Complicaciones y mortalidad en pacientes neurocríticos / Complications and mortality in neurocritic patients

Objetivo: Relacionar las complicaciones y el riesgo de muerte en pacientes neurocríticos admitidos en la unidad de cuidados intensivos (UCI) del Hospital Universitario de Caracas durante un período de 5 meses. Métodos: investigación observacional, prospectiva, descriptiva. La muestra estuvo conformada por 65 pacientes neurocríticos, ≥ 18 años, con patologías médicas o quirúrgicas, ingresados en la UCI. El análisis estadístico incluyó la determinación de frecuencias, promedios, porcentajes y medias para descripción de variables y el T de Student. Resultados: La edad promedio fue 50,98 ± 16,66 años; la población masculinarepresentó el 50,76%. Entre las complicaciones, la mayor incidencia correspondió a las no infecciosas (70,77 %) y los trastornos ácido-básicos de tipo metabólico, la anemia y las alteraciones electrolíticas fueron las más frecuentes; el 29,23% de los pacientes presentaron complicaciones infecciosas, y la neumonía asociada a ventilación mecánica fue la más frecuente (73,91 %). La comorbilidad con mayor incidencia fue hipertensión arterial sistémica (53,84%). El 90.70% requirió ventilación mecánica y el tiempo en VM fue 4.29 ± 6.43 días. La estancia en UCI fue 5.96 ± 7.72 días. El 29,23% presentó un puntaje en la escala APACHE II entre 5-9; el SAPS II presentó mayor incidencia entre los 6-21 y 22-37 puntos con (66,70%); el SOFA al ingreso se reportó < 15 puntos en 98,46% y > 15 en 1,53%. La mortalidad del grupo fue 23,08 % (n=15). Conclusiones: Las complicaciones no infecciosas predominaron sobre las infecciosas las primeras íntimamente relacionadas con la mortalida(AU)

Objective: To relate complications and the risk of death in neurocritical patients admitted to the intensive care unit (ICU) of the University Hospital of Caracas during a period of 5 months. Methods: observational, prospective, descriptive research. The sample was made up of 65 neurocritical patients, ≥ 18 years old, with medical or surgical pathologies, admitted to the ICU.The statistical analysis included the determination of frequencies, averages, percentages and meansfor description of variables and Student's T.Results: The average age was 50.98 ± 16.66 years; the male population represented 50.76%. Among the complications, the highest incidence corresponded to non-infectious complications (70.77%) and metabolic acid-base disorders, anemia and electrolyte alterations were the most frequent; 29.23% of patients presented infectious complications, and pneumonia associated with mechanical ventilation was the most frequent (73.91%). The comorbidity with the highest incidence was systemic arterial hypertension (53.84%), 90.70% required mechanical ventilation and the time on MV was 4.29 ± 6.43 days. The ICU stay was 5.96 ± 7.72 days. 29.23% had a score on the APACHE II scale between 5-9; SAPS II presented the highest incidence between 6-21 and 22-37 points with (66.70%); The SOFA upon admission was reported to be < 15 points in 98.46% and > 15 in 1.53%. The mortality of the group was 23.08% (n=15). Conclusions: Non-infectious complications predominated over infectious complications, the former being closely related to mortalit(AU)

Study of spectrum of sepsis and prediction of its outcome in patients admitted to ICU using different scoring systems

Background: Although sepsis is one of the leading causes of mortality in hospitalized patients, information regarding early predictive factors for mortality and morbidity is limited. The aim was to identify reliable and early prognostic variables predicting mortality in patients admitted to ICU with sepsis.Methods: Patients fulfilling the Surviving Sepsis Campaign 2012 guidelines criteria for sepsis within the ICU were included over two years. Apart from baseline haematological, biochemical and metabolic parameters, APACHE II, SAPS II and SOFA scores were calculated on day 1 of admission. Patients were followed till death or discharge from the ICU. Chi-square test, student t-test, receiver operating curve analyses were done.Results: 100 patients were enrolled during the study period. The overall mortality was 35% (68.6% in males and 31.4% in females). Mortality was 88.6% and 11.4% in patients with septic shock and severe sepsis and none in the sepsis group, respectively. On multivariate analysis, significant predictors of mortality were APACHE II score greater than 27, SAPS II score greater than 43 and SOFA score greater than 11 on day the of admission. On ROC analysis APACHE II had the highest sensitivity (92.3%) and SAPS II had the highest specificity (82.9%).Conclusions: All three scores performed well in predicting the mortality. Overall, APACHE II had highest sensitivity, hence was the best predictor of mortality in critically ill patients. SAPS II had the highest specificity, hence it predicted improvement better than death. SOFA had intermediate sensitivity and specificity.

Severity of disease scoring systems and mortality after non-cardiac surgery / Sistemas de classificação da gravidade da doença e mortalidade após cirurgia não cardíaca

Abstract Background: Mortality after surgery is frequent and severity of disease scoring systems are used for prediction. Our aim was to evaluate predictors for mortality after non-cardiac surgery. Methods: Adult patients admitted at our surgical intensive care unit between January 2006 and July 2013 was included. Univariate analysis was carried using Mann-Whitney, Chi-square or Fisher's exact test. Logistic regression was performed to assess independent factors with calculation of odds ratio and 95% confidence interval (95% CI). Results: 4398 patients were included. Mortality was 1.4% in surgical intensive care unit and 7.4% during hospital stay. Independent predictors of mortality in surgical intensive care unit were APACHE II (OR = 1.24); emergent surgery (OR = 4.10), serum sodium (OR = 1.06) and FiO2 at admission (OR = 14.31). Serum bicarbonate at admission (OR = 0.89) was considered a protective factor. Independent predictors of hospital mortality were age (OR = 1.02), APACHE II (OR = 1.09), emergency surgery (OR = 1.82), high-risk surgery (OR = 1.61), FiO2 at admission (OR = 1.02), postoperative acute renal failure (OR = 1.96), heart rate (OR = 1.01) and serum sodium (OR = 1.04). Dying patients had higher scores in severity of disease scoring systems and longer surgical intensive care unit stay. Conclusion: Some factors influenced both surgical intensive care unit and hospital mortality.

Resumo Justificativa: A mortalidade após cirurgia é frequente e os sistemas de classificação da gravidade da doença são usados para a previsão. Nosso objetivo foi avaliar os preditivos de mortalidade após cirurgia não cardíaca. Métodos: Os pacientes adultos admitidos em nossa unidade de terapia intensiva cirúrgica entre janeiro de 2006 e julho de 2013 foram incluídos. Análise univariada foi feita com o teste de Mann-Whitney, qui-quadrado ou exato de Fisher. Regressão logística foi feita para avaliar fatores independentes com cálculo de razão de chances (odds ratio - OR) e intervalo de confiança de 95% (IC 95%). Resultados: No total, 4.398 pacientes foram incluídos. A mortalidade foi de 1,4% na unidade de terapia intensiva cirúrgica e de 7,4% durante a internação hospitalar. Os preditivos independentes de mortalidade na unidade de terapia intensiva cirúrgica foram APACHE II (OR = 1,24); cirurgia de emergência (OR = 4,10), sódio sérico (OR = 1,06) e FiO2 na admissão (OR = 14,31). Bicarbonato sérico na admissão (OR = 0,89) foi considerado um fator protetor. Os preditivos independentes de mortalidade hospitalar foram idade (OR = 1,02), APACHE II (OR = 1,09), cirurgia de emergência (OR = 1,82), cirurgia de alto risco (OR = 1,61), FiO2 na admissão (OR = 1,02), insuficiência renal aguda no pós-operatório (OR = 1,96), frequência cardíaca (OR = 1,01) e sódio sérico (OR = 1,04). Os pacientes moribundos apresentaram escores mais altos de gravidade da doença nos sistemas de classificação e mais tempo de permanência em unidade de terapia intensiva cirúrgica. Conclusão: Alguns fatores tiveram influencia sobre a mortalidade tanto hospitalar quanto na unidade de terapia intensiva cirúrgica.

Prediction of Outcome in ICU Patients Using SAPS II Scoring-A Prospective Study.

Introduction: Since 1981, several severity scores have been proposed for ICU patients. The first ones were acute physiology and chronic health evaluation(APACHE, APACHEII),Simplified acute physiology score (SAPS); later, mortality probability model(MPM) and APACHE III were introduced. The SAPS II scoring system, have been used as a method for converting the score to a probability of hospital mortality.The present prospective study is designed to predict the ICU outcome in medical ICU patients. Objective of the Study: To predict the mortality and morbidity of the patients admitted in ICU for various emergencies using SAPS II scoring system and correlate it with the outcome of the patient on discharge. Materials and Methods: The study prospective type, data was obtained from the patients admitted to ICU ,SAPS II scoring was given and were followed up till they got discharged to assess the outcome .Results:45 patients were studied the total mortality was 26.6%. The SAPS II Scores of the patients and the number of deaths in the different groups are given in table below. The chi-square value was 23.04, df= 6with a p + 0.0007 and this study is well within the p value of 0.05, hence it is significant which means the higher the score the more is the risk of morbidity and mortality, when score is >50 there is increased risk of morbidity and mortality, when score is >50 there is increased risk of mortality. Conclusion:The present study imposes on the following conclusions -SAPS II scoring is useful in predicting the ICU outcome of patients admitted in the ICU even when the primary diagnosis is not specified.

Performance Assessment of the SOFA, APACHE II Scoring System, and SAPS II in Intensive Care Unit Organophosphate Poisoned Patients

This study assessed the ability of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology, Chronic Health Evaluation (APACHE) II scoring systems, as well as the Simplified Acute Physiology Score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with organophosphate. The medical records of 149 organophosphate poisoned patients admitted to the ICU from September 2006 to December 2012 were retrospectively examined. The SOFA, APACHE II, and SAPS II were calculated based on initial laboratory data in the Emergency Department, and during the first 24 hr of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II equations. The ability to predict group mortality by the SOFA score, APACHE II score, and SAPS II method was assessed using two by two decision matrices and receiver operating characteristic (ROC) curve analysis. A total of 131 patients (mean age, 61 yr) were enrolled. The sensitivities, specificities, and accuracies were 86.2%, 82.4%, and 83.2% for the SOFA score, respectively; 65.5%, 68.6%, and 67.9% for the APACHE II scoring system, respectively; and 86.2%, 77.5%, and 79.4% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.896, 0.716, and 0.852, respectively. In conclusion, the SOFA, APACHE II, and SAPS II have different capability to discriminate and estimate early in-hospital mortality of organophosphate poisoned patients. The SOFA score is more useful in predicting mortality, and easier and simpler than the APACHE II and SAPS II.

Desempenho do escore SAPS II em uma unidade de terapia intensiva / The SAPS II performance in an intensive care unit

Introdução: O Simplified Acute Physiology Score (SAPS) é um modelo desenvolvido na França por Le Gall et al. em 1983, modificado para SAPS II em 1993. É composto por 12 variáveis fisiológicas, idade, tipo de admissão e presença de doença crônica. Este estudo tem como objetivo analisar a predição de mortalidade do SAPS II nos pacientes internados na UTI do Hospital São José, Criciúma, SC. Métodos: Estudo prospectivo de coorte realizado entre julho de 2007 a fevereiro de 2008. Foram inclusos pacientes de ambos os sexos, com idade maior que 18 anos e tempo de internação na UTI superior a 24 horas. Resultados: 144 (59%) pacientes foram do sexo masculino e 97 (41%) do sexo feminino. A idade média foi de 55 ± 17 anos, 85 (35%) pacientes tiveram sua admissão devido a pós-operatório de cirurgias eletivas, 33 (14%) devido a pós-operatório de cirurgias de urgência e 123 (51%) devido à intercorrências clínicas. A média de pontos do SAPS II foi de 28,7 ± 14,3. Conclusão: O modelo estudado não foi adequado para o uso nesta amostra de pacientes, sendo que o escore SAPS II apresentou uma discriminação regular e subestimou a letalidade hospitalar. Além disso, o estudo foi realizado em uma única UTI, o que mostra somente um determinado perfil de pacientes.

Introduction: The Simplified Acute Physiology Score (SAPS) is a model developed in France By Le Gall et al. in 1983, modified for SAPS II in 1993. It consists of 12 physiological variables, age, type of admission and presence of chronic disease. This study aims to analyze the prediction of mortality of SAPS II in patients admitted to the ICU of São José Hospital, Criciúma, SC. Methods: Prospective cohort study conducted from July 2007 to February 2008. We included patients of both sexes, older than 18years and duration of ICU stay longer than 24 hours. Results: 144 (59%) patients were male and 97 (41%) were female. The average age was 55 ± 17 years, 85 (35%) patients had their admission due to postoperative elective surgery, 33 (14%) due to postoperative emergency surgery and 123 (51%) due to clinical complications. The average score on the SAPS II was 28,7 ± 14,3. Conclusion: ICU scoring systems has become an important tool to measure the performance of the ICU and may be used for resource allocation, selection of patients, quality assurance. The model studied was not suitable for use in this sample of patients. The SAPS II score had a regular discrimination and underestimated the mortality rate. In addition, the study was conducted in a single ICU, which shows only a certain profile of patients.

The Value of Procalcitonin and the SAPS II and APACHE III Scores in the Differentiation of Infectious and Non-infectious Fever in the ICU: A Prospective, Cohort Study

Early and accurate differentiation between infectious and non-infectious fever is vitally important in the intensive care unit (ICU). In the present study, patients admitted to the medical ICU were screened daily from August 2008 to February 2009. Within 24 hr after the development of fever (>38.3degrees C), serum was collected for the measurement of the procalcitonin (PCT) and high mobility group B 1 levels. Simplified Acute Physiology Score (SAPS) II and Acute Physiology And Chronic Health Evaluation (APACHE) III scores were also analyzed. Sixty-three patients developed fever among 448 consecutive patients (14.1%). Fever was caused by either infectious (84.1%) or non-infectious processes (15.9%). Patients with fever due to infectious causes showed higher values of serum PCT (7.8+/-10.2 vs 0.5+/-0.2 ng/mL, P=0.026), SAPS II (12.0+/-3.8 vs 7.6+/-2.7, P=0.006), and APACHE III (48+/-20 vs 28.7+/-13.3, P=0.039) than those with non-infectious fever. In receiver operating characteristic curve analysis, the area under the curve was 0.726 (95% CI; 0.587-0.865) for PCT, 0.759 (95% CI; 0.597-0.922) for SAPS II, and 0.715 (95% CI; 0.550-0.880) for APACHE III. Serum PCT, SAPS II, and APACHE III are useful in the differentiation between infectious and non-infectious fever in the ICU.

The Clinical Efficacy of GOCA Scoring System in Patients with Acute Respiratory Distress Syndrome

To explore the following hypotheses: 1) Gas exchange, Organ failure, Cause, Associated disease (GOCA) score, which reflects both general health and the severity of lung injury, would be a better mortality predictor of acute respiratory distress syndrome (ARDS) than acute physiology and chronic health evaluation (APACHE II) or simplified acute physiology score (SAPS II), which are not specific to lung injury, and lung injury score (LIS) that focuses on the lung injury; 2) the performance of APACHE II and SAPS II will be improved when reinforced by LIS, we retrospectively analyzed ARDS patients (N=158) admitted to a medical intensive care unit for five years. The overall mortality of the ARDS patients was 53.2%. Calibrations for all models were good. The area under the curve of (AUC) of LIS (0.622) was significantly less than those of APACHE II (0.743) and SAPS II (0.753). The AUC of GOCA (0.703) was not better than those of APACHE II and SAPS II. The AUCs of APACHE II and SAPS II tended to further increase when reinforced by LIS. In conclusion, GOCA was not superior to APACHE II or SAPS II. The performance of the APACHE II or SAPS II tended to improve when combining a general scoring system with a scoring system that focused on the severity of lung injury.

Factors of Cardiopulmonary Resuscitation Outcome for In-hospital Adult Patients / 대한구급학회지

BACKGROUND: The purpose of this study was to evaluate the factors of cardiopulmonary resuscitation (CPR) outcome for in-hospital adult patients, acquiring data with standardized reporting guideline of in-hospital cardiopulmonary resuscitation in Korea. METHODS: All adult cardiac arrest patients from July 2004 to December 2006 in this general hospital were included. Their clinical spectrums were reviewed retrospectively using Utstein-style based template. RESULTS: For the study time period, one hundred and forty-two patients underwent cardiac arrest in this hospital. 136 patients were performed CPR. Return of spontaneous circulation (ROSC) occurred in 42 cases, and 15 patients were survived to hospital discharge. A shorter CPR time and a lower Simplified Acute Physiology Score II (SAPS II) were significant for survivor to hospital discharge (p<0.01). Sex, age, and location in cardiac arrest were not attributed to survival to hospital discharge. CONCLUSIONS: In-hospital CPR patients, the high rate of ROSC and survival to hospital discharge were associated to the cause of arrest, shorter time of CPR, and lesser severity of disease (SAPS II). This result can be a great implication of survivor from CPR in-hospital adult patients in Korea. Further evaluation with consistent data acquisition of CPR using Utstein-style would contribute to improve CPR practice and outcome.

Evolução da gravidade de pacientes adultos internados em uma Unidade de Terapia Intensiva / Evolution of the severity of adult patients admitted to an Intensive Care Unit

Trata-se de um estudo que teve por objetivos caracterizar a evolução da gravidade dos pacientes internados em uma Unidade de Terapia Intensiva (UTI), segundo o Simplified Acute Physiological Score (SAPS II) e o Therapeutic Intervention Scoring System-28 (TISS-28), e verificar a relação desses escores com a variável idade, tempo de permanência e condição de saída da unidade. Compuseram a amostra, 61 pacientes adultos, admitidos consecutivamente na UTI de um hospital geral do Vale do Paraíba, São Paulo, de 16 de março a 16 de maio de 2002. Diariamente, da admissão à alta da UTI, foram aplicados, por um único avaliador, os índices SAPS II e TISS-28 em cada paciente, tendo por base as informações do prontuário. Os resultados mostraram uma maioria de pacientes do sexo masculino, (65,57%), faixa etária predominante de 41 a 60 anos (39,34%), procedentes, em maior parte, do Centro Cirúrgico (45,90%), após cirurgia de urgência (45,90%). O tempo de permanência médio foi de 8,9 dias e a maioria dos pacientes (67,21%) recebeu alta para a unidade de internação. Observou-se uma mortalidade de 24,59%. As pontuações médias do TISS-28 e SAPS II dos pacientes durante a internação foi de, respectivamente, 19 e 27 pontos, com risco de mortalidade (RM) de 14,0%. Quanto à evolução diária da gravidade, foram observadas médias crescentes do TISS-28, SAPS II e RM, do primeiro ao trigésimo terceiro dia de internação na UTI, em contraposição a um número decrescente de pacientes. Verificou-se relação entre a pontuação média do TISS-28 e o tempo de permanência na UTI, assim como entre a pontuação média do SAPS II e a idade. Pacientes que sobreviveram apresentaram escores médios de TISS-28, SAPS II e respectivo RM significativamente menores do que os pacientes não sobreviventes. A utilização dos índices SAPS II e TISS-28 mostrou-se útil para a medida da evolução da gravidade e da carga de trabalho de enfermagem na UTI, devendo ser ) empregados como índices complementares.

This is a study that its objectives was to characterize an Intensive Care Unit (ICU) patients' gravity evolution, according to the Simplified Acute Physiological Score (SAPS II) and the Therapeutic Intervention Scoring System-28 (TISS-28), and to check the relation of this two scores with variables as: age, permanence period and discharge condition of ICU. That was part of the sample, 61 adult patients, admitted consecutively at a general hospital ICU of Vale do Paraíba, São Paulo state, from March, 16 to May, 16, 2002. Daily, from ICU admission to discharge, it was applicable, by an only evaluator, SAPS II e TISS-28 scores in each patient, based on the patient informations papers. Results showed most of male patients (65,6%), predominant age was from 41 to 60 years (39,3%), coming, mostly, from Operating Center (45,9%), after urgency surgery. Median permanence period was 8,9 days and most of patients (67,2%) went to hospital ward. It was observed 24,6% mortality rate. TISS-28 and SAPS II median scores during the ICU permanence period was, respectively, 19 and 27 points, with a Mortality Risk (MR) of 14,0%. About daily gravity evolution, it was observed increasing medians of TISS-28, SAPS II and MR, from first to thirty-third ICU day permanence, in opposition to a decreasing number of patients. It was verified a relation between median TISS-28 score and ICU permanence period, as well as between SAPS II median score and age. Survivors had TISS-28, SAPS II median scores and respective MR meaningfully smaller than non-survivors. SAPS II and TISS-28 scores uses has shown useful to measure gravity evolution and nursing working load at ICU, so they must be used as complementary scores.