failure assessment (SOFA) were assessed within the first 24 hours after admission.Logistic regression analyses were used to evaluate the predictors for outcome.The receiver operating characteristic curve (ROC) was used to compare the performance of these scores between different methods.Results Of 160 enrolled patients,76 (48.8％) were CAP,82 (51.2％) HAP,and 106 (66.3％) male,54 (33.7％) female,and 99 (61.9％) patients survived and 61 (38.1％) died.The average age was (62.4 ± 17.3) years old.Compared with survivors,WIC,APACHE Ⅱ and SOFA scores were significantly higher in death group (P ＜ 0.05).The multivariate logistic regression revealed that risk of death depends predominantly on age (OR =1.049,95％ CI:1.011-1.088,P =0.011),WIC (OR =1.725,95％ CI:1.194-2.492,P =0.004),APACHE Ⅱ score (OR =1.175,95％CI:1.058-1.305,P =0.003),SOFA score (OR =1.277,95％ CI:1.048-1.556,P =0.015),presence of ARDS (OR =0.081,95％ CI:0.008-0.829,P =0.034),and complicated with severe sepsis (OR =0.149,95％ CI:0.232-0.622,P =0.004).The area under the receiver operating characteristics curve in predicting mortality was 0.639 (0.547-0.730) for the WIC,0.782 (0.709-0.856) for APACHE Ⅱ score,0.79 (0.714-0.866) for SOFA score and 0.842 (0.777-0.907) for the merger of three.Conclusions In pneumonia patients of ICU,WIC is a useful approach to predicting 28-day mortality,and the risk of death significantly depends on co-morbidities.

Prognostic investigation of AKIN criteria combined with APACHE Ⅱ and SOFA scoring system in acute kidney injury after cardiac surgery / 中华肾脏病杂志

Objective To explore the prognostic value of Acute Kidney Injury Network (AKIN)criteria combined with Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ)and Sequential Organ Failure Assessment(SOFA)scoring system in acute kidney injury(AKI)after cardiac surgery. Methods Clinical data of patients who underwent open-heart surgery in Zhongshan Hospital,Fudan University from April 2009 to August 2009 were prospectively collected.AKI after cardiac surgery was classified by AKIN staging system.APACHE Ⅱ and SOFA scores were evaluated according to the worst value of physiologic variables in the 1st 24 h after surgery.Discrimination and calibration of these three models were assessed by receiver operating characteristic(ROC) curve and Hosmer-Lemeshow goodness-of-fit test.Besides,their effects on inhospital mortality were evaluated by multivariate Logistic regression analysis. Results Of the 993 admissions,309 patients developed AKI and the incidence was 31.1%.The median time that developed postoperative AKI and reached the Scr peak were 1 d and 2 d respectively.Either APACHE Ⅱ or SOFA scores,which was positively correlted with the severity of AKI(APACHEⅡr=0.37,P<0.01;SOFA r=0.42,P<0.01)was higher in AKI patients compared with that in nonAKI patients(P<0.01).The mortality rose corresponding to the severity of kidney injury.However,the predicted death rate-adjusted(PDR-A)calculated by APACHE Ⅱ scoreS Was higher than the actual value in non-AKI patients and AKIN stage 1(P<0.01),while it was lower in AKIN stage 3 (P<0.01).The areas under the ROC curve of APACHEⅡ,SOFA and AKIN criteria were all above 0.8 and the results of Hosmer-Lemeshow goodness-of-fit test indicated good calibration of three models.Multivariate analysis showed that APACHE Ⅱ≥19(OR=4.26)and AKIN stage 3(OR=76.151 were independent predictors of in-hospital mortality. Conclusions AKI can be classified by AKIN criteria in the early stage after cardiac surgery and the AKIN staging system may serve the prediction of prognosis.The APACHE Ⅱ and SOFA scores just evaluated in the 1st 24 h after operation can discern the severity of patients'illness.Three models all present good discrimination and calibration in predicting patients'outcome.APACHE Ⅱ≥19 along with AKIN stage 3 are found to be the independent predictors of in-hospital mortality.It should be noticed that the deviation between PDR-A and the actual mortality in subgroups,dynamic evaluation may raise the accuracy of scoring system.

Early Changes in the Sequential Organ Failure Assessment (SOFA) Score as a Prognostic Factor in Acute Respiratory Failure in Children with Mechanical Ventilator Support / 소아알레르기및호흡기학회지

PURPOSE: In pediatric acute respiratory failure patients requiring mechanical ventilator support, mortality is seldom related to respiratory disease alone, but more generally to multiple organ dysfunction syndrome. The purpose of this study is to evaluate whether early changes in the SOFA score (Delta-SOFA) are more effective for predicting the outcome than a single assessment upon admission for pediatric acute respiratory failure patients requiring mechanical ventilator support. METHODS: The medical records of pediatric patients with acute respiratory failure requiring mechanical ventilator support for more than 72 hours in the PICU of the Asan Medical Center Children's Hospital, Seoul, Korea, between January 2008 and May 2009 were retrospectively reviewed. RESULTS: Early Delta-SOFA showed a significantly stronger correlation with patient mortality compared with the initial SOFA score, PRISM III score and PELOD score (P<0.05). When analyzing the trends in the SOFA score during the first 72 hours, the mortality rate was significantly higher in children with increased and unchanged SOFA scores 72 hours after admission than in children with a decreased SOFA score. (14.5% vs. 42.9%, P<0.05) CONCLUSION: Regardless of the initial SOFA score, early serial evaluation of the SOFA scores during the first 3 days of PICU admission is a better indicator of the prognosis than a single assessment obtained at admission in acute respiratory failure patients mechanically ventilated for more than 3 days.