Hipoalbuminemia y riesgo de muerte en pacientes críticos en una unidad polivalente

Introducción: La hipoalbuminemia se puede desarrollar en las primeras horas posteriores a una enfermedad aguda y está muy relacionada con un estado inflamatorio activo, independientemente del estado nutricional del paciente. Se ha asociado con la mortalidad hospitalaria en pacientes con complicaciones postquirúrgicas, pacientes con sepsis y trauma. Objetivo: Evaluar la asociación entre los niveles de hipoalbuminemia y el riesgo de mortalidad del paciente crítico en una unidad polivalente. Métodos: Estudio observacional, descriptivo, prospectivo, de serie de casos, con 216 pacientes que ingresaron en la unidad. Se analizaron variables demográficas, clínicas, de laboratorio y se aplicó el índice pronóstico APACHE II. Se determinó la concentración de albúmina al ingreso y se clasificó la hipoalbuminemia en leve (30-35 g/L) y moderada/grave (≤ 30 g/L). Resultados: En el estudio fallecieron 28 pacientes, lo que representó un 13 % del total de pacientes ingresados. La albúmina presentó niveles bajos en 118 pacientes (54,6 %), y de estos, 66 (56 %) presentaron cifras inferiores a los 30 g/L; o sea, una hipoalbuminemia moderada o grave. Los pacientes con hipoalbuminemia moderada-grave tuvieron un riesgo de muerte superior (23,5 %) a aquellos con niveles clasificados como leve (15,3 %), diferencia estadísticamente significativa (p= 0,034); y en el grupo de pacientes con hipoalbuminemia moderada- grave falleció el 67 %, en relación con el 33 % de los pacientes con niveles clasificados como leve. Conclusiones: La hipoalbuminemia moderada-grave se asocia con el riesgo de mortalidad, independientemente del diagnóstico al ingreso.

Introduction: Hypoalbuminemia can develop in the first hours after an acute illness, and is closely related to an active inflammatory state, regardless of the patient's nutritional status. It has been associated with hospital mortality in patients with post-surgical complications, patients with sepsis and trauma. Objective: To evaluate the association between hypoalbuminemia level and the risk of mortality in critically ill patients in a polyvalent unit. Methods: Observational, descriptive, prospective, case series study, with 216 patients admitted to the unit. Demographic, clinical, and laboratory variables were analyzed and the APACHE II prognostic score was applied. Albumin concentration is calculated on admission and hypoalbuminemia is classified as mild (30-35 g/L) and moderate/severe (≤ 30 g/L). Results: In the study, 28 patients died, which represented 13% of the total number of patients admitted. Albumin levels were low in 118 patients (54.6%), and of these 66 patients (56%) were classified as hypoalbuminemia moderate/severe, with albumin values below 30 g/L. Patients with moderate-severe hypoalbuminemia had a higher risk of death (23.5%) than those patients with levels classified as mild (15.3%), a statistically significant difference (p= 0.034); and in the group of patients with moderate-severe hypoalbuminemia, 67% died, in relation to 33% of patients with levels classified as mild. Conclusions: Moderate-severe hypoalbuminemia is associated with mortality risk, regardless of admission diagnosis.

Acute abdomen in intensive care unit: etiology, comorbidity and severity of 1,523 patients / Abdome agudo em unidade de terapia intensiva: etiologia, comorbidades e severidade de 1.523 pacientes

ABSTRACT BACKGROUND: Clinical features and outcomes of patients admitted to the intensive care unit due to acute abdomen are important to be investigated. AIMS: To evaluate the outcomes of critically ill subjects with acute abdomen according to etiology, comorbidity and severity. METHODS: Outcomes of 1,523 patients (878 women, mean age 66±18 years) consecutively admitted to a specialized gastrointestinal intensive care unit with different causes of acute abdomen from January 2012 to December 2019, were retrospectively evaluated according to etiology, comorbidity and severity. RESULTS: The most common causes of acute abdomen were obstructive and inflammatory, particularly large bowel obstruction (27%), small bowel obstruction (18%) and acute pancreatitis (17%). Overall mortality was 13%. Surgery was required in 34% of patients. Median length of stay in the hospital was 9 [1-101] days. On univariate analysis mortality was significantly associated with age, APACHE II, Charlson comorbidity index, requirement for surgery and malignancy (p<0.0001), but only APACHE II, Charlson comorbidity index and surgical interventional remained significant on multivariate analysis. CONCLUSIONS: Critically ill patients admitted to the intensive care unit with acute abdomen constitute a heterogeneous group of subjects with different prognosis. Mortality is more related to the severity of the disease, comorbidity and need for surgery than to the etiology of the acute abdomen.

RESUMO RACIONAL: As características clínicas e os desfechos dos pacientes internados na unidade de terapia intensiva devido ao abdômen agudo são importantes serem investigados. OBJETIVOS: Avaliar os desfechos de indivíduos gravemente doentes com abdômen agudo de acordo com etiologia, gravidade e comorbidade. MÉTODOS: Os desfechos de 1.523 pacientes (878 mulheres, média de idade 66±18 anos) que foram previamente admitidos em uma unidade de terapia intensiva especializada em doenças gastrointestinais, com diferentes causas de abdômen agudo entre janeiro de 2012 e dezembro de 2019, foram avaliados retrospectivamente segundo etiologia, comorbidade e gravidade. RESULTADOS: As causas mais comuns de abdômen agudo foram obstrutivas e inflamatórias, com destaque para obstrução em colon (27%), em intestino delgado (18%) e pancreatite aguda (17%). A mortalidade geral foi de 13%. A cirurgia foi necessária em 34%. A média de permanência no hospital foi de 9 [1-101] dias. Na análise univariada a mortalidade foi significativamente associada à idade, APACHE II, índice de comorbidade de Charlson, necessidade de abordagem cirúrgica e presença de malignidade (p<0,0001), mas apenas APACHE II, índice de comorbidade de Charlson e intervenção cirúrgica permaneceram significativos na análise multivariada. CONCLUSÕES: Pacientes internados na unidade de terapia intensiva com abdômen agudo constituem um grupo heterogêneo de indivíduos com prognóstico diferente. A mortalidade está mais relacionada com a gravidade da doença, comorbidade e necessidade de cirurgia do que com a etiologia do abdome agudo.

Comparing the Prognosticative Value of APACHE II and mSOFA Scores in Critically Ill Patients: A Prospective Study

Objective: Several predictive scoring systems measuring disease severity are used to predict outcomes, typically mortality, of critically ill patients in the intensive care unit (ICU). Two common validated predictive scoring systems include acute physiology and chronic health evaluation II (APACHE II) and modified sequential organ failure assessment score (mSOFA). To compare performance of APACHE II and mSOFA score in critically ill patients regarding the outcomes in the form of morbidity and mortality in ICU. Methods: This prospective observational clinical study was conducted on 100 patients over 6 months. For each patient, APACHE II score on day of admission and serial mSOFA scores on day 0, 3, 7 and 10 were calculated and compared. Results: The age of the non-survivors was significantly older than survivors was (57.1±11.76 and 54.28±15.16). [In our study we found that the mean length of ICU stay of non-survivors was (5.41±4.81) & survivors(8.63± 4.81) days.] In our study mortality rate was 40%.The APACHE II score with cut-off point of 23 demonstrated a sensitivity rate of 98.33% & specificity rate of 17.5%, accuracy of 66.00%. Serial mSOFA scores with cut-off of 11 on day0, day3, day7 better differentiated survivors from non-survivors with 98.3% sensitivity, 27.5% specificity and 70% accuracy. Conclusion: Both APACHE II and mSOFA scores can help ICU physicians as a significant predictive marker for mortality in critically ill patients. The serial measurement of mSOFA score in the first week is a better mortality predictor tool than APACHE II score in critically ill patients.

Mortality of Elderly Patients Supported by Mechanical Ventilation at a General Critical Care Unit in a Tertiary Care Centre

Background : There has been a steady rise in the geriatric population in India and increasing number of elderly patients are being admitted in Critical Care Unit (CCU). They need mechanical ventilation during their hospital stay. Hence, there is continued need for evaluation and research to develop a validating scoring systems used to predict the outcome of CCU patients supported by mechanical ventilation. Objective : Analysis to predict the outcome (survival or mortality) of mechanically ventilated elderly patients in different age groups at the CCU. Material and Method : A Prospective observational study was done in CCU for a period of one year. A group of 40 elderly ventilated patients greater than 60 years of age (Group 1-elderly case group) and another group of 40 ventilated patients less than 60 years of age (Group-2- control group) were included in the study. A clinical database was collected which included age, sex, Acute Physiology and Chronic health Evaluation II (APACHE II) score and an Sequential Organ Failure Assessment (SOFA) scores were calculated in the first 24 hours of ventilation,indication of mechanical ventilation, co-morbidity, according to the Charlson Comorbidity Index (CCI), functional capacity according to the Barthel Index (BI). Patients outcome (survival or mortality) were analyzed. All the patients in two groups were on ventilation support. Result : In case group (n=40), mortality was 55%. In control group (n=40), mortality was 52.5%. On comparison of outcome between two groups (case with control group) the difference was not statistically significant (p= 0.8225). In case group, association of outcome to different age groups (60-65 years, 66-75years, more than75years) (p=0.3357) andto gender (p=0.3854) was not statistically significant. Multivariate logistic regression analysis of the study variables showed APACHE II score to be statistically significant for outcome (p=0.0229). Conclusion : Mortality of elderly patients supported by mechanical ventilation at CCU were slightly higher(55%) than in mechanically ventilated younger populations (52.5%) though the difference was not statistically significant between two groups (p=0.82). APACHE II, score measured within 24 hours of ventilation was a significant predictor of mortality in the patients on mechanical ventilation.

Role of Procalcitonin Levels in Patients with Sepsis in Medical Intensive Care Unit

Introduction: Sepsis has a death rate of ?25% globally and its clinical treatment presents an important clinical challenge. The Acute Physiology and Chronic Health Evaluation II (APACHE II) is the standard method for assessing sepsis. Serum PCT level can be increase in case of sepsis. With this background, the present research is aimed to study the survival among the sepsis cases and correlate them with serum procalcitonin levels, APACHE II Score and other risk factors. Methodology: The study was conducted among 75 cases diagnosed having sepsis admitted in medical ICU. APACHE II score, serum procalcitonin (PCT) and other investigation were carried out along with clinical history and examination. Data were analysed using epi-info software. Results: The cases fatality rate of sepsis cases in medical intensive care unit in our hospital was 37.3%. The mortality rate was significantly higher patients with comorbidities, especially cases with respiratory or CNS involvement. The serum PCT levels were significantly higher in the group of non survivors as compared to group of survivors. Higher APACHE II score associated with higher mortality. Serum PCT levels go on increasing along the spectrum of sepsis. A PCT level was significantly hire in culture positive cases compare to sterile cases. Conclusion: From this study we conclude that serum PCT level is useful investigation in sepsis cases to predict mortality

Caracterización de pacientes con pancreatitis aguda en una unidad de cuidados intensivos polivalente / Characterization of patients with Acute Pancreatitis in the multipurpose intensive care unit

RESUMEN Introducción: La pancreatitis es la inflamación del páncreas exocrino, resultado del daño a las células acinares. Sus características clínicas principales son el dolor abdominal y la elevación de los niveles séricos de amilasa y lipasa. La evolución es muy variable, desde una recuperación completa de un primer episodio, hasta una enfermedad crónica debilitante, o la muerte. Objetivos: Caracterizar a los pacientes ingresados en la unidad de cuidados intensivos, con el diagnóstico de pancreatitis aguda y evaluarlos según los criterios de gravedad. Métodos: Se realizó un estudio descriptivo en el que se revisaron 46 historias clínicas de pacientes ingresados con diagnóstico de pancreatitis aguda en la unidad de terapia intensiva polivalente, desde enero del 2014 a diciembre del 2019. Se confeccionó una base de datos con las variables edad, etiología, complicaciones, letalidad y la aplicación de escalas de Ranson, APACHE II y Balthazar-Hill, para evaluar evolutivamente la gravedad y pronóstico. Se hizo un análisis de frecuencias de dichas variables. Resultados: La edad de mayor incidencia correspondió a los grupos menores de 61 años, con predominio del sexo masculino. La causa más frecuente fue la litiasis vesicular y el alcoholismo, para un 43,4 % y 34,7 % respectivamente. El 47,8 % presentó la forma leve de la enfermedad. La letalidad fue del 21,7 %. Conclusiones: Son más frecuentes las formas graves de la enfermedad; la insuficiencia renal aguda y la insuficiencia respiratoria aguda son las complicaciones más representativas.

ABSTRACT Introduction: Pancreatitis is the inflammation of the exocrine pancreas, as a result of damage to the acinar cells. Its main clinical features are abdominal pain and elevated serum levels of amylase and lipase. The evolution is very variable, from a complete recovery from a first episode, to a debilitating chronic disease, or death. Objectives: To characterize patients admitted to the intensive care unit with a diagnosis of acute pancreatitis and to evaluate them according to severity criteria. Methods: A descriptive study was carried out in which 46 medical records of patients admitted with a diagnosis of acute pancreatitis in the multipurpose intensive care unit were reviewed, from January 2014 to December 2019. A database was created with the variables age, etiology, complications, lethality and the application of the Ranson, APACHE II and Balthazar-Hill scales, to evaluate severity and prognosis. An analysis of the frequencies of these variables was carried out. Results: The age with the highest incidence corresponded to groups under 61 years of age, with a predominance of males. The most frequent cause was gallstones and alcoholism, for 43.4 % and 34.7 % respectively. 47.8 % presented the mild form of the disease. The lethality was 21.7 %. Conclusions: Severe forms of the disease are more frequent; acute renal failure and acute respiratory failure are the most representative complications.

Delta de ácido úrico como predictor de severidad en pacientes con SARS-CoV-2 / Delta uric acid as a predicator of severity in patients with SARS-CoV-2 / Delta do ácido úrico como preditor de gravidade em pacientes com SARS-CoV-2

Resumen Introducción: El SARS-CoV-2 representa la primera causa de mortalidad actual en la población mexicana, a nivel global se han acumulado 1'919,126 defunciones. Las regiones con más muertes son América (47%) y Europa (33%). Hasta la semana 2 del año 2021 en México se estimaban 1'541,633 casos, siendo la Ciudad de México la entidad más afectada; hasta ese momento se habían registrado 18,443 fallecimientos, con una necesidad hospitalaria de 80% y con alta demanda de hospitalización en el servicio de Unidad de Cuidados Intensivos (UCI). Por esta razón, surge la necesidad de nuevos marcadores tempranos de severidad y pronóstico. Objetivo: Correlacionar el delta de ácido úrico (DAU) con la mortalidad en pacientes con SARS-CoV-2 tratados en la UCI, así como su relación con otras variables de severidad. Material y métodos: Se realizó un estudio longitudinal en una UCI con 71 pacientes; las variables de estudio fueron: demográficas, comorbilidades, días de estancia en la UCI, días de ventilación mecánica (VM), escala predictora de mortalidad, ácido úrico inicial y ácido úrico final, DAU; desenlace: mortalidad. Resultados: De los participantes, 69% fueron varones, 31% mujeres, edad promedio de 54.35 años (± 10.28), ácido úrico al ingreso de 3.9 mg/dL (± 1.74), ácido úrico al egreso de 2.89 mg/dL (± 1.70), delta de ácido úrico promedio de 1.077 mg/dL (± 1.59), APACHE II al ingreso de 18.35 puntos (± 9.04) y al egreso de 22.95 puntos (± 19.68), mortalidad global de 50.7%, de los cuales 78.67% requirió ventilación mecánica y 21.12% no la requirió. La correlación de Spearman para DAU y mortalidad fue r = -0.34, el índice de determinación r2 = 0.13, con significancia p = 0.004, (IC) 95%. Conclusiones: Se demostró la correlación entre el DAU con la mortalidad de los pacientes con SARS-CoV-2 con adecuada significancia estadística a un intervalo de corte de 1-1.5 mg/dL y una mortalidad de 50.7%. Adicionalmente, se demostró que dicho intervalo tuvo correlación con el inicio de la ventilación mecánica. Se identificó que sí existe relación entre la puntuación de APACHE II y la mortalidad por SARS-CoV-2; para este estudio un puntaje mayor a 18 demostró la mejor significancia estadística.

Abstract Introduction: SARS-CoV-2 represents the first cause of current mortality in the Mexican population, globally it has accumulated 1'919,126 deaths. The regions with the most deaths are America (47%), Europe (33%). Until week two of 2021 in Mexico, 1'541,633 cases were estimated, with Mexico City being the most affected entity, until that moment 18,443 deaths had been registered, with a hospital need of 80%, and with a high demand for hospitalization in the service of Intensive Care Unit (ICU). For this reason, the need arises for new early markers of severity and prognosis. Objective: To correlate the uric acid delta (DAU) with mortality in patients with SARS-CoV-2 treated in the ICU, as well as its relationship with other variables of severity. Material and methods: A longitudinal study was carried out in the ICU with 71 patients and study variables: demographic, comorbidities, days of ICU stay, days of mechanical ventilation (MV), predictive mortality scale, initial uric acid and final uric acid, DAU; outcome: mortality. Results: Of the participants, 69% were men, 31% women, mean age of 54.35 years (± 10.28), uric acid at admission of 3.9 mg/dL (± 1.74), uric acid at discharge of 2.89 mg/dL (± 1.70), mean uric acid delta of 1.077 mg/dL (± 1.59 mg/dL), APACHE II at entry of 18.35 points (± 9.04) at discharge of 22.95 points (± 19.68), global mortality of 50.7%, of which 78.67% required mechanical ventilation (MV) and 21.12% did not require. The Spearman correlation for DAU and mortality was r = -0.34, the determination index r2 = 0.13, with significance p = 0.004, (CI) 95%. Conclusions: The correlation between the DAU with the mortality of the patients with SARS-CoV-2 was demonstrated with adequate statistical significance at a cut-off interval of 1-1.5 mg/dL, and a mortality of 50.7%. Additionally, it was shown that said interval had a correlation with the start of mechanical ventilation. It was identified that if there is a relationship between the APACHE II score and SARS-CoV-2 mortality, for this study a score greater than 18 demonstrated the best statistical significance.

Resumo Introdução: O SARS-CoV-2 representa a primeira causa de mortalidade atual na população mexicana, globalmente acumulou 1.919.126 mortes. As regiões com mais mortes são América (47%), Europa (33%). Até a semana 2 de 2021 no México, foram estimados 1.541.633 casos, sendo a Cidade do México a entidade mais afetada, até então foram registrados 18.443 óbitos, com necessidade hospitalar de 80% e com alta demanda de internação no serviço de emergência Unidade de Terapia Intensiva (UTI). Por esta razão, há necessidade de novos marcadores precoces de gravidade e prognóstico. Objetivo: Correlacionar o delta do ácido úrico (DAC) com a mortalidade em pacientes com SARS-CoV-2 atendidos na UTI, bem como sua relação com outras variáveis de gravidade. Material e métodos: Realizou-se um estudo longitudinal na UTI com 71 pacientes e variáveis de estudo: demografia, comorbidades, dias de internação na UTI, dias de ventilação mecânica (VM), escala preditiva de mortalidade, ácido úrico inicial e ácido úrico final, DAC; resultado: mortalidade. Resultados: Dos participantes, 69% eram homens, 31% mulheres, idade média 54.35 anos (± 10.28), ácido úrico na admissão 3.9 mg/dL (± 1.74), ácido úrico na alta 2.89 mg/dL (± 1.70), delta de ácido úrico médio de 1.077 mg/dL (± 1.59 mg/dL), APACHE II na admissão de 18.35 pontos (± 9.04) na alta de 22.95 pontos (± 19.68), mortalidade geral de 50.7%, dos quais 78.67% necessitaram de ventilação mecânica (VM) e 21.12% não necessitaram. A correlação de Spearman para DAU e mortalidade foi r = -0.34, o índice de determinação r2 = 0.13, com significância p = 0.004, (IC) 95%. Conclusões: Demonstrou-se a correlação entre o DAU com a mortalidade de pacientes com SARS-CoV-2 com adequada significância estatística no intervalo de corte de 1-1.5 mg/dL e mortalidade de 50.7%. Além disso, foi demonstrado que esse intervalo se correlacionou com o início da ventilação mecânica. Identificou-se que existe relação entre o escore APACHE II e a mortalidade por SARS-CoV-2, para este estudo um escore maior que 18 apresentou a melhor significância estatística.

Ética do uso de escores prognósticos em unidade de terapia intensiva: revisão integrativa / Ethics in the use of prognostic scores in intensive care units: an integrative review / Ética del uso de puntajes pronósticos en una unidad de cuidados intensivos: una revisión integradora

Resumo O enfrentamento da covid-19 suscitou uma série de problemas na área da saúde, em razão do aumento da demanda de cuidados intensivos. Para solucionar a crise causada pela escassez de recursos de alta complexidade, a tomada de decisão tem se norteado por escores prognósticos, porém esse processo inclui uma dimensão moral, ainda que esta seja menos evidente. Mediante revisão integrativa, este artigo buscou refletir sobre a razoabilidade da utilização de indicadores de gravidade para definir a alocação de recursos escassos na saúde. Observou-se que o trabalho realizado em situações de escassez de recursos provoca sobrecarga moral, convergindo para busca por soluções padronizadas e objetivas, como a utilização de escores prognósticos. Conclui-se que seu uso isolado e indiscriminado não é eticamente aceitável e merece avaliação cautelosa, mesmo em situações emergenciais, como a da covid-19.

Abstract Facing COVID-19 caused many problems in the healthcare field, due to the rise in the intensive care demand. To solve this crisis, caused by the scarcity of resources of high complexity, decision-making has been guided by prognostic scores; however, this process includes a moral dimension, although less evident. With na integrative review, this article sought to reflect on the reasonability of using severity indicators to define the allocation of the scarce resources in healthcare. We observed that the work carried out on resource scarcity situations causes moral overload, converging to the search for standard and objective solutions, such as the use of prognostic scores. We conclude that their isolated and indiscriminate use is not ethically acceptable and deserves cautious evaluation, even in emergency situations, such as COVID-19.

Resumen La lucha contra el Covid-19 implicó una serie de problemas en el área de la salud, debido al aumento de la demanda de cuidados intensivos. Para solucionar la crisis provocada por la escasez de recursos de alta complejidad, la toma de decisiones estuvo orientada por puntuaciones pronósticas, pero este proceso incluye una dimensión moral aún menos evidente. A partir de una revisión integradora, este artículo buscó reflexionar sobre la razonabilidad de utilizar indicadores de gravedad para definir la asignación de recursos escasos en salud. El trabajo realizado en situaciones de escasez de recursos genera sobrecarga moral, llevando a la búsqueda de soluciones estandarizadas y objetivas, como el uso de puntuaciones de pronóstico. Se concluye que su uso aislado e indiscriminado no es éticamente aceptable y merece una cuidadosa evaluación, incluso en situaciones de emergencia, como la del Covid-19.

Outcome of Patients with Sepsis Admitted in Intensive Care Unit of a Tertiary Care Hospital in India

Introduction: Sepsis has a death rate of ?25% globally and its clinical treatment presents an important clinical challenge. The rapid progression of sepsis requires correspondingly swift adjustments in therapy, and accurate identification of disease severity is therefore vitally important for predicting prognosis, treatment, preventing complications, reducing complication and mortality. With this background, the present research is aimed to study the relation of serum procalcitonin levels in cases with sepsis, to calculate APACHE II scores and to correlate the levels of serum PCT levels with APACHE II Score with the outcome. Methodology: This was a prospective observational non interventional cohort study was conducted in the Clinic of Intensive Care unit of a tertiary care hospital and medical college in western India from May 2020 to December 2020. Results: A total of 75 patients, admitted to the ICU with the diagnosis of sepsis, were included in this prospective observational study. Of them 47 (62.7%) were males and highest cases were aged between 60 to 69 years. Of the total 75 patients, 47 (62.7%) patients were survivors. Age, gender and involvement of system were not associated with mortality while lower APACHE II score and presence of co-morbidities were significantly associated with mortality. Conclusion: From this study we conclude that the lower APCHE II score and presence of co-morbidity significantly increases the mortality in ICU patients admitted with sepsis

Obesidad como factor pronóstico en el paciente crítico / Obesity as a prognostic factor in the critical ill patients / Obesidade como fator prognóstico no paciente crítico

Resumen: Introducción: La obesidad es una enfermedad con impacto negativo en la sobrevida; se hace referencia al término «paradoja de la obesidad¼ utilizado como un efecto protector en la mortalidad. Objetivo: Determinar si la obesidad es un factor de protección en el paciente crítico. Material y métodos: Se realizó un estudio de cohorte. Se obtuvo información de expedientes de Unidad de Cuidados Intensivos (UCI) del Hospital Regional Monterrey del Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE) Monterrey durante 2018. Se hizo análisis bivariado para asociación χ2 y U de Mann-Whitney para correlación fórmula de Pearson y análisis de supervivencia con curva de Kaplan-Meier. Resultados: Se analizaron 151 expedientes de pacientes, 73 obesos y 78 no obesos, se observó que la obesidad es un factor protector para mortalidad (p = 0.044, OR 0.431 (IC 0.187-0.992). El IMC no se correlaciona con el Acute physiology and chronic health evaluation (APACHE) II (p = 0.066); sin embargo, con un impacto en la curva de supervivencia (p = 0.42). Conclusiones: Se detecta la obesidad como factor protector; sin embargo, su asociación con enfermedades crónicas degenerativas, estancia prolongada en UCI y sus complicaciones no dejan de tener impacto negativo en la supervivencia fuera de la unidad.

Abstract: Introduction: Obesity is a disease with a negative impact on survival; the prognosis of these patients is has controversial results. The term «obesity paradox¼ refers as a protective effect on mortality. Objective: To determine whether obesity is a protective factor in the critically ill patient. Material y methods: A cohort study was conducted. Data was obtained from ICU records of the ISSSTE Monterrey Regional Hospital during 2018, bivariate analysis was performed for χ2 and Mann Whitney's U association, for Pearson's formula correlation and survival analysis with Kaplan-Meier curve. Results: 151 records of 73 obese and 78 non-obese patients were analyzed, it was observed that obesity is a protective factor for mortality (p = 0.044, OR 0.431(IC 0.187-0.992), BMI does not correlate with APACHE II (p = 0.066), however, an impact on the survival curve was observed (p = 0.42). Conclusions: According to the results obtained, it matches with the term «obesity paradox¼, however, its association with chronic degenerative diseases, prolonged stay in the ICU and its complications do not cease to have a negative impact on survival outside the unit.

Resumo: Introdução: A obesidade é uma doença com impacto negativo na sobrevida; O termo «paradoxo da obesidade¼ refere-se a um efeito protetor sobre a mortalidade. Objetivo: Determinar se a obesidade é um fator protetor em pacientes críticos. Material e métodos: Foi realizado um estudo de coorte. As informações foram obtidas dos registros da UTI do ISSSTE Monterrey Regional Hospital durante o ano de 2018, foi realizada análise bivariada para associação χ2 eU Mann-Whitney, para correlação da fórmula de Pearson e análise de sobrevida com curva de Kaplan-Meier. Resultados: Foram analisados 151 prontuários de 73 pacientes obesos e 78 não obesos, observou-se que a obesidade é fator protetor para mortalidade (p = 0.044, OR 0.431(IC 0.187-0.992), IMC não se correlaciona com APACHE II (p = 0.066), porém, com impacto na curva de sobrevida (p = 0.42). Conclusões: A obesidade é encontrada como fator de proteção, porém, sua associação com doenças crônico-degenerativas, permanência prolongada na UTI e suas complicações não deixam de ter impacto negativo na sobrevida fora da unidade.

Superioridad del APACHE-II para el pronóstico de mortalidad después de cirugía abdominal urgente: estudio multicéntrico

RESUMEN Introducción: El pronóstico de mortalidad del paciente, después de una cirugía abdominal, requiere de sistemas de ayuda que sean a la vez eficaces y reproducibles. Objetivo: Comparar la eficacia de tres procedimientos en la predicción de la mortalidad de pacientes laparotomizados de urgencia. Métodos: Estudio multicéntrico observacional de cohorte prospectiva con 200 pacientes en el posoperatorio de cirugía abdominal mayor urgente atendidos en los hospitales "Miguel Enríquez", "Carlos J. Finlay" y "Hermanos Ameijeiras" entre noviembre de 2016 y noviembre 2018. Se aplicaron media, desviación estándar, mediana y rango intercuartílico para la comparación entre vivos y fallecidos y se calculó la probabilidad de morir según el modelo que incluye ambos procedimientos. Se evaluó la capacidad de discriminación mediante la construcción de tres curvas de características operacionales del receptor, sus áreas bajo las curvas e intervalos de confianza. Resultados: La mortalidad total fue de 38 % y predominó significativamente en los pacientes de mayor edad, con mayor número de complicaciones, los reoperados y aquellos con hallazgos sépticos durante la reoperación. El poder predictivo fue mayor para el APACHE II en comparación a los otros dos procedimientos (área bajo la curva 0,912, IC 95 %: 0,840-0,933, p< 0,001). Conclusiones: El APACHE II es un modelo eficaz y confiable para la predicción de la mortalidad de pacientes en el posoperatorio de cirugía mayor de urgencia, que lo hacen muy recomendable para este propósito.

ABSTRACT Introduction: The mortality prognosis of patients after abdominal surgery demands effective and reproducible aid systems. Objective: To compare the efficacy of three procedures in predicting mortality in emergency laparotomy patients. Methods: Prospective cohort observational multicenter study with 200 patients in the postoperative period of urgent major abdominal surgery assisted at the "Miguel Enríquez", "Carlos J Finlay", "Hermanos Ameijeiras" hospitals between November 2016 and November 2018. Mean, standard deviation median and interquartile range measures were applied for the comparison between living and deceased and the probability of dying was calculated according to the model that includes both procedures. Discrimination capacity was evaluated by constructing three curves of receiver operational characteristics, areas under the curves and confidence intervals were determined. Results: Total mortality was 38% and significantly prevailed in older patients, with a greater number of complications, reoperated patients, and those with septic findings during reoperation. Predictive power was higher for APACHE II compared to the other two procedures (area under the curve 0.912, CI 95%: 0.840-0.933, p< 0.001). Conclusions: APACHE II is an effective and reliable model for predicting mortality in patients in the postoperative period of major emergency surgery, which makes it highly recommended for this purpose.

Surgical Management of Infected Pancreatic Necrosis. Case Series in a Quaternary Care Hospital in Bogotá, Colombia, 2014-2021 / Manejo quirúrgico de la necrosis pancreática infectada. Serie de casos en un hospital de cuarto nivel en Bogotá, Colombia, 2014-2021

Abstract Introduction: Pancreatitis is a frequent pathology in our environment, mostly related to benign biliary pathology. It can progress to severe forms in 10-15 % of cases, where the pancreatic tissue becomes necrotic and forms large collections with risk of infection. We do not have epidemiological data about the incidence or management of this complication in Colombia. Aim: This study aims to study the prevalence of infected pancreatic necrosis and describe the cases identified in a quaternary care hospital between 2014 and 2021. Materials and methods: A cross-sectional observational study. We analyzed records of patients diagnosed with stage 2 pancreatitis. Those cases with infected pancreatic necrosis that underwent debridement plus laparoscopic and open surgical drainage at Hospital Universitario Mayor Méderi in Bogotá, Colombia, between January 2014 and January 2021 were studied. A convenience sampling was carried out without calculating the sample size. We collected the patients' demographic and clinical variables, performing a descriptive statistical analysis in Excel. Qualitative variables were described through absolute and relative frequencies, while quantitative ones were expressed through measures of central tendency and dispersion based on their distribution. Results: We analyzed 1020 episodes of pancreatitis, finding pancreatic necrosis in 30 patients, i.e., a period prevalence of 2.9 %. Of the patients, 83 % (n = 25) underwent open drainage, with 48 % (n = 12) mortality. About laparoscopic management, the reduction in postoperative organ failure was 40 % (n = 2), with a 30 % shorter hospital stay than the open drainage approach. Those patients with a level of procalcitonin (PCT) lower than 1.8 ng/mL had less mortality. Conclusions: The laparoscopic approach shows promising results regarding final morbidity and mortality.

Resumen Introducción: la pancreatitis es una patología frecuente en nuestro medio, mayormente relacionada con la patología biliar benigna. Esta puede progresar a formas severas en 10 %-15 % de los casos, en donde el tejido pancreático se necrosa y forma grandes colecciones, con riesgo de infección. En Colombia no conocemos los datos epidemiológicos acerca de la incidencia de este tipo de complicaciones, ni del manejo de las mismas. Objetivo: este estudio tiene como objetivo estudiar la prevalencia de la necrosis pancreática infectada y describir los casos identificados en un hospital de alto nivel de complejidad entre 2014 y 2021. Métodos: estudio observacional de corte transversal. Se analizaron los registros de pacientes diagnosticados con pancreatitis en segunda etapa. Se estudiaron aquellos casos que presentaron necrosis pancreática infectada y se sometieron a desbridamiento más drenaje quirúrgico por vía laparoscópica y abierta en el Hospital Universitario Mayor Méderi de Bogotá, Colombia, entre enero de 2014 y enero de 2021. Se realizó un muestreo por conveniencia, sin cálculo de tamaño de muestra. Se recolectaron variables demográficas y clínicas de los pacientes. Se realizó un análisis estadístico descriptivo de las variables obtenidas en Excel. Las variables cualitativas se describieron a través de frecuencias absolutas y relativas; mientras que las cuantitativas se expresaron mediante medidas de tendencia central y de dispersión en función de su distribución. Resultados: se analizaron 1020 episodios de pancreatitis y se evidenció necrosis pancreática en 30 pacientes, es decir, una prevalencia de período de 2,9 %. De los pacientes, 83 % (n = 25) se llevó a drenajes por vía abierta, con un 48 % (n = 12) de mortalidad. En relación con el manejo por vía laparoscópica, la reducción en la falla orgánica posoperatoria fue de 40 % (n = 2), con un 30 % menos de duración en la estancia hospitalaria, comparado con la vía abierta. Aquellos pacientes que presentaron un nivel de procalcitonina (PCT) menor de 1,8 ng/mL tuvieron menos mortalidad. Conclusiones: el abordaje laparoscópico muestra resultados prometedores en cuanto a la morbilidad y mortalidad final observada.

A Study of Hypomagnesemia in Patients Admitted in Medical ICU and Its Correlation with Final Outcome

Introduction: Magnesium is the second most common intracellular cation found in the body that is required as cofactor in numerous enzymatic reactions, smooth functioning of cardiac and neurological systems. Magnesium deficiency is often overlooked in critically ill patients and is linked with risk of electrolyte imbalance, difficulty weaning off ventilator, sudden cardiac deaths and poorer outcome. Objective- To assess prevalence of magnesium deficiency in critically ill patients admitted to Medical ICU and its association with requirement & duration of mechanical ventilation, ICU stay, APACHE-II & mortality. Methods- Prospective descriptive study was conducted on 69 critically ill patients admitted in medical ICU. After taking informed consent serum magnesium level of patients were collected and entered in spreadsheet and final analysis was done with help of Open EPI and SPSS software. Results-It was concluded that patients having hypomagnesemia were at increased risk of electrolyte abnormalities, longer ventilatory support, longer hospital and ultimately poorer outcome stay as compared to patients with normal magnesium levels. Conclusion- Magnesium remains an important but often side-lined cation in critically ill patients. However, Hypomagnesemia is a repeated finding seen in critically ill patients and is significantly associated with a higher mortality rate and frequent need for mechanical ventilation.

Clinical significance of prognostic serum marker expression in older adult patients with sepsis-associated encephalopathy / 中国基层医药

Objective:To investigate the clinical significance of prognostic serum marker expression in older adult patients with sepsis-associated encephalopathy (SAE).Methods:The clinical data of 79 older adult patients with SAE who received treatment in The Second People's Hospital of Hefei from June 2019 to February 2021 (study group) and 121 sepsis patients without encephalopathy concurrently (control group) were retrospectively analyzed. The indexes with statistically significant difference between the two groups were subjected to multivariate binary logistic regression. Survival curve was plotted.Results:There were no significant differences in neuron specific enolase [NSE, (10.69 ± 4.31) μg/L vs. (24.84 ± 3.28) μg/L, t = 26.25, P < 0.01], S100β [(0.25 ± 0.06) μg/L vs. (0.53 ± 0.09) μg/L, t = 22.45, P < 0.01], monocyte chemoattractant protein-1 [MCP-1, (99.33 ± 4.87) ng/L vs. (179.99 ± 6.02) ng/L, t = 99.94, P < 0.01], malondialdehyde [MDA, (4.22 ± 0.08) nmol/L vs. (6.78 ± 0.11) nmol/L, t = 33.76, P < 0.01], glial fibrillary acidic protein [GFAP, (0.21±0.08) μg/L vs. (2.03 ± 0.47) μg/L, t = 33.76, P < 0.01], procalcitonin [(7.04 ± 2.50) ng/L vs. (16.23 ± 2.48) ng/L, t = 25.47, P < 0.01], interleukin-6 [(29.91 ± 4.51) ng/L vs. (69.22 ± 6.79) ng/L, t = 45.51, P < 0.01], Acute Physiology and Chronic Health Evaluation II (APACHE II) score [(18.33 ± 2.12) points vs. (28.89 ± 5.09) points, t = 17.53, P < 0.01], and sequential organ failure assessment score [(7.69 ± 1.50) points vs. (14.05 ± 1.55) points, t = 28.92, P < 0.01] between the control and study groups. N-terminal pro B-type natriuretic peptide was (868.38 ± 25.28) ng/L and (1 037.19 ± 25.34) ng/L in the control and study groups, respectively. Logistic regression analysis revealed that NSE, MCP-1, MDA, and GFAP were the independent risk factors for developing SAE in older adults (NSE: t = 8.42, P < 0.01; MCP-1: t = 4.16, P < 0.01; MDA: t = 18.4, P < 0.01; GFAP: t = 2.88, P < 0.01). The survival curve indicated that survival rate was significantly lower in the study group than in the control group. Conclusion:NSE, MCP-1, MDA, and GFAP are independent risk factors for developing SAE in older adults.

Application value of neutrophil to lymphocyte rate combined with red blood cell distribution width to platelet count ratio in emergency elderly sepsis patients / 中国综合临床

Objective:To explore the value of neutrophil to lymphocyte rate (NLR) combined with red blood cell distribution width to platelet count ratio (RPR) in evaluating the condition and prognosis of emergency elderly sepsis patients.Methods:A prospective research method was conducted to select 169 elderly patients with sepsis who visited the emergency department of Xuanwu Hospital of Capital Medical University from January 2020 to February 2022.After admission, blood routine examination, chest computerized tomography, biochemical examination, procalcitonin, and pathogenic examination were given, and the scores of acute physiology and chronic health evaluation (APACHE Ⅱ) were scored according to worst value of 24 hours. After 28 days of follow-up, the patients were divided into the survival group(125 cases) and the death group(44 cases) according to the prognosis. The differences of white blood cell count(WBC), NLR, PCT, RPR and APACHE Ⅱ scores were compared between the two groups. The correlation between NLR,RPR and APACHE Ⅱ scores were analyzed. The difference of area under receiver operating characteristic curve (ROC) of RPR, NLR, their combination and PCT in predicting mortality were compared in elderly patients with sepsis. The independent sample t test was used to compare the measurement data with normal distribution, and the χ 2 test was used to compare the enumeration data. The risk factors were analyzed by multiple logistic regression analysis. Results:There was no significant difference in WBC between the survival group and the death group ( P=0.361). The APACHE Ⅱ scores ((18.52±2.41) points), RPR (0.17±0.03), NLR (10.64±3.48), PCT ((2.55±1.14) μg/L) in the death group were higher than those in the survival group ((14.17±2.71) points, (0.14±0.03), NLR (7.67±3.33), (1.19±0.81) μg/L), the difference was statistically significant ( t values were 9.44,7.32,4.92, and 7.32, respectively; all P<0.001). RPR and NLR were positively correlated with APACHE Ⅱ scores ( r=0.393,0.368;both P<0.001). Multivariate logistic regression analysis showed that increased NLR ( OR=1.174,95% CI 1.041-1.325), procalcitonin ( OR=4.353,95% CI 2.382-7.954), RPR ( OR=14.247,95% CI 2.635-77.025) were independent risk factors for the prognosis of sepsis patients ( P values were 0.009,<0.001, and 0.002, respectively).The area under receiver operating characteristic curve (AUC) of PCT in predicting mortality was 0.859 (95% CI:0.801-0.917), the AUC of RPR was 0.755 (95% CI:0.665-0.845), and the AUC of NLR was 0.727 (95% CI: 0.643-0.812). The AUC of RPR and NLR was smaller than that of PCT ( P=0.033, 0.015), but the AUC of RPR combined with NLR was 0.799, which had no significant difference compared with PCT ( P=0.195). Conclusion:Both NLR and RPR had a certain predictive value for the condition and prognosis of elderly sepsis patients in emergency, and their combined evaluation value was similar to that of PCT.

Clinical features and risk factor analysis of severe trauma patients with acute kidney injury / 中华急诊医学杂志

Objective:To investigate the clinical characteristics of the severe trauma patients with Acute kidney injury (AKI) ,and analyze the risk factors and clinical prognosis.Methods:Clinical data of severe trauma patients admitted to ICU of Xiaolan Hospital of Southern Medical University, from July 2018 to December 2020 were retrospectively analyzed. Demographic data, basic diseases, critical disease score, serum creatinine, hemoglobin, treatment options, blood transfusion volume, and clinical outcomes were collected to establish a clinical database. AKI was diagnosed and graded according to the Kidney Disease Improving Global Outcomes (KDIGO) criterion, and trauma type was classified according to the main injury part. The clinical data and laboratory examination of different groups were compared to analyze the clinical characteristics and prognosis in severe trauma patients. The risk factors of AKI in severe trauma patients were analyzed by Logistic regression.Results:(1) A total of 175 patients with severe trauma were eligible for inclusion, and the incidence of AKI was 30.9%(54/175), including 29 patients with AKI stage 1(16.6%), 15 patients with AKI stage 2 (8.6%), and 10 patients with AKI stage 3 (5.7%). In the cohort, the rate of in-hospital renal replacement therapy was 4%, in-hospital mortality was 5.7%, and 28-day mortality was 16.6%. (2) The age, shock patients, ICU admission serum creatinine, APACHEⅡscore and ISS score of AKI group were significantly higher than those of non-AKI group ( P<0.05). There were no significant differences between the two groups in gender, underlying diseases (hypertension and diabetes), ICU admission hemoglobin level and contrast agent utilization rate( P>0.05). Compared with the non-AKI group, AKI group had higher rates of surgical treatment (63% vs. 44.6%), more blood transfusion [875(720,1110)mL & 670(610,750)mL], longer ICU stay [6(4,11)d & 4(2.5,7.5)d], and higher rates of mechanical ventilation (96.3% vs. 81%), renal replacement therapy rate (13% vs. 0), in-hospital mortality (13% vs. 2.5%) and 28-day mortality (25.9% vs. 12.4%), the differences were statistically significant ( P<0.05). (3) The incidence of AKI was different in patients with different types of severe trauma, and the abdominal trauma group with a highest rate (50%). The serum creatinine at ICU admission and the peak value during hospitalization in abdominal trauma group were significantly higher than those in other injury types ( P<0.05). (4) Logistic regression analysis showed Age [ OR=1.020, 95% CI(1.003,1.038), P=0.024], APACHEⅡscore [ OR=1.137, 95% CI(1.053,1.228), P=0.001], shock [ OR=1.102, 95% CI(0.906,1.208), P=0.034], ICU admission serum creatinine [ OR=1.068, 95% CI(1.036,1.102), P=0.000], surgical treatment [ OR=4.205, 95% CI(1.446,12.233), P=0.008], blood transfusion volume [ OR=1.006, 95% CI(1.002,1.009), P=0.001] were independent risk factors for AKI in severe trauma patients. Conclusions:Severe trauma patients yield a high incidence of AKI influencing clinical prognosis. The incidence of AKI varies with different types of severe trauma. Age, APACHEⅡscore, shock, ICU admission serum creatinine, surgical treatment, and blood transfusion volume are independent risk factors for AKI in severe trauma patients.

Decaf Score in Predicting Prognosis of Acute Exacerbation of Copd in Patient Required Hospital and ICU Admission

@#Introduction: Exacerbation refers to deterioration of patient’s respiratory indications and requires a robust scoring tool for subjects suffering from Chronic Obstructive Pulmonary Disease (COPD) undergoing acute exacerbation. The Dyspnoea, Eosinopenia, Consolidation, Acidaemia, and atrial Fibrillation (DECAF) score can be utilized bedside and predicts in-hospital mortality using indices. The study aimed at assessing the prognostic standards (of duration of ICU stay, hospital stay and mortality) and the sensitivity and specificity of acute exacerbation of COPD patients based on DECAF score. Methods: This prospective study was carried out in a tertiary hospital with 84 patients between October 2016 to September 2018. On admission, DECAF score of all patients with acute exacerbation of COPD was noted and admitted to ICU. The mean duration of stay in ICU and hospital were compared. Various components of APACHE II, BAP 65, CURB 65 were also noted on admission. Results: Mean age of population was 68.29±11.80 with male predominance (68%). The study observed mortality in 6% of patients with mean ICU stay of 3.65±2.21 days and mean hospital stay of 6.45±3.28 days. For a score of 5 and 6 mean DECAF score could not be calculated as the mortality rate was 100%. ROC of DECAF score was 0.81 which was more than APACHE II (0.72) and BAP 65 (0.69) (p-value 0.07 and 0.056 suggested significance). Conclusion: The DECAF Score has been observed to be a stronger predictor for hospital mortality. Higher the DECAF score, higher is the in-hospital death rate. The DECAF score also helps in forecasting the duration of ICU stay and hospital stay.

Research progress on liver transplantation for drug-induced liver injury / 器官移植

Drug-induced liver injury (DILI) is a type of necrotizing and inflammatory liver disease caused by certain commonly-used drugs, Chinese herbal medicines or dietary supplements. In severe cases, it may lead to acute liver failure. Without liver transplantation, the fatality could reach up to 80%. It is of significance to master the indications of liver transplantation. Several prognostic scoring systems have been developed to help clinicians to decide which patients need urgent liver transplantation, such as King's College criteria (KCC) and model for end-stage liver disease (MELD) scoring systems. However, these scoring methods have been developed for a long period of time and lack of modifications. Therefore, scholars have proposed several new scoring systems, such as acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) scoring systems, which provide novel ideas for the evaluation of liver transplantation. As an important treatment measure for drug-induced acute liver failure, urgent liver transplantation has greatly improved the survival rate of patients. In this article, the classification, clinical diagnosis, liver transplantation evaluation and prognosis of DILI were summarized, aiming to provide reference for the treatment of DILI by liver transplantation.

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.

Poisoning Severity Score And Its Correlation With APACHE II And Glasgow Coma Scale In Predicting Outcome In Patients Presented With Poisoning In Emergency Department

Background:Standardized scales for scoring severity of poisoning is need of time in Emergency department(ED)to identify high risk patients for intensive monitoring and treatment before disposal and for compatibility of data. So in this study we try to evaluate utility of Glasgow coma scale (GCS), poisoning severity score (PSS) and Acute physiology and chronic health evaluation II (APACHE II) in estimating clinical severity and prognosis of poisoning patients.Material and methods: A Retrospective observational study was conducted between1stJune 2019 to 28thFebruary 2021 in the Emergency Department of tertiary care teaching hospital, Ahmedabad, India. Data was collected from computerized hospital information system and analysed in CDC software Epi Info (version 7.3.2.1).Results:Out of total 50 patients during study,majority of patients were in age group of 21-30 year (yr)with Male: Female ratio of 1:1. Out of 50 cases, 44 consumed chemical substances, 3 had corrosive and 3 had medication consumption with organophosphates (OP) being most common compound. Mean PSS in expired was significantly high in comparisonof survivors (p value= 0.0118). Present study found significant association between PSS within first 24 hours and GCS of patients pre sented with poisoning with p value 0.0117 (GCS on admission) and 0.0002 (GCS at 24 hr). A statistically significant correlation was found between PSS and APACHE II, with a p value= 0.0242 and also between GCS and APACHE II with a p value= 0.0018 (CI=95%).Conclusion:Both PSS and GCSare effective in predicting Severity and outcome of patients presented with poisoning in ED.GCSis more useful as it is easy to use, does not require any laboratory investigations and less time consuming.