Clinical Features and Risk Factors of Patients Readmitted to ICU / 대한마취과학회지

BACKGROUND: Premature discharge from the intensive care unit (ICU) results in ICU readmission and poor outcome. Understanding the clinical features of the readmitted patients may be helpful for intensivists to improve ICU care. We performed this study to determine the causes, outcomes, and risk factors of patients readmitted to the ICU. METHODS: Data was collected from the patients admitted to medical and surgical ICUs of Severance Hospital between January, 1999 and July, 2001 retrospectively. Readmission cause, source, indication, length of ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) III score, and multiple-organ failure (MOF) score of readmitted patients were evaluated. Non-survivors and survivors after ICU readmission were compared. RESULTS: One hundred and thirty-seven readmitted and 2,412 non-readmitted patients were examined and the readmission rate was 6.3%. Respiratory disease was the major cause of readmission. Readmitted patients had longer initial ICU lengths of stay than non-readmitted patients (13.6 vs 9.4 days, p<0.05). The ICU mortality rate was not significantly higher in the readmitted patients compared with the non-readmitted patients. The MOF score on readmission (5.4 vs 3.1) and APACHE III score on initial discharge (40.7 vs 30.4) and readmission (76.3 vs 44.4), in non-survivors were higher than survivors of the readmitted patients, respectively (p<0.05). CONCLUSIONS: ICU readmission was associated with longer ICU stay and respiratory disease was the major cause of readmission. The MOF score at readmission and APACHE III score at discharge and readmission were significant risk factors of the outcome in readmitted patients.

APACHE II Score and Multiple Organ Failure Score as Predictors of Mortality Rate of Critically Ill Patients / 대한마취과학회지

BACKGROUND: The APACHE II scoring system has been regarded as a useful tool in the assessment of the severity of injury and prognosis for acutely ill patients. Recently, there have been many reports that multiple organ failure(MOF) score is the better predictor of the mortality of critically ill patients than any other scoring system. The purpose of this study was to compare APACHE II score and MOF score for mortality prediction in critically ill patients. METHODS: 163 critically ill patients were studied. We analyzed the correlation between the mortality rate and the scores that were produced by APACHE II and MOF scoring system within the first 24 hours in the ICU. We analyzed the correlation between each score and the number of days of ICU stay. We also calculated the mortality rate according to the number of organ failure. RESULTS: 1) The APACHE II score and MOF score of the survivors(n=129) were 9 6 and 1 1, respectively and those of nonsurvivors(n=34) were 16 7 and 5 2(mean SD), respectively. 2) The r2 was 0.62 between APACHE II score and mortality rate, and 0.77 between MOF score and mortality rate. 3) The r2 was 0.06 between APACHE II score and ICU stay, 0.01 between MOF score and ICU stay. 4) The mortality rates were 0, 2, 20, 64, 73, 75 and 100 % in 0, 1, 2, 3, 4, 5 and 6 organ failures, respectively. CONCLUSIONS: The MOF score was more sensitive predictor of the mortality of critically ill patients than the APACHE II score.