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Patients with great clinical impairment, due to extensive burns, need to be admitted to intensive care units, in these treatment sites, indices are used to classify the severity of patients. The aim of this study was to compare the accuracy of the FLAMES score in relation to the Acute Physiologic and Chronic Health Evaluation II (APACHE II), the Simplified Acute Physiologic Score II (SAPS II), the Logistic Organ Dysfunction System (LODS), and the Abbreviated Burn Severity Index (ABSI) applied to the severe burn patient facing mortality in an ICU of a reference center for burns in Brazil. A retrospective study conducted in ICU comparing the accuracy the APACHE II, SAPS II, LODS, ABSI, and FLAMES instruments were applied to all the selected medical records. In order to assess the accuracy of the severity scores of the instruments (SIs) chosen for this study, the area under the receiver operating characteristic (ROC) curve was used. Among the 574 patients included in the study, male individuals (70.13%), with an average age of 44.01 ± 28.64 prevailed and the majority of the burns were caused by accidents (76.53%). The outcome accounted for 35.29% of deaths. It was observed that the FLAMES and ABSI presented the two largest areas under the ROC curves and the highest sensitivities (96% and 89%, respectively). The APACHE II, SAPS II, and LODS presented sensitivities equal to or greater than 80%. It has been demonstrated that indices specifically developed for burn patients, specifically the FLAMES and ABSI indices, presented better accuracies and prediction performances. [ABSTRACT FROM AUTHOR]

Background- Sepsis is a severe, life-threatening condition resulting from an abnormal and uncontrolled immune response to infection, posing a significant global health challenge. Blood coagulation disorders are significant complications in sepsis, often exacerbating the severity of the condition. The APACHE II (Acute Physiology and Chronic Health Evaluation II) score is a widely used severity-of-disease classification system that provides valuable prognostic information in critically ill patients. This study aims to investigate the relationship between various blood coagulation parameters and the severity of sepsis as assessed by the APACHE II score. Materials And Methods- A descriptive cross-sectional hospital-based study was conducted in the Department of General Medicine at Mahatma Gandhi Medical College & Hospital, Jaipur, on patients admitted to the ICU diagnosed with sepsis according to Sepsis-3 criteria. Blood coagulation parameters, including platelet count, PT, aPTT, D-dimer, and fibrinogen levels, were monitored and compared to assess the severity of sepsis using the APACHE II score. Results- The study included 168 sepsis patients aged 18 to 65 years. The mean APACHE II score was 29.08, with a significant correlation between age and APACHE II scores (p<0.001). The study found 68.5% of patients in a hypo-coagulation state and 31.5% in a hyper-coagulation state. Significant correlations were observed between APACHE II scores and PT, aPTT, D-dimer, and platelet count. Conclusions- The study highlights the critical role of blood coagulation disorders in the pathophysiology of sepsis and their correlation with disease severity as assessed by the APACHE II score. Routine monitoring of coagulation parameters in sepsis patients is essential, and incorporating these parameters into the APACHE II scoring system could provide a more comprehensive assessment of sepsis severity, aiding in better prognostication and treatment planning. [ABSTRACT FROM AUTHOR]

Background & objective: Thyroid hormone levels are often raised during stress and acute illness. APACHE II score has been linked to adverse outcome after severe disease. We analyzed the impact of the level of free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormones (TSH), and APACHE II scores on the outcome of critically ill patients admitted to Intensive Care Unit (ICU). Methodology: A cohort prospective study was conducted on critically ill patients in the ICU. Patients’ baseline data, thyroid hormone levels, including fT3, fT4, TSH, and APACHE II score within 24 h of admission were compared between 30-day survivors and non-survivors. Multivariate Cox proportional hazards regression analysis was conducted to assess the risk factors for mortality. fT3Non-survivors were significantly older than survivors (55.81 ± 12.61 vs 41.40 ± 11.40, P = 0.003). The APACHE II score was higher in non-survivors (25.88 ± 9.28 vs 22.13 ± 10.42, P = 0.299). Thyroid hormone levels showed no significant difference between the two groups. The area under the receiver-operating curve for APACHE II was 0.610 (0.403-0.818), and for fT3 was 0.523 (0.311-0.735). Conclusion: Although there was no significant difference in thyroid hormone levels between the survivors and nonsurvivors, the results of this study show that low fT3 levels and high APACHE II scores had a more significant association with adverse clinical outcomes in critically ill patients. [ABSTRACT FROM AUTHOR]

ObjectiveTo determine the diagnostic and prognostic value of soluble suppression of tumorigenicity 2 (sST2) in patients with sepsis.MethodsA total of 113 critically ill patients were enrolled at the emergency department of Beijing Chaoyang Hospital Jing Xi Branch. Venous blood levels of sST2 were measured using the AFIAS-6 dry fluorescence immunoassay analyzer. Based on Sepsis 3.0 criteria, patients were categorized into a sepsis group (76 cases) and a non-sepsis group (37 cases). The sepsis group was further divided into non-survivors (38 cases) and survivors (38 cases) based on 28-day survival outcomes. The vital signs, blood gas analysis, routine blood tests, liver and kidney function tests, procalcitonin (PCT), C-reactive protein (CRP), sST2, left ventricular ejection fraction (LVEF), and other basic characteristics of the patients were recorded. Further, the SOFA, qSOFA and APACHE II scores of each patient were calculated. Statistical analysis was performed using SPSS 25.0, including logistic regression and ROC curve analysis to assess prognostic factors.ResultsThe serum sST2 levels in the sepsis group (125.00 ± 60.32 ng/mL) were significantly higher than in the non-sepsis group (58.55 ± 39.03 ng/mL) (p

Sepsis is the major cause of morbidity and mortality for patients admitted to an intensive care unit worldwide. Currently, procalcitonin (PCT) is a widely used prognostic marker for sepsis. The high cost of estimating Procalcitonin limits its utility in all health facilities. Lipid profile, being a frequently done routine investigation, is studied in sepsis patients to predict the prognosis of sepsis. This study was aimed to assess the association between lipid profile parameters, procalcitonin and clinical outcomes in patients with sepsis.

Background: Understanding the characteristics and outcomes of cancer patients with unplanned ICU admission is imperative for therapeutic decisions and prognostication purposes. Objective: To describe the clinical characteristics of patients with hematological and non-hematological malignancies (NHM) who require unplanned ICU admission and to determine the predictors of mortality and long-term survival. Methods: This retrospective study included all patients with cancer who had an unplanned ICU admission between 2011 and 2016 at a tertiary hospital in Saudi Arabia. The following variables were collected: age, gender, ICU length of stay (LOS), APACHE II score, type of malignancy, febrile neutropenia, source and time of admission, and need for mechanical ventilation (MV), renal replacement therapy (RRT), and treatment with vasopressors (VP). Predictors of mortality and survival rates at 28 days and 3, 6, and 12 months were calculated. Results: The study included 410 cancer patients with 466 unplanned ICU admissions. Of these, 52% had NHM. The average LOS in the ICU was 9.6 days and the mean APACHE score was 21.9. MV was needed in 73% of the patients, RRT in 15%, and VP in 24%, while febrile neutropenia was present in 24%. There were statistically significant differences between survivors and non-survivors in the APACHE II score (17.7 ± 8.0 vs. 25.6 ± 9.2), MV use (52% vs. 92%), need for RRT (6% vs. 23%), VP use (42% vs. 85%), and presence of febrile neutropenia (18% vs. 30%). The predictors of mortality were need for MV (OR = 4.97), VP (OR = 3.43), RRT (OR = 3.31), and APACHE II score (OR = 1.10). Survival rates at 28 days, 3, 6, and 12 months were 52%, 28%, 22%, and 15%, respectively. Conclusion: The survival rate of cancer patients with an unplanned admission to the ICU remains low. Predictors of mortality include need for MV, RRT, and VP and presence of febrile neutropenia. About 85% of cancer patients died within 1 year after ICU admission.

OBJECTIVE: To predict mortality using the APACHE II score in patients presenting with peritonitis and undergoing emergency exploratory laparotomy. Methodology: The prospective study was conducted in Civil Hospital Karachi's surgery department from April to September 2021, with a non-probability sampling technique. A total of 84 patients of either sex between the age of 16-70 years who met the diagnostic criteria of peritonitis were included consecutively. Patients with incomplete laboratory records and uncorrectable preoperative comorbidities were excluded. The APACHE II score was categorized into three groups, and demographic details and outcomes were calculated using SPSS version 20 for the data analysis. Post-stratification Chi-square test was applied, taking a p-value of < 0.05 as statistically significant. RESULTS: Out of 84 patients, 38 (45.2%), 37 (44%) and 09 (10.7%) had APACHE score < 10, 11-20 and ≥ 20 respectively. The total in-hospital mortality rate was 8.3%. In the patients with the lowest APACHE score < 10, a mortality rate of 2.6% was recorded. A mortality of 5.4% was recorded in patients with APACHE II group 2, while group 3 with APACHE II score > 20 had the highest mortality rate of 44%. The difference was statistically significant. (p=0.001). CONCLUSION: The results of the APACHE II score obtained in patients classified them into three different groups based on the severity of conditions in patients with peritonitis, which validated the Prediction of increased mortality with higher scores.

Background: Understanding the characteristics and outcomes of cancer patients with unplanned ICU admission is imperative for therapeutic decisions and prognostication purposes. Objective: To describe the clinical characteristics of patients with hematological and non-hematological malignancies (NHM) who require unplanned ICU admission and to determine the predictors of mortality and long-term survival. Methods: This retrospective study included all patients with cancer who had an unplanned ICU admission between 2011 and 2016 at a tertiary hospital in Saudi Arabia. The following variables were collected: age, gender, ICU length of stay (LOS), APACHE II score, type of malignancy, febrile neutropenia, source and time of admission, and need for mechanical ventilation (MV), renal replacement therapy (RRT), and treatment with vasopressors (VP). Predictors of mortality and survival rates at 28 days and 3, 6, and 12 months were calculated. Results: The study included 410 cancer patients with 466 unplanned ICU admissions. Of these, 52% had NHM. The average LOS in the ICU was 9.6 days and the mean APACHE score was 21.9. MV was needed in 73% of the patients, RRT in 15%, and VP in 24%, while febrile neutropenia was present in 24%. There were statistically significant differences between survivors and non-survivors in the APACHE II score (17.7 ± 8.0 vs. 25.6 ± 9.2), MV use (52% vs. 92%), need for RRT (6% vs. 23%), VP use (42% vs. 85%), and presence of febrile neutropenia (18% vs. 30%). The predictors of mortality were need for MV (OR = 4.97), VP (OR = 3.43), RRT (OR = 3.31), and APACHE II score (OR = 1.10). Survival rates at 28 days, 3, 6, and 12 months were 52%, 28%, 22%, and 15%, respectively. Conclusion: The survival rate of cancer patients with an unplanned admission to the ICU remains low. Predictors of mortality include need for MV, RRT, and VP and presence of febrile neutropenia. About 85% of cancer patients died within 1 year after ICU admission. [ABSTRACT FROM AUTHOR]

Abstract Background The prognostic performance of soluble CD40L (sCD40L) for illness severity in infectious diseases is rarely reported. We investigated the ability of sCD40L combined with Acute Physiology and Chronic Health Evaluation II (APACHE II) score to evaluate mortality in septic patients in the emergency department(ED). Methods We enrolled 222 septic patients in the ED of Beijing Chao-Yang Hospital from October 2020 to April 2021. Their serum sCD40L, PCT, lactate (Lac), Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score were used to predict the prognosis of septic patients in terms of 28-day mortality. Serum sCD40L was detected by Human XL Cytokine Luminex. Logistic regression analysis and receiver operating characteristic (ROC) curves were used to assess the prognostic value of the variables. Results One hundred ninety-five patients met the inclusion criteria, divided into survival group (55 cases) and non-survival group (140 cases). sCD40L, PCT, Lac, SOFA and APACHE II score were found to independently predict 28-day mortality (P

The purpose of our study was to reveal the expression of miR-30d-5p and its function in the occurrence and development of acute pancreatitis (AP). Quantitative real-time PCR was used to detect the expression of miR-30d-5p in patients with severe acute pancreatitis (SAP). Pearson correlation analysis was used to substantiate the correlation between miR-30d-5p and laboratory scoring systems, namely the Ranson score and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The receiver operating characteristic curve was used to illustrate the function of miR-30d-5p in SAP. The predictive roles of miR-30d-5p in the process from mild acute pancreatitis (MAP) to SAP were unveiled by logistic regression. Our result showed the relative expression of miR-30d-5p was elevated in patients with MAP and SAP when compared with control individuals. Pearson correlation analysis documented that the overexpression of miR-30d-5p was related to high APACHE II scores and Ranson scores. In addition, miR-30d-5p might function as a diagnostic indicator and an independent biomarker in the emergence and development of AP. Conclusions: The elevated expression of miR-30d-5p was found in patients with SAP and had positive correlations with the APACHE II score and Ranson score. Moreover, miR-30d-5p might be an alternative index for the diagnosis and progress of SAP. [ABSTRACT FROM AUTHOR]

INTRODUCTION: In this study, the aim was to investigate the relationship between immunological parameters, specifically the fibrinogen/albumin ratio, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and the widely used acute physiology and chronic health assessment (APACHE) II scoring system in critically ill patients in the intensive care unit. METHODS: The retrospective analysis included 166 patients admitted between January 2023 and July 2023, evaluating their 28-day mortality. The patients were categorised into groups: Group M (mortality), with 53 patients and Group S (survival) with 113 patients. The immunological parameters of the patients between the groups were analyzed statistically. RESULTS: APACHE II score, fibrinogen, lactate, and fibrinogen/albumin ratio were identified as independent parameters associated with mortality. The ROC analysis determined the optimal cutoff points for predicting mortality for APACHE II score, fibrinogen, lactate, and fibrinogen/albumin ratio. DISCUSSION AND CONCLUSION: This study revealed a significant correlation between APACHE II score and immunological parameters, including fibrinogen, lactate, and fibrinogen/albumin ratio. These findings can be used to predict mortality.

Effectiveness of using inflammatory markers for prognosis assessment in the intensive care units (ICU) is still not clear. The current study aimed to examines the relationship among procalcitonin, C-reactive protein, and neutrophil/lymphocyte ratio of patients who are getting treatment in the ICU during hospitalization and mortality. The study was carried out with a total of 788 patients who were hospitalized in the ICU longer than a day. All participants were over the age of 18 years old. C-reactive protein, procalcitonin, and neutrophil/lymphocyte ratios were compared between the groups of those who died and those who were discharged from the ICU.54.6% (n= 430) of 788 patients who were admitted to the study, were male whereas45.4% (n= 358) of them were female. The median age of the study group was calculated as 79 years (IQR = 19 years) (P [Med-Science 2023; 12(2.000): 383-8]

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Background: Studies have shown that vagus nerve-mediated inflammatory reflex could inhibit cytokine production and inflammation in sepsis animals. Objectives: This study aimed to explore the efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) on inflammation and disease severity of sepsis patients. Methods: A randomized, double-blind, sham-controlled pilot study was performed. Twenty sepsis patients were randomly assigned to receive taVNS or sham stimulation for five consecutive days. Stimulation effect was assessed with serum cytokine levels, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, and Sequential Organ Failure Assessment (SOFA) score at baseline and on Day 3, Day 5, and Day 7. Results: TaVNS was well tolerated in the study population. Patients receiving taVNS experienced significant reductions in serum TNF-α and IL-1β levels and increases in IL-4 and IL-10 levels. SOFA scores decreased on Day 5 and Day 7 compared with baseline in the taVNS group. However, no changes were found in sham stimulation group. The changes of cytokine from Day 7 to Day 1 were greater with taVNS than sham stimulation. No differences in the APACHE Ⅱ score and SOFA score were observed between the two groups. Conclusions: TaVNS resulted in significantly lower serum pro-inflammatory cytokines and higher serum anti-inflammatory cytokines in sepsis patients.

To estimate the serum nitric oxide (NO), urine nitric oxide level, and urinary nitric oxide-to-creatinine ratio in patients with acute pancreatitis and to correlate it with the established severity markers of pancreatitis, like C-reactive protein (CRP), APACHE II score, and CT severity index (CTSI). Thirty cases of acute pancreatitis, presenting within 72 h of onset of pain were included in the study and their serum NO level, urine NO level, and urinary nitric oxide-to-creatinine ratio was assessed. Another 15 cases were included as controls. The patients were followed until discharge and the complications, organ failure, and interventions required were noted. Patients with acute pancreatitis had statistically significant increase in the levels of serum NO and urine nitric oxide-to-creatinine ratio compared to control patients (p = 0.001). Serum NO, urine NO, and urine NO-to-creatinine ratio were lower in patients with severe pancreatitis. Patients with collection, pleural effusion, and organ failure had lower levels of serum and urine NO and urine NO-to-creatinine ratio. Patients with pancreatic necrosis had higher level of serum NO. Patients who needed percutaneous drain (PCD)/surgery or those who died had lower levels of serum and urine NO and urine NO-to-creatinine ratio. Only urine NO level had a negative correlation with CRP levels, APACHE II score, and CTSI. Patients with acute pancreatitis had statistically significant increase in levels of serum nitric oxide and urine nitric oxide-to-creatinine ratio, compared to controls. Serum nitric oxide and urine nitric oxide-to-creatinine ratio does not help in assessing severity of acute pancreatitis. [ABSTRACT FROM AUTHOR]

The integration of illness severity and organ dysfunction scores into clinical practice, including the APACHE II and SOFA scores, has been challenging due to constraints associated to manual score calculation. With electronic medical records (EMR), score calculation automation using data extraction scripts has emerged as a solution. We aimed to demonstrate that APACHE II and SOFA scores calculated with an automated EMR-based data extraction script predict important clinical endpoints. In this retrospective cohort study, every adult patient admitted to one of our three ICUs, between July 1, 2019, and December 31, 2020, were enrolled. For every patient, an automated ICU admission APACHE II score was calculated using EMR data and minimal clinician input. Fully automated daily SOFA scores were calculated for every patient. 4 794 ICU admissions met our selection criteria. Of these ICU admissions, 522 deaths were recorded (10.9% in-hospital mortality rate). The automated APACHE II was discriminant for in-hospital mortality (AU-ROC = 0.83 (95% CI 0.81–0.85)). We observed an association between the APACHE II score and ICU LOS, with a statistically significant mean increase of 1.1 days of ICU LOS (1.1 [1–1.2]; p = <.0001) for each 10 units increase in APACHE score. SOFA score curves did not discrimate significantly between survivors and non-survivors. A partially automated APACHE II score, calculated with real-world EMR data using an extraction script, is associated with in-hospital mortality risk. The automated APACHE II score could potentially constitute an acceptable surrogate of ICU acuity to be used in resource allocation and triaging, especially in time of high demand for ICU beds. [ABSTRACT FROM AUTHOR]

The intensive care system have a duty to help patients in healing process and not to delay patient’s death. Therefore many scoring methods was developed to predict the outcome of care and mortality rate in the ICU. One of those methods is APACHE II that scores 12 physiological variables and preexisting conditions in the patients. This research was done to find the correlation between APACHE II score and mortality rate of PKU Gamping hospital ICU patients. The data used medical records for 61 non-operative patients from June-December 2019. This research found that 37 (60.6%) died and 24 (39.4%) lived after treatment. The average APACHE II score was 21.28 with the lowest score of 3 and the highest score of 43, after the data gathering a correlation test was conducted using Spearman-correlation test. In the data analysis p value of 0.000 (p<0.05) and correlation coefficient of .698 was found. there was a significant correlation between the APACHE II score and the mortality rate of the PKU Gamping hospital ICU patients, where with higher number of score there was higher number of patient’s death. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective analysis aimed to elucidate the key factors influencing survival outcomes in patients diagnosed with lymphoma and admitted to an Intensive Care Unit (ICU). Materials and Methods: The study cohort comprised individuals aged 18 or older diagnosed with lymphoma and admitted to the ICU between November 2015 and February 2023. Data were collected on patients' demographic characteristics, primary hematological diagnoses, reasons for ICU admission, laboratory parameters, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, Sequential Organ Failure Assessment (SOFA) scores, clinical trajectory, and 28-day mortality rates. Patients were stratified into two categories based on their mortality outcomes: Survivors and nonsurvivors. Results: A total of 165 patients were included in the study, with a mean age of 52.41 ± 17.99 years; 63% were male. Table 1 summarizes the demographic characteristics, clinical trajectories, and 28-day mortality rates. The APACHE II and SOFA scores of the patients were 34 (7-- 53) and 12 (10--14), respectively. The predominant reasons for ICU admission were sepsis (58.2%) and acute respiratory failure (57.6%). Vasopressor necessity prior to and during ICU stay was 23.6% and 92.4%, respectively. During ICU monitoring, thrombocytopenia, and acute kidney injury (AKI) were observed in 77.6% and 66.4% of patients, respectively; 10% required renal replacement therapy. The 28-day mortality rate was 84.8%. Kaplan- Meier analysis revealed that patients with a SOFA score ≥ 9 had a significantly reduced survival time of 4.5 ± 0.4 days compared to those with lower SOFA scores (14.3 ± 2.6 days). Patients with AKI and those requiring invasive mechanical ventilation (IMV) exhibited reduced survival times of 4.7 ± 0.5 days and 5.6 ± 0.5 days, respectively. Elevated SOFA scores (HR 2.355, 95% CI 1.485--3.734), presence of AKI (HR 1.511, 95% CI 1.055--2.163), and the need for IMV (HR 5.721, 95% CI 1.377--23.770) were significantly correlated with increased 28-day mortality. Receiver Operating Characteristic (ROC) curve analysis identified the optimal SOFA cut-off point for predicting 28-day mortality as nine, with an Area Under the Curve (AUC) of 0.897, sensitivity 83.6% and specificity 92%. Conclusions: The findings of this study underscore the elevated mortality rates among lymphoma patients admitted to the ICU. Our data suggest that several factors serve as significant predictors of 28-day mortality in this patient population. Specifically, elevated APACHE II scores, SOFA scores, the presence of AKI, and the requirement for IMV emerged as crucial indicators associated with adverse survival outcomes. Consequently, these factors warrant meticulous monitoring and could inform targeted interventions to improve survival rates among lymphoma patients in critical care settings. [ABSTRACT FROM AUTHOR]

The APACHE II score is a method for determining disease severity and assessing patient mortality in ICU. The result of measuring the patient's condition was obtained in the first 24 hours of admission to the ICU. Scoring is used to estimate prognostic risk factors for patients who can leave the ICU room in recovering or dying conditions. The length of hospitalization for patients in the Intensive Care Unit (ICU) is on average more than 5 days. The purpose of this study was to determine the relationship between the APACHE II score and the range of days in the Intensive Care Unit (ICU) at RSUD Harapan Insan Sendawar West Kutai. The design of this study was cross-sectional. The sampling technique in this study used accidental sampling, and the research samplers were 30 respondents. The test instrument used the APACHE II Observation sheet. The results of the statistical analysis of the bivariate test using Chi-Square obtained a pvalue of 0.757, which is greater than the alpha value, it means that there is no relationship between the APACHE II score and the range of days of hospitalization in the Intensive Care Unit (ICU) at Harapan Insan Hospital, Sendawar, West Kutai. The Odds Ratio (OR) value was obtained at 0.786, which means that patients who have an APACHE II score were in a low category, and they have an opportunity of 0.786 times to have a range of days of hospitalization in the category of short hospital days. There is no relationship between the APACHE II score and the range of days of hospitalization in the Intensive Care Unit (ICU) at Harapan Insan Hospital, Sendawar, West Kutai. The suggestions for hospital management to add beds in the ICU and the results of the research are expected to be guidelines for patient care in the ICU by using the APACHE II score and improving services in the ICU. [ABSTRACT FROM AUTHOR]

Effectiveness of using inflammatory markers for prognosis assessment in the intensive care units (ICU) is still not clear. The current study aimed to examines the relationship among procalcitonin, C-reactive protein, and neutrophil/lymphocyte ratio of patients who are getting treatment in the ICU during hospitalization and mortality. The study was carried out with a total of 788 patients who were hospitalized in the ICU longer than a day. All participants were over the age of 18 years old. C-reactive protein, procalcitonin, and neutrophil/lymphocyte ratios were compared between the groups of those who died and those who were discharged from the ICU.54.6% (n= 430) of 788 patients who were admitted to the study, were male whereas45.4% (n= 358) of them were female. The median age of the study group was calculated as 79 years (IQR = 19 years) (P<0,001). The univariate Cox regression analysis performed to examine the parameters affecting mortality, the analysissuggested following P-values for the procalcitonin, C-reactive protein, and neutrophil/lymphocyte ratio; <0.001, 0.887, and 0.014 respectively. Conversely, the multivariate Cox regression analysis which is performed to examine the parameters affecting mortalityyielded following P-valuesfor the same variables respectively: 0.242, 0.116, and 0.523. Although inflammatory markers (i.e., C-reactive protein, procalcitonin, and neutrophil/lymphocyte ratios) were high in patients who died, their relationship with mortality in the ICU could not be shown. [ABSTRACT FROM AUTHOR]

Abstract Background We established 1-h and 1-day survival models after terminal extubation to optimize ventilator use and achieve a balance between critical care for COVID-19 and hospice medicine. Methods Data were obtained from patients with end-of-life status at terminal extubation from 2015 to 2020. The associations between APACHE II scores and parameters with survival time were analyzed. Parameters with a p-value ≤ 0.2 in univariate analysis were included in multivariate models. Cox proportional hazards regression analysis was used for the multivariate analysis of survival time at 1 h and 1 day. Results Of the 140 enrolled patients, 76 (54.3%) died within 1 h and 35 (25%) survived beyond 24 h. No spontaneous breathing trial (SBT) within the past 24 h, minute ventilation (MV) ≥ 12 L/min, and APACHE II score ≥ 25 were associated with shorter survival in the 1 h regression model. Lower MV, SpO2 ≥ 96% and SBT were related to longer survival in the 1-day model. Hospice medications did not influence survival time. Conclusion An APACHE II score of ≥ 25 at 1 h and SpO2 ≥ 96% at 1 day were strong predictors of disposition of patients to intensivists. These factors can help to objectively tailor pathways for post-extubation transition and rapidly allocate intensive care unit resources without sacrificing the quality of palliative care in the era of COVID-19. Trial registration They study was retrospectively registered. IRB No.: 202101929B0.

Abstract Background The mortality rate is high in critically ill patients due to the difficulty of diagnosis and treatment. Thus, it is very important to explore the predictive value of different indicators related to prognosis in critically ill patients. Methods This was a retrospective cohort study of patients in the intensive care unit (ICU) of the Sixth People’s Hospital in Shanghai, China. A total of 1465 ICU patients had lactate values > 2.1 mmol/L at least once within 24 h of ICU admission, and arterial blood gas was monitored more than twice during the ICU stay. Results The predictive value of lactate clearance at 24 h was not high, and the sensitivity and specificity were lower. The predictive value of the lactate level at baseline and the APACHE II score was higher than that of lactate clearance at 24 h in critically ill patients. The predictive value of the lactate level at baseline combined with the APACHE II score was higher than that of the lactate level at baseline or the APACHE II score alone. In addition, the predictive value of lactate clearance at 24 h combined with the APACHE II score was also significantly higher than that of lactate clearance at 24 h or the APACHE II score alone. In particular, the area under the ROC curve reached 0.900, the predictive value was markedly higher than that of the ROC alone, and the sensitivity and specificity were better when these three indicators were combined. Conclusions The combination of lactate level, lactate clearance and APACHE II score better predicts short-term outcomes in critically ill patients.

Abstract Background Maternal mortality is still a major challenge for health systems, while severe maternal complications are the primary causes of maternal death. Our study aimed to determine whether severe maternal morbidity is effectively predicted by a newly proposed Modified Obstetric Early Warning Score (MOEWS) in the setting of an obstetric intensive care unit (ICU). Methods A retrospective study of pregnant women admitted in the ICU from August 2019 to August 2020 was conducted. MOEWS was calculated 24 h before and 24 h after admission in the ICU, and the highest score was taken as the final value. For women directly admitted from the emergency department, the worst value before admission was collected. The aggregate performance of MOEWS in predicting critical illness in pregnant women was evaluated and finally compared with that of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Results A total of 352 pregnant women were enrolled; 290 women (82.4%) with severe maternal morbidity were identified and two of them died (0.6%). The MOEWSs of women with serious obstetric complications were significantly higher than those of women without serious obstetric complications [8(6, 10) vs. 4(2, 4.25), z = -10.347, P

BACKGROUND AND AIM: Readmission of patients discharged from the intensive care unit (ICU) to the ICU is common and increases mortality. The Stability and Workload Index for Transfer (SWIFT) score is a scoring system developed and validated to predict the risk of readmission to the ICU. We evaluated the usability of this scoring system in patients with respiratory failure in a pulmonary intensive care unit (PICU). METHODS: This study was a retrospective cross-sectional study that included patients hospitalized in the PICU between January 1, 2020, and December 31, 2020. Patients who were discharged to the clinic or home and readmitted in the first 7–30 days were included in the study. Patients referred to an upper-level ICU or another hospital and those who died in the hospital were excluded from the study. RESULTS: A total of 442 patients received inpatient treatment during the study period, and 421 patients were included. Eight (1.9%) patients were readmitted within the first 7 days, and 25 (5.9%) patients were readmitted within 7–30 days. There was no significant difference between the SWIFT score, Acute Physiology and Chronic Health Evaluation II (APACHE II), and modified Charlson Comorbidity Index (mCCI) scores of the readmitted patients and those who were not. We calculated the area under the curve value for the SWIFT score as 0.548 (95% CI: 0.440–0.656). CONCLUSIONS: For patients discharged from the PICU, neither the SWIFT score nor APACHE II and mCCI were not sufficient to predict readmission. This study showed that existing scoring systems is insufficient to predict the readmission of patients with respiratory failure, and there is still a need for scoring systems to predict the readmission of these patients. [ABSTRACT FROM AUTHOR]

Aim: Psoas abscess is rare infectious condition with frequent complications in the diagnosis and treatment process. Unfortunately, there is limited information in the literature about the prognostic factors that determine the prognosis of psoas abscess. Therefore, the aim of this study was to evaluate the clinical and laboratory parameters associated with recurrence in primary psoas abscess. Material and Methods: Fifty-two patients who were diagnosed with psoas abscess and treated with surgical drainage in a university hospital between 1998 and 2018 were included in our study. The patients were seperated into two groups as those who recovered after surgical drainage (Group A) and those who developed recurrence (Group B). Clinical and laboratory data of the patients from the beginning of the preoperative period to the postoperative period were compared. Results: The mean age was 47.42±14.12 years in Group A and 53.81±15.83 years in Group B. The mean follow-up time was 43.96±14.29 months. The neutrophil to lymphocyte ratio was 11.38±1.69 in Group A and 18.75±2.31 in Group B (p=0.001). The platelet to lymphocyte ratio was 114.96±30.31 in Group A and 139.70±42.25 in Group B (p=0.016). The Acute Physiology and Chronic Health Evaluation (APACHE II) score was higher in Group B (p=0.001). Conclusion: According to the results of the current study, the neutrophil to lymphocyte ratio, the platelet to lymphocyte ratio, the APACHE II score, and the delayed diagnosis are all important prognostic indicators linked to recurrence in instances with primary psoas abscess. [ABSTRACT FROM AUTHOR]

Studies have shown that vagus nerve-mediated inflammatory reflex could inhibit cytokine production and inflammation in sepsis animals. This study aimed to explore the efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) on inflammation and disease severity of sepsis patients. A randomized, double-blind, sham-controlled pilot study was performed. Twenty sepsis patients were randomly assigned to receive taVNS or sham stimulation for five consecutive days. Stimulation effect was assessed with serum cytokine levels, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, and Sequential Organ Failure Assessment (SOFA) score at baseline and on Day 3, Day 5, and Day 7. TaVNS was well tolerated in the study population. Patients receiving taVNS experienced significant reductions in serum TNF-α and IL-1β levels and increases in IL-4 and IL-10 levels. SOFA scores decreased on Day 5 and Day 7 compared with baseline in the taVNS group. However, no changes were found in sham stimulation group. The changes of cytokine from Day 7 to Day 1 were greater with taVNS than sham stimulation. No differences in the APACHE Ⅱ score and SOFA score were observed between the two groups. TaVNS resulted in significantly lower serum pro-inflammatory cytokines and higher serum anti-inflammatory cytokines in sepsis patients. • The first clinical study on transcutaneous auricular vagus nerve stimulation in sepsis patients. • Transcutaneous auricular vagus nerve stimulation significantly inhibits proinflammatory cytokine produce. • Transcutaneous auricular vagus nerve stimulation significantly increases anti-inflammatory cytokine produce. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: We established 1-h and 1-day survival models after terminal extubation to optimize ventilator use and achieve a balance between critical care for COVID-19 and hospice medicine. Methods: Data were obtained from patients with end-of-life status at terminal extubation from 2015 to 2020. The associations between APACHE II scores and parameters with survival time were analyzed. Parameters with a p-value ≤ 0.2 in univariate analysis were included in multivariate models. Cox proportional hazards regression analysis was used for the multivariate analysis of survival time at 1 h and 1 day. Results: Of the 140 enrolled patients, 76 (54.3%) died within 1 h and 35 (25%) survived beyond 24 h. No spontaneous breathing trial (SBT) within the past 24 h, minute ventilation (MV) ≥ 12 L/min, and APACHE II score ≥ 25 were associated with shorter survival in the 1 h regression model. Lower MV, SpO2 ≥ 96% and SBT were related to longer survival in the 1-day model. Hospice medications did not influence survival time. Conclusion: An APACHE II score of ≥ 25 at 1 h and SpO2 ≥ 96% at 1 day were strong predictors of disposition of patients to intensivists. These factors can help to objectively tailor pathways for post-extubation transition and rapidly allocate intensive care unit resources without sacrificing the quality of palliative care in the era of COVID-19. Trial registration They study was retrospectively registered. IRB No.: 202101929B0. [ABSTRACT FROM AUTHOR]

Background: The mortality rate is high in critically ill patients due to the difficulty of diagnosis and treatment. Thus, it is very important to explore the predictive value of different indicators related to prognosis in critically ill patients. Methods: This was a retrospective cohort study of patients in the intensive care unit (ICU) of the Sixth People's Hospital in Shanghai, China. A total of 1465 ICU patients had lactate values > 2.1 mmol/L at least once within 24 h of ICU admission, and arterial blood gas was monitored more than twice during the ICU stay. Results: The predictive value of lactate clearance at 24 h was not high, and the sensitivity and specificity were lower. The predictive value of the lactate level at baseline and the APACHE II score was higher than that of lactate clearance at 24 h in critically ill patients. The predictive value of the lactate level at baseline combined with the APACHE II score was higher than that of the lactate level at baseline or the APACHE II score alone. In addition, the predictive value of lactate clearance at 24 h combined with the APACHE II score was also significantly higher than that of lactate clearance at 24 h or the APACHE II score alone. In particular, the area under the ROC curve reached 0.900, the predictive value was markedly higher than that of the ROC alone, and the sensitivity and specificity were better when these three indicators were combined. Conclusions: The combination of lactate level, lactate clearance and APACHE II score better predicts short-term outcomes in critically ill patients. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality is still a major challenge for health systems, while severe maternal complications are the primary causes of maternal death. Our study aimed to determine whether severe maternal morbidity is effectively predicted by a newly proposed Modified Obstetric Early Warning Score (MOEWS) in the setting of an obstetric intensive care unit (ICU).Methods: A retrospective study of pregnant women admitted in the ICU from August 2019 to August 2020 was conducted. MOEWS was calculated 24 h before and 24 h after admission in the ICU, and the highest score was taken as the final value. For women directly admitted from the emergency department, the worst value before admission was collected. The aggregate performance of MOEWS in predicting critical illness in pregnant women was evaluated and finally compared with that of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score.Results: A total of 352 pregnant women were enrolled; 290 women (82.4%) with severe maternal morbidity were identified and two of them died (0.6%). The MOEWSs of women with serious obstetric complications were significantly higher than those of women without serious obstetric complications [8(6, 10) vs. 4(2, 4.25), z = -10.347, P < 0.001]. MOEWSs of 24 h after ICU admission had higher sensitivity, specificity and AUROC than MOEWSs of 24 h before ICU admission. When combining the two MOEWSs, sensitivity of MOEWS was 99.3% (95% CI: 98-100), specificity 75.8% (95% CI: 63-86), positive predictive value (PPV) 95.1% (95% CI: 92-97) and negative predictive value (NPV) 95.9% (95% CI: 86-100). The areas under the receiver operator characteristic (ROC) curves of MOEWS were 0.92 (95% CI: 0.88-0.96) and 0.70 (95% CI: 0.63-0.76) of the APACHE II score.Conclusion: The newly proposed MOEWS has an excellent ability to identify critically ill women early and is more effective than APACHE II. It will be a valuable tool for discriminating severe maternal morbidity and ultimately improve maternal health. [ABSTRACT FROM AUTHOR]

Abstract Aim This study aimed to investigate the effect of early intervention on the short‐term prognosis of patients with myocardial injury induced by acute carbon monoxide poisoning (ACOP). Methods and results We performed a retrospective cohort study of 139 patients admitted to the hospital for ACOP‐induced acute toxic cardiopathy. Compared with the mild and moderate toxic cardiopathy group, the severe toxic cardiopathy group has significantly increased coma time, acute physiology and chronic health status (APACHE) II score, and the length of hospital stay and significantly reduced proportion of patients with immediate endotracheal intubation and early admission to intensive care unit (ICU) (all P

Ying-Yi Luan,1,&ast; Yan-Hong Chen,2,&ast; Xue Li,3 Zhi-Peng Zhou,2 Jia-Jia Huang,2,4 Zhen-Jia Yang,2,4 Jing-Jing Zhang,2,5 Ming Wu2,4,6 1Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, People’s Republic of China; 2Department of Critical Care Medicine and Hospital Infection Prevention and Control, Shenzhen Second People`s Hospital & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, 518035, People’s Republic of China; 3Department of Emergency, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, People’s Republic of China; 4Shantou University Medical College, Shantou, 515041, People’s Republic of China; 5Department of Critical Care Medicine, Pingshan District People’s Hospital of Shenzhen, Shenzhen, 518118, People’s Republic of China; 6Guangxi University of Chinese Medicine, Nanning, 530200, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ming Wu Tel +86 755 83676149Email boshiyy@126.comBackground: Increasing evidence indicates carbapenem-resistant Klebsiella pneumoniae (CrKP) is increasingly prevalent in intensive care unit (ICU), but its clinical characteristics and risk factors remain unknown.Aim: The aim of the present study was to evaluate clinical characteristics, risk factors in critically ill patients with CrKP infection.Methods: A retrospective study was included in patients from January 2013 to October 2019. Clinical data were collected from CrKP patients on the day of specimen collection admitted to ICU. Multivariable logistic regression was used for risk factors. Receiver operating curve (ROC) and the area under the curve (AUC) with DeLong method of MedCalc software were used. Two-way repeated-measures ANOVA analysis was used to analyze the characteristics of independent risk factors over time.Findings: A total of 147 adult patients with CrKP were screened, among them, 89 (median age 64.0 years, 66 (74.15%) males) patients with CrKP were finally included, of which 38 patients (42.7%) were non-survival group. Multivariate logistic regression analysis indicated that lactic acid (OR3.04 95% CI 1.38– 6.68, P = 0.006), APACHE II score (OR 1.20, 95% CI 1.09– 1.33, P < 0.001), tigecycline combined with fosfomycin treatment (OR0.15, 95% CI 0.04– 0.65, P = 0.011) are independent risk factors for 28-day mortality in patients with CRKP infection (P< 0.05). Combined lactic acid with APACHE II score could predict 28-day mortality, of which AUC value was 0.916 (95% CI, 0.847– 0.985), with sensitivity 0.76 and specificity 0.98. ANOVA analysis showed that APACHE II score and lactic acid between the two groups at three-time points were statistically significant, which interactive with time and showed an upward and downward trend with time (P < 0.05).Conclusion: Therapeutic strategy based on improving lactic acid and APACHE II would contribute to the outcome in patients with CrKP infection. Tigecycline combined with fosfomycin could reduce the 28-day mortality in patients with CrKP infection in developing country.Keywords: carbapenem resistant Klebsiella pneumoniae, lactic acid, APACHE II score, tigecycline, fosfomycin, mortality

Objective: Acinetobacter baumannii is one of the most important pathogenic bacteria causing nosocomial infections and has a high mortality rate. Assessment of the microbiological characteristics and risk factors on prognosis associated with A.baumannii is essential. In this study, we aimed to investigate the clinical characteristics and prognostic risk factors of patients with A.baumannii bacteremia. Patients and Methods: This study retrospectively analyzed the antibiotic resistance of pathogens based on the clinical data of A.baumannii bacteremia patients presented in a tertiary teaching hospital from 2017 to 2022. Logistic regression and decision tree identified the prognostic risk factors for patients with baumannemia. Kaplan-Meier method was used for survival analysis between MDR and Non-MDR groups. The area under receiver-operating characteristic curve (ROC curve) was used to compare the predictive value of the APACHE II score and Sequential Organ Failure Assessment (SOFA) score. Results: A total of 110 patients with positive A. Baumannii blood cultures were included. Most of the patients were from intensive care unit (ICU) wards. The drug sensitivity results showed that the resistance rate of A. baumannii to colistin was the lowest (1.1%), followed by tigecycline (3.6%). The survival time of MDR group was significantly shorter than that of Non- MDR group. Multivariate analysis showed that, APACHE II score and SOFA score were independent risk factors affecting the prognosis of 28 days of A.baumannii bacteremia. And both scores displayed excellent AUROCs (SOFA: 0.909, APACHE II: 0.895 in predicting 28-day mortality). The two scoring systems were highly correlated and predicted no significant difference (r2 = 0.4410, P < 0.001). We found that SOFA > 7 and APACHE II > 21 are associated with significantly higher mortality rates. Conclusion: A.baumannii bacteremia have the highest incidence in the ICU, with high drug resistance and mortality rates. The survival time of patients with MDR A. Baumannii bacteremia was significantly shortened. The SOFA score and APACHE II score can reflect the severity of A.baumannii bacteremia patients and evaluate the 28-day prognosis. In addition, for the convenience of calculation, the SOFA score may be more clinically useful than the APACHE II score in predicting the mortality rate of A.baumannii bacteremia. [ABSTRACT FROM AUTHOR]

Objective: To study the clinical efficacy of cefoperazone/sulbactam combined with tegacyclin in the treatment of carbapenem resistant acinetobacter baumannii infection and its effect on the acute physiology and chronic health（APACHE Ⅱ） score and the levels of serum C-reactive protein（CRP） and procalcitonin（PCT）, so as to provide basis for the prevention and control of carbapenem resistant acinetobacter baumannii infection. Methods: 80 patients with carbapenem resistant acinetobacter baumannii infection collected from December 2018 to December 2021 were selected as the research objects. All subjects were randomly divided into observation group（40 cases） and control group（40 cases） by coin tossing method. The control group was treated with cefoperazone/sulbactam, and the observation group was treated with cefoperazone/sulbactam combined with tegacyclin.After 7 days of treatment, the total effective rate and total bacterial clearance rate of the two groups were compared. The changes of APACHE Ⅱ score, CRP and PCT levels before and after treatment were compared. Results: After 7 days of treatment, the total effective rate of the observation group was 72.50%（29/40）,which was significantly higher than that of the control group(40.00%（16/40）, and the difference was statistically significant（P<0.05）.After 7 days of treatment, the total bacterial clearance rate in the observation group was 67.50%（27/40）, higher than 30.00%（12/40） in the control group, and the difference was statistically significant（P<0.05）. There was no significant difference in APACHE Ⅱ score, CRP and PCT levels between the two groups before treatment（P>0.05）; After 7 days of treatment, APACHE Ⅱ score, CRP and PCT levels in the two groups decreased, and the observation group was significantly lower than that in the control group. The difference between the two groups was statistically significant（P<0.05）. Conclusion: The clinical effect of cefoperazone/sulbactam combined with tegacyclin in the treatment of carbapenem resistant acinetobacter baumannii infection is significant,which is conducive to alleviate the inflammatory reaction of patients, improve their clinical symptoms and control infection, and is worthy of clinical application. [ABSTRACT FROM AUTHOR]

Background: The sudden outbreak of the COVID-19 pandemic has caused tremendous challenges to the medical system. The government and hospitals have taken robust measures to curb the spread of the deadly virus. Its impact on routine medical services is gradually being taken seriously. Objective: To identify the impact of the novel Coronavirus pandemic on emergency department (ED) patient flow and the performance of the routine ED service. Methods: This retrospective cohort study was undertaken in a tertiary public teaching hospital ED in Chengdu, China. ED data of patients were routinely collected to compare demographic, clinical characteristics and outcomes during an 8-week period from January 1, 2019 to February 25, 2020. Data were analyzed with the chi-square statistical test. Results: Over the study periods, there were 31855 and 25244 patients presented to the ED in 2019 and 2020 respectively. During the pandemic period in 2020, the daily number of average ED visits was lower than that in 2019 (430 ± 134.9 versus 572 ± 38.6, P = 0.00), with fewer triage 1&2 cases (145 ± 33.3 versus 178 ± 15.0, P = 0.00). Nevertheless, the mortality increased remarkably during the pandemic period in 2020 (0.2% versus 0.1%, P = 0.009), with higher APACHE II scores (28 versus 19, P = 0.022) and shorter ED elapsed time (0.2 versus 1.4 days, P = 0.016) among these death cases. Conclusions: The COVID-19 pandemic had an evident impact on the patient's behavioral patterns and routine emergency services, which caused higher ED mortality. [ABSTRACT FROM AUTHOR]

Introduction Critical illness refers to life-threatening conditions requiring mechanical or pharmacological intervention to maintain organ function. Prognostic models, such as the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores, have been widely used to predict mortality in intensive care unit (ICU) patients. Lactate levels are emerging as a valuable biomarker in this context. This study aims to determine the prognostic value of lactate levels upon admission in critically ill patients and to assess their correlation with SOFA and APACHE II scores. Methods This descriptive cross-sectional study included 200 critically ill patients admitted to the emergency department over one year. Data on patient demographics, clinical findings, and laboratory results were collected, and lactate levels and SOFA and APACHE II scores were measured at the time of admission. Patients were followed throughout their hospital stay, with outcomes classified as survival or mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of lactate, SOFA, and APACHE II scores. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States). Results The mean age of the patients was 56.8±16.9 years; 110 (55%) were men, and 90 (45%) were women. In total, 79 patients (39.5%) were non-survivors, and 121 (60.5%) were survivors. Lactate levels were significantly higher in non-survivors (3.56±1.90 mmol/L) compared to survivors (1.47±0.82 mmol/L) (p<0.001). The SOFA and APACHE II scores were also significantly higher in non-survivors (SOFA: 6.35±3.19; APACHE II: 19.91±8.21) than in survivors (SOFA: 3.14±2.02; APACHE II: 12.45±5.76) (p<0.001). The ROC curve analysis showed that lactate had an area under the curve (AUC) of 0.909, SOFA had an AUC of 0.809, and APACHE II had an AUC of 0.769 for predicting mortality. Conclusions Lactate levels are a highly sensitive predictor of mortality in critically ill patients, with significant correlations to SOFA and APACHE II scores. Lactate, as a single rapid test, provides substantial prognostic information and can aid in early triage and clinical decision-making, particularly in resource-limited settings. A single arterial lactate measurement at admission is an effective tool for predicting patient outcomes in the ICU., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee of Maharishi Markandeshwar Institute of Medical Sciences and Research issued approval IEC/2518/2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kumrawat et al.)

Objective: Acute Physiology and Chronic Health Evaluation II (APACHE II) is based on the data of intensive care unit (ICU) patients and often correlates with disease severity and prognosis. However, no prognostic predictors exist based on ICU admission data for patients with brain tumors, and no studies have reported an association between APACHE II and prognosis in patients with brain tumors. The Japanese Intensive Care Patients Database (JIPAD) was established to improve the quality of care delivered in intensive care medicine in Japan. We used JIPAD to examine factors associated with in-hospital mortality based on available data of postoperative patients with brain tumors admitted to the ICU., Methods: Patients aged ≥16 years enrolled in JIPAD between April 2015 and March 2018 after surgical brain tumor resection or biopsy of brain tumors. We examined factors related to outcomes at discharge based on blood tests and medical procedures performed during ICU admission, tumor type, and APACHE II score., Results: Among the 1454 patients (male:female ratio: 1:1.1, mean age: 62 years) in the study, 32 (2.2 %) died during hospital stay. In multivariate analysis, male sex (odds ratio [OR] 2.70, [95 % confidence interval, CI 1.22-6.00]), malignant tumor (OR 2.51 [95 % CI 1.13-5.55]), and APACHE II score ≥15 (OR 2.51 [95 % CI 3.08-14.3]) were significantly associated with in-hospital mortality., Conclusion: By picking up cases with a high risk of in-hospital death at an early stage, it is possible to improve methods of treatment and support for the patient's family., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: In acute and chronic phases of severe diseases, endocrine changes occur. Some hormones, such as prolactin (PRL) and thyroid hormones, were considered predictors of ICU patients' outcomes. The present study evaluates thyroid hormone profile, serum PRL level, and their relationship with ICU poisoned patients' mortality rate.Methods: This study included 140 inpatients in the Toxicology Intensive Care Unit (TICU) who enrolled in a prospective study of a single center and observational. After admission to the ICU, the researchers collected venous blood samples from all patients directly. Concurrently, the APACHE II score was calculated. The collected samples analysis was performed based on the entire triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), and PRL level.Results: One hundred and forty subjects were studied, of which 109 (75.85%) were male with a mean age of 34.17 ± 14.01. One hundred and eighteen patients were survivors with a mean age of 33.29 ±13.76. In contrast, 22 patients with a mean age of 38.91 ±14.69 died. The model of PRL combined with APACHE II score (OR 1.17, 95% CI 1.06 to 1.28, P-value =0.001) was the best model for predicting post-ICU mortality in our study.Conclusions: This study’s results are consistent with the previous research, indicating a higher incidence of thyroid and PRL hormone changes in patients hospitalized in the ICU. It can be concluded that the presence of PRL based on the APACHE II score can lead us to be more precise in predicting the outcome of poisoning in hospitalized patients.

This research aims to explore the influence of seamless nursing mode of humanistic care on nursing quality and blood infection risk of ICU patients in neurosurgery, and the model of correlation with APACHE II score. 110 ICU patients are grouped into control set and study set, which are, respectively, given the previous routine nursing and the seamless management based on humanistic care to compare the two sets in the following aspects: nursing quality, blood infection rate, anxiety and depression extension before and after nursing, nursing satisfaction and APACHE II score, and to figure out the correlation between patient nursing quality score, and to compare blood infection and APACHE II score. Comparison and statistical analysis are used to disclose the influence and the correlation. The results show that there is not only a large negative correlation between nursing quality scores and APACHE II scores, but also a large negative correlation between the risk of blood infection and APACHE II score.

Objective: To investigate the value of serum uromodulin (UMOD), heparin-binding protein (HBP), Klotho protein combined with Acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ) score in predicting the 28-day prognosis in patients with sepsis complicated with acute kidney injury (AKI) . Methods: 120 patients with sepsis complicated with AKI who were diagnosed and treated in our hospital from January 2018 to January 2020 were selected as the research object. According to the survival within 28 days, they were divided into survival group (86 cases) and death group (34 cases) . Enzyme linked immunosorbent assay was used to detect the expression levels of serum UMOD, HBP and Klotho proteins in each group. The expression of serum UMOD, HBP, Klotho protein and APACHE Ⅱ score difference in patients with AKI at different stages were compared. Multivariate Logistic regression analysis was used to analyze the risk factors affecting the 28 day prognosis of patients with sepsis complicated with AKI. The receiver operating characteristic (ROC) curve was used to analyze the value of serum UMOD, HBP, Klotho protein and APACHE Ⅱ score alone and in combination in predicting the 28 day prognosis of patients with sepsis complicated with AKI. Results: Compared with the survival group, the serum UMOD and Klotho in the death group were lower, and the procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), HBP and APACHE Ⅱ scores were higher (all P<0.05) . There were significant differences in the serum UMOD, HBP, Klotho and APACHE Ⅱ scores in patients with different AKI stages (all P<0.05) . Multivariate Logistic regression analysis showed that UMOD <62.43 mg/mL and HBP > 30.14 μg/L, Klotho ≤ 180.37 ng/L and APACHE Ⅱ score > 16.00 scores were the risk factors affecting the prognosis of 28 day death. The area under the curve of the combined prediction of serum UMOD, HBP, Klotho and APACHE Ⅱ score for 28 day death in patients with sepsis complicated with AKI was 0.897 (0.842 ～ 0.939), which was significantly higher than that of the single detection of serum UMOD [0.724 (0.674 ～ 0.765) ], HBP [0.666 (0.622 ～ 0.710) ], Klotho [0.767 (0.731 ～ 0.804) ] and APACHE Ⅱscore [0.840 (0.802 ～ 0.878) ]. Conclusions: Serum UMOD and Klotho decrease, HBP level increases and APACHE Ⅱ score is higher in patients with sepsis complicated with AKI, which are related to the severity of sepsis complicated with AKI. The combination of the four can help to predict 28 days death of sepsis complicated with AKI. [ABSTRACT FROM AUTHOR]

Intra-abdominal hypertension (IAH) is a known but neglected complication in acute pancreatitis. The present study was conducted to establish the role of intra-abdominal pressure (IAP) as a prognostic marker in patients with acute pancreatitis and also to correlate IAP with APACHE II and SOFA scores. A prospective observational single-center cohort study was conducted on adult patients diagnosed with acute pancreatitis. Intra-abdominal pressure was measured through a transurethral Foley's bladder catheter. APACHE II and SOFA scores were calculated at the time of admission (day 1). APACHE II score was reevaluated on day 3 and 5. SOFA score was reevaluated everyday till day 5. APACHE II score, SOFA score, and IAP at admission were significantly higher among non survivors when compared to survivors. There was significant correlation of IAP with APACHE II and SOFA scores. APACHE II and SOFA scores at cut-off values of 12 and 6 predicted IAP of > 12 (mm of Hg) with reasonable sensitivity and specificity. IAP could be used as a reliable negative prognostic marker in acute pancreatitis. APACHE II and SOFA scores could be used to predict intra-abdominal hypertension in patients of acute pancreatitis. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the effects of linazolamine combined with Shenfu injection intervention on serum tumor necrosis factor α (TNF-α), procalcitonin (PCT), hypersensitivity C-reactive protein (hs-CRP) levels and and acute physiological and chronic health evaluation Ⅱ (APACHE Ⅱ) score in patients with sepsis. METHODS: Totally 197 patients with sepsis admitted into Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine Hospital from Jan. 2019 in Jan. 2021 were selected for retrospectively analysis, which were divided into control group and observation group according to the admission time. The 98 patients in the control group were treated with linazolamine injection, while the 99 patients in the observation group was given linazolamine combined with Shenfu injection. Changes of TNF-α, PCT, hs-CRP levels and APACHE Ⅱ score before and after treatment were compared between two groups. RESULTS: The serum TNF-α, PCT, hs-CRP levels and APACHE Ⅱ score in the observation group were significantly lower than those of the control group,with statistically significant differences (P<0. 05). All the TNF-α, PCT, hs-CRP levels and APACHE Ⅱ score were independent risk factors affecting the prognosis of patients with sepsis (P<0. 05), the APACHE Ⅱ score was positively associated with TNF-α, PCT and hs-CRP expression (P <0. 05). CONCLUSIONS: All the TNF-α, PCT, hs-CRP expression and APACHE Ⅱ score were independent risk factors of patients with sepsis, and the treatment of linazolamine combined with Shenfu injection can improve the clinical efficacy. [ABSTRACT FROM AUTHOR]

Background: The presence of pneumonia in patients with traumatic brain injury (TBI) is associated with high fatality and poor outcomes. Patients with severe TBI are often admitted to the intensive care unit, in which the utilization of APACHE II score is commonly used to predict mortality risk. Therefore, we aimed to evaluate the association between the APACHE II score and the incidence of ventilator-associated pneumonia (VAP) in patients with severe TBI. Methods: This was a retrospective study. A total of 32 patients with severe TBI who were admitted to the intensive care unit at Dr. Hasan Sadikin Hospital from January 1, 2018 – December 31, 2019, were investigated in this study. The patients were assessed for APACHE II score within 24 h of admission and the occurrence of VAP. Results: To define the risk of having VAP in patients with severe TBI, we analyzed APACHE II score using ROC analysis. We identified that a value of 15 as a cut-off for the APACHE II score for predicting VAP occurrence in patients with severe TBI (p = 0.0307). Then, we evaluated the reliability of the APACHE II score as a predictor of VAP occurrence compared to the duration of mechanical ventilation and tracheostomy. In subsequent analysis, high APACHE II score (OR = 10.20 (1.21–229.90), p = 0.0385) and prolonged mechanical ventilation (OR = 27.59 (2.27–1149.00), p = 0.0067) were associated with a higher chance of having VAP during the period of hospitalization. Conclusion: Patients with severe TBI with a high APACHE score (≥15) or prolonged mechanical ventilation (15 days) are at higher risk for having VAP during the period of hospitalization.

Background: The APACHE II score assesses patient prognosis in intensive care units. Different disease entities are predictable by using a specific factor called Diagnostic Category Weight (DCW). We aimed to validate the prognostic value of the APACHE II score in patients treated with a percutaneous left ventricular assist device because of refractory cardiogenic shock (CS). Methods: From the Dresden Impella Registry, we analyzed 180 patients receiving an Impella CP®. The main outcome was the observed intrahospital mortality (S^(thosp)), which was compared to the predicted mortality estimated by the APACHE II score. Results: The APACHE II score, which was 33.5 ± 0.6, significantly overestimated intrahospital mortality (S^(thosp) 54.4 ± 3.7% vs. APACHE II 74.6 ± 1.6%; p

Aim: This study aimed to investigate the effect of early intervention on the short‐term prognosis of patients with myocardial injury induced by acute carbon monoxide poisoning (ACOP). Methods and results: We performed a retrospective cohort study of 139 patients admitted to the hospital for ACOP‐induced acute toxic cardiopathy. Compared with the mild and moderate toxic cardiopathy group, the severe toxic cardiopathy group has significantly increased coma time, acute physiology and chronic health status (APACHE) II score, and the length of hospital stay and significantly reduced proportion of patients with immediate endotracheal intubation and early admission to intensive care unit (ICU) (all P < 0.05). The cardiac troponin I (cTnI) levels and corrected QT dispersion (QTcd) duration in three patient groups were significantly higher (all P < 0.05) than those in the control group, with the highest in the severely toxic heart disease group. Serum cTnI level and QTcd duration were two independent predictors of myocardial injury in ACOP patients. There was a positive correlation between the APACHE II score and serum cTnI level/QTcd duration at admission. The sensitivities of cTnI and QTcd at admission to diagnose serious cardiovascular events were 78.6% and 85.7%, respectively, and the specificities were both 75%. Conclusions: Acute carbon monoxide poisoning patients with myocardial injury need to be admitted to the hospital as early as possible. For patients with severe hypoxia, an artificial airway should be established as early as possible, and patients should be admitted to the monitoring ward to stabilize their condition at the early stage of poisoning. Meanwhile, changes in QTcd, serum cTnI, and creatine kinase‐MB (CK‐MB) should be closely observed. [ABSTRACT FROM AUTHOR]

Background: The acute physiology and chronic health evaluation (APACHE) II severity score has shown a good calibration and discriminatory value across a range of disease processes and remains the most widely used source of prognostic information on the risk for death in patients admitted to intensive care units (ICUs). Objectives: To study APACHE II scores in patients of acute kidney injury (AKI) admitted in the ICU and to find its association with outcome. Materials and methods: One hundred patients with AKI aged 18 years or above were admitted in the ICU, department of general medicine, of a tertiary care institute in Haryana, North India, from October 2019 to September 2020, were studied. Patients who had known causes of chronic kidney disease (CKD), on maintenance hemodialysis, and those who underwent renal replacement therapy (RRT) or nephrectomy were excluded. All required investigations were performed, and data were collected. The patients were followed till discharge or in-hospital mortality. Results: The mean age of the patients was 55.92 ± 18.18 years. Male-female ratio was 1.5:1. Thirty-five percent of the admitted patients had an in-hospital mortality. Sepsis (47%) was the most common cause of AKI, and 83% of the patients had underlying comorbid conditions. The mean APACHE II score of the expired patients on admission, i.e., 24.80 ± 13.65, was found to be significantly higher compared to the mean APACHE II score (17.25 ± 10.12) of the discharged patients (p-value <0.001). APACHE II score was found to have 57.14% sensitivity, 86.15% specificity, 69% PPV, 78.9% NPV, and 76% diagnostic accuracy to predict mortality among the AKI patients. Conclusion: APACHE II scoring system has a good discrimination and calibration when applied to ICU-admitted AKI patients and is a good predictor of prognosis in them. [ABSTRACT FROM AUTHOR]