Comparison of clinical parameters with APACHE-II, Sequential Organ Failure Assessment and Clinical Pulmonary Infection Score scores in predicting treatment outcome of patients with ventilator associated pneumonia

Background: The objective of this study was to study the multiple clinical parameters in patients with VAP and to compare the 3 scores namely, APACHE II, SOFA and CPIS in predicting the treatment outcome of patients with ventilator associated pneumonia.Methods: It was a cross sectional observational study conducted on forty patients admitted in ICU between June 2018 and July 2019, who developed VAP after admission to ICU. Logistic regression analysis was applied to estimate the predictive ability of the APACHE II, SOFA and CPIS scoring systems in assessing VAP-related mortality. A p value of <0.05 was considered significant. All analyses were performed using SPSS software version 10.Results: The sample size in our study was 40 patients. The mean age of patients was 43.4±15.9. The mean duration of mechanical ventilation before VAP onset was 8±2 days. Klebsiella species was the most common organism isolated from ET aspirate. Of the three scores only APACHE II was independent predictor of the mortality in the logistic regression analysis.Conclusions: APACHE II score is better at predicting mortality in patients with VAP as compared to SOFA and CPIS scores. Age, co-morbidities, duration of ICU stay, time of acquiring VAP, multi organ dysfunction, need for ionotropes and multi drug resistant organisms play an important role in predicting the outcome of patients.

A Study to Assess the Utility of Peradeniya Organophosphorous Poisoning (POP) Scale, Poisoning Severity Score (PSS) and Glasgow Coma Scale (GCS) in Predicting Severity and Treatment Outcome in Acute Organophosphorous Poisoning

Introduction: Organophosphate compounds are often usedfor homicidal and suicidal purposes. It accounts for about80% of pesticide related hospital admissions. Study aimed toassess the severity of OP poisoning by POP scale, PSS andGCS and to compare POP scale, PSS and GCS in predictingthe treatment outcome in OP poisoning.Material and Methods: 100 patients of OP compoundpoisoning were included in the study. POP score, PSS andGCS were assessed at the time of presentation and weregrouped based on the severity. These scores were individuallyevaluated in predicting the ventilator requirement andmortality in OP compound poisoning and the scores werecompared with each other, as to asses which score was betterin predicting the severity of OP poisoning.Results: Ventilator requirement and mortality was found tobe in 43% and 16% of patients respectively. Intubation ratesand mortality rates were higher in patients with severe gradesof POP score, PSS and GCS with a significant p value (0.00),than in patients with mild to moderate grades. All three scorescorrelated well in predicting the requirement of ventilatorysupport and mortality in OP compound poisoning cases.Conclusion- The three scoring systems are simple andeffective tool that can be assessed based on the clinicalexamination. For a resource limited country, like India, any ofthe three scoring systems can be applied at the primary caresetting level which helps in making timely decision regardingneed for ventilatory support and timely shifting of patient tothe ICU care setting.