Serial evaluation of the MODS, SOFA and LOD scores to predict ICU mortality in mixed critically ill patients.

OBJECTIVE: To perform a serial assessment and compare ability in predicting the intensive care unit (ICU) mortality of the multiple organ dysfunction score (MODS), sequential organ failure assessment (SOFA) and logistic organ dysfunction (LOD) score. MATERIAL AND METHOD: The data were collected prospectively on consecutive ICU admissions over a 24-month period at a tertiary referral university hospital. The MODS, SOFA, and LOD scores were calculated on initial and repeated every 24 hrs. RESULTS: Two thousand fifty four patients were enrolled in the present study. The maximum and delta-scores of all the organ dysfunction scores correlated with ICU mortality. The maximum score of all models had better ability for predicting ICU mortality than initial or delta score. The areas under the receiver operating characteristic curve (AUC) for maximum scores was 0.892 for the MODS, 0.907 for the SOFA, and 0.92for the LOD. No statistical difference existed between all maximum scores and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. CONCLUSION: Serial assessment of organ dysfunction during the ICU stay is reliable with ICU mortality. The maximum scores is the best discrimination comparable with APACHE II score in predicting ICU mortality.

Validation of the LOD score compared with APACHE II score in prediction of the hospital outcome in critically ill patients.

The Logistic Organ Dysfunction score (LOD) is an organ dysfunction score that can predict hospital mortality. The aim of this study was to validate the performance of the LOD score compared with the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in a mixed intensive care unit (ICU) at a tertiary referral university hospital in Thailand. The data were collected prospectively on consecutive ICU admissions over a 24 month period from July1, 2004 until June 30, 2006. Discrimination was evaluated by the area under the receiver operating characteristic curve (AUROC). The calibration was assessed by the Hosmer-Lemeshow goodness-of-fit H statistic. The overall fit of the model was evaluated by the Brier's score. Overall, 1,429 patients were enrolled during the study period. The mortality in the ICU was 20.9% and in the hospital was 27.9%. The median ICU and hospital lengths of stay were 3 and 18 days, respectively, for all patients. Both models showed excellent discrimination. The AUROC for the LOD and APACHE II were 0.860 [95% confidence interval (CI) = 0.838-0.882] and 0.898 (95% Cl = 0.879-0.917), respectively. The LOD score had perfect calibration with the Hosmer-Lemeshow goodness-of-fit H chi-2 = 10 (p = 0.44). However, the APACHE II had poor calibration with the Hosmer-Lemeshow goodness-of-fit H chi-2 = 75.69 (p < 0.001). Brier's score showed the overall fit for both models were 0.123 (95%Cl = 0.107-0.141) and 0.114 (0.098-0.132) for the LOD and APACHE II, respectively. Thus, the LOD score was found to be accurate for predicting hospital mortality for general critically ill patients in Thailand.

A comparison of three organ dysfunction scores: MODS, SOFA and LOD for predicting ICU mortality in critically ill patients.

OBJECTIVE: To compare the validity of the Multiple Organ Dysfunction Score (MODS), Sequential Organ Failure Assessment (SOFA), and Logistic Organ Dysfunction Score (LOD) for predicting ICU mortality of Thai critically ill patients. MATERIAL AND METHOD: A retrospective study was made of prospective data collected between the 1st July 2004 and 31st March 2006 at Songklanagarind Hospital. RESULTS: One thousand seven hundred and eighty two patients were enrolled in the present study. Two hundred and ninety three (16.4%) deaths were recorded in the ICU. The areas under the Receiver Operating Curves (A UC) for the prediction of ICU mortality the results were 0.861 for MODS, 0.879 for SOFA and 0.880 for LOD. The AUC of SOFA and LOD showed a statistical significance higher than the MODS score (p = 0.014 and p = 0.042, respectively). Of all the models, the neurological failure score showed the best correlation with ICU mortality. CONCLUSION: All three organ dysfunction scores satisfactorily predicted ICU mortality. The LOD and neurological failure had the best correlation with ICU outcome.

A comparison of APACHE II and SAPS II scoring systems in predicting hospital mortality in Thai adult intensive care units.

OBJECTIVE: To assess the performance of Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in Thai critically ill patients. MATERIAL AND METHOD: Prospective observational cohort study conducted between July 1, 2004 and October 31, 2005 in the Intensive Care Unit (ICU) of Songklanagarind Hospital, an 800-beds tertiary referral university teaching hospital. RESULTS: One thousand three hundred sixteen patients were enrolled. There were 310 deaths (23.6%) at hospital discharge. APACHE II and SAPS II predicted hospital mortality 30.5 +/- 28.2 and 30.5 +/- 29.8 respectively. Both models showed excellent discrimination. The discrimination of APACHE II was better than SAPS II (0.911 and 0.888, p < 0.001). However both systems presented a poor calibration. The Hosmer-Lemeshow goodness-of-fit Hand C statistics were 66.59 and 66.65 of APACHE II (p < 0.001) and 54.01 and 71.44 of SAPS II (p < 0.001). CONCLUSION: APACHE II provided better discrimination than SAPS II, but both models showed poor calibration in over predicting mortality in our ICU patients. Customized or new severity scoring systems should be developed for critically ill patients in Thailand.

Acute bacterial meningitis in adults: a 20 year review.

During the period Jaunuary 1982 to December 2001 (20 years), a retrospective study in patients 15 years or older with acute bacterial meningitis who were admitted to Songklanagarind Hospital was carried out. There were 180 episodes in 161 cases of acute bacterial meningitis with an increasing incidence of disease during the study. Fifty-nine percent of episodes were nosocomial infection. The classic triad of acute bacterial meningitis was found in 54% of cases. The most common pathogen was Streptococcus pneumoniae (11.7%) in which 19% of these strain were penicillin-resistant. Gram-negative bacilli were common organisms in nosocomial meningitis (32.1%). Twenty-five patients died from meningitis with a mortality rate of 15.5%. Risk factors for mortality older age were than 60 years, HIV infection, impaired mental status and shock.