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Objective To explore the application value of traditional Chinese medicine (TCM) symptom score in the evaluation of the prognosis of patients with acute exacerbation of chronic cardiac insufficiency and establish a mortality probability model to assess the patients' consistency between the risk of death and actual death. Methods A retrospective observational study was conducted. Three hundred and twenty patients with acute exacerbation of chronic cardiac insufficiency admitted to Zhuji Hospital of TCM from January 2015 to June 2017 were divided into survival and death groups according to 28-day prognosis. The TCM symptom score and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score were recorded on admission, then Spearman correlation analysis was used to determine the correlation between the two types of evaluating score; the differences in APACHE Ⅱ score and TCM symptom score between the two groups of patients were compared; the receiver operating characteristic curve (ROC) was drawn, and the area under ROC curve (AUC) was calculated to evaluate the values of APACHE Ⅱ score and TCM symptom score in predicting the prognosis of patients. Whether the patients being dead or not and the TCM symptom score were used to carry out the logistic regression analysis and establish the regression model, then the relationship between the risk of death and actual death was verified. Results A total of 320 patients were enrolled, of whom 279 survived and 41 died.① The APACHE Ⅱ score and TCM symptom score in the dead group were significantly higher than those in survival group [APACHE Ⅱ score: 30.0 (22.5, 33.5) vs. 14.0 (8.0, 21.0); TCM symptom score: 28 (25, 33) vs. 15 (10, 20); both P < 0.01]. ② The APACHE Ⅱ score of patients with acute exacerbation of chronic cardiac insufficiency was positively correlated with their TCM symptom score obviously (r = 0.814, P < 0.01). ③ The AUC for predicting the prognosis of patients with acute exacerbation of chronic cardiac insufficiency by APACHE Ⅱ score and TCM symptom score were 0.816 and 0.920 respectively, when the best critical value of APACHE Ⅱ score was 21, the sensitivity of predicting death in the patients was 82.9%, and specificity was 74.1%, and the 95% confidence interval (95%CI) was 0.739-0.893;when the best critical value of TCM symptom score was 25, the sensitivity of predicting death in patients was 82.7%, specificity was 91.0% and 95%CI was 0.876-0.964. ④ Whether the patient being dead or not and TCM symptom score were brought into logistic regression analysis to obtain the death risk model: ln [R/(1-R)] = -8.131+0.283×TCM symptom score, after the TCM symptom score was substituted into the death risk model, the result revealed that the death risk was consistent with the actual death situation, that is with the rising of TCM symptom score, the death risk rate increases, and the actual fatality rate also increases gradually. Conclusions The application of TCM symptom score is helpful to realize the degree of disease severity and early judgement of prognosis in patients with chronic cardiac insufficiency.
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Objective To explore the application value of traditional Chinese medicine (TCM) symptom score in the evaluation of the prognosis of patients with acute exacerbation of chronic cardiac insufficiency and establish a mortality probability model to assess the patients' consistency between the risk of death and actual death. Methods A retrospective observational study was conducted. Three hundred and twenty patients with acute exacerbation of chronic cardiac insufficiency admitted to Zhuji Hospital of TCM from January 2015 to June 2017 were divided into survival and death groups according to 28-day prognosis. The TCM symptom score and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score were recorded on admission, then Spearman correlation analysis was used to determine the correlation between the two types of evaluating score; the differences in APACHE Ⅱ score and TCM symptom score between the two groups of patients were compared; the receiver operating characteristic curve (ROC) was drawn, and the area under ROC curve (AUC) was calculated to evaluate the values of APACHE Ⅱ score and TCM symptom score in predicting the prognosis of patients. Whether the patients being dead or not and the TCM symptom score were used to carry out the logistic regression analysis and establish the regression model, then the relationship between the risk of death and actual death was verified. Results A total of 320 patients were enrolled, of whom 279 survived and 41 died.① The APACHE Ⅱ score and TCM symptom score in the dead group were significantly higher than those in survival group [APACHE Ⅱ score: 30.0 (22.5, 33.5) vs. 14.0 (8.0, 21.0); TCM symptom score: 28 (25, 33) vs. 15 (10, 20); both P < 0.01]. ② The APACHE Ⅱ score of patients with acute exacerbation of chronic cardiac insufficiency was positively correlated with their TCM symptom score obviously (r = 0.814, P < 0.01). ③ The AUC for predicting the prognosis of patients with acute exacerbation of chronic cardiac insufficiency by APACHE Ⅱ score and TCM symptom score were 0.816 and 0.920 respectively, when the best critical value of APACHE Ⅱ score was 21, the sensitivity of predicting death in the patients was 82.9%, and specificity was 74.1%, and the 95% confidence interval (95%CI) was 0.739-0.893;when the best critical value of TCM symptom score was 25, the sensitivity of predicting death in patients was 82.7%, specificity was 91.0% and 95%CI was 0.876-0.964. ④ Whether the patient being dead or not and TCM symptom score were brought into logistic regression analysis to obtain the death risk model: ln [R/(1-R)] = -8.131+0.283×TCM symptom score, after the TCM symptom score was substituted into the death risk model, the result revealed that the death risk was consistent with the actual death situation, that is with the rising of TCM symptom score, the death risk rate increases, and the actual fatality rate also increases gradually. Conclusions The application of TCM symptom score is helpful to realize the degree of disease severity and early judgement of prognosis in patients with chronic cardiac insufficiency.
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Aims: Ventilator-associated pneumonia (VAP) due to mechanical ventilation is an important issue that increases mortality and cost of treatment. In this study, we aimed to compare the effectiveness of three scoring models for estimation of mortality and morbidity in patients with ventilator associated pneumonia. Study Design: Prospective research. Place and Duration of Study: Patients with VAP who were admitted into intensive care unit Pamukkale University Hospital prospectively included in the study between January 2012 and June 2012. Methodology: Demographical data, diagnosis on admission, departments from where admitted, APACHE II, Mortality Probability Model II0 (MPMII0) and Mortality Probability Model II24 (MPMII24) scores on admission, length of stay in intensive care and hospital, duration of mechanical ventilation, microbiological data for pneumonia, outcome and Clinical Pulmonary Infection Score values on day 1, 3, 5 and 7 were recorded. Results: Eighty patients (F/M: 37/43) were included study. Mortality was 67.5%. MPM II0, MPMII24 values were significantly high in patients who has died but ROC curves were not significant for any of the scoring systems. In addition, relationship between scoring models and mortality, duration of mechanical ventilation, length of stay in intensive care and hospital was not statistically significant (P=.05). Conclusion: We concluded that each of the three scoring systems for the prediction of mortality in VAP was not superior to each other.
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BACKGROUND: We constructed a prospective study to evaluate the outcome of patients referred to an intensivist for ICU admission as well as the factors associated with ICU admission refusal. METHODS: Patients referred for ICU admission to medico-surgical ICU in our hospital for 16 weeks were included in this study. We classified the reasons for refusal into three categories: inappropriate referral; triage; futility. Also we classified admitted patients into two categories: immediate admission; delayed admission. After initial evaluation of a patient by an intensivist, we checked the patient's outcome for following 28 days. RESULTS: 632 patients had been referred for ICU admission during study period. Among them, 445 (70%) patients were admitted and 187 (30%) patients were refused ICU admission. 116 patients were refused because of inappropriate referral, 52 for triage and 19 for futility. 394 patients were admitted immediately and 51 were refused initially but were later admitted. When 116 inappropriate referral patients were excluded, the mortality rates for immediate admission, delayed admission and triage/futility were 14.4%, 39.2% and 56.3%, respectively (P<0.05). Standardized mortality ratio was 0.70 for immediate admission, 1.20 for delayed admission, 1.28 for triage and 1.30 for futility (P<0.05). The factors associated with refusal for ICU admission were age, medical division, diagnostic group and high Mortality Probability Model II0 (MPM II0) grades. CONCLUSIONS: Because the triage decision for ICU admission influences the patients' outcome, an intensivist must carefully come to a decision when admitting patients to ICU by considering the appropriate guidelines for ICU admission and triage.