PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “APACHE III”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources
PubMed2003

[Analysis of acute physiology and chronic health evaluation III in the 54 patients with severe acute respiratory syndrome].

OBJECTIVE: To evaluate the acute physiology and chronic health evaluation III (APACHE III) in the severe acute respiratory syndrome (SARS) patients and its significance in prognosis. METHODS: The clinical data of 54 SARS patients, including survivors (43 cases) and nonsurvivors (11 cases) were collected and evaluated with APACHE III scoring system. The correlation of scores and prognosis was evaluated. RESULTS: The scores of the nonsurvivors were higher remarkably than those of the surviving group(P<00.01). The scores of the acute physiology score (APS) and year score (YS) in the death group were higher obviously than those of the surviving group(both P<0.01). Elderly patients with severe disease had a high mortality. The scores of APACHE III had positive correlation with the over all fatality rate. When the scores of APACHE III was higher than 60, the fatality rate increased obviously. CONCLUSION: The scores of APACHE III in the SARS are correlated with the patient's condition and prognosis.

APACHE↗
PubMed2005

[Study of continuous blood purification in severe pneumonia patients with multiple organ failure].

OBJECTIVE: To review retrospectively the effect of continuous blood purification (CBP) on septic shock with acute renal failure and respiratory failure as a result of severe pneumonia, and to analyze its relationship with prognosis. METHODS: Twenty-five patients diagnosed as severe pneumonia with varying degrees of multiple organ failure (MOF), septic shock and anuria, were allocated into three groups based on outcome of the patients A (7 patients), died of progressive worsening of septic shock, (9 patients, yet died of severe pneumonia afterwards). Laboratory data and critical scored of the patients 1 day before and 24, 48, and 72 hours after the initiation of CBP were compared among the three groups. RESULTS: (1) The survival rate in group A was 28%, while the combined fatality in groups B and C was 72%. (2) CBP was forced to be stopped in group B patients within less than 48 hours from the start of treatment. Single-factor analysis suggested: group B exhibited higher level of blood sugar compared with group A [(13.17+/-5.84) mmol/L vs. (8.07+/-2.28) mmol/L, P<0.05], and higher fibrinogen levels compared with group C[(5.75+/-3.08) g/L vs. (3.10+/-1.06) g/L, P<0.05] before the treatment. Forty-eight hours after the initiation of CBP, patients in group B exhibited higher fibrinogen and dopamine levels compared with those of groups A and C [(8.24+/-3.57) g/L vs. (5.13+/-0.94) g/L, (3.01+/-1.22) g/L, P<0.05 and (12.00+/-6.93) microgxkg(-1)xmin(-1) vs. (1.00+/-2.45) microgxkg(-1)xmin(-1), (2.89+/-4.37) microgxkg(-1)xmin(-1), P<0.05, respectively]. (3) Acute physiology and chronic health evaluation III (APACHE III) score of group A before treatment was significantly lower than those in groups B and C (89.43+/-11.28 vs. 108.00+/-15.10 and 104.67+/-13.77, both P<0.05). After 72 hours of CBP treatment, patients in groups A and C showed significantly different changed in APACHE II scores compared with group B (-10.43+/-4.89, -9.11+/-3.76 vs. -2.33+/-4.39, P<0.05) and APACHE III scores (-2.14+/-2.19, -1.00+/-1.87 vs. 0.56+/-1.88, P<0.05). CONCLUSION: (1) CBP is curative for some patients in septic shock with acute renal failure and respiratory failure as a result of severe pneumonia, with and overall survival rate of 28%. (2) APACHE III score is a sensitive index before and after CBP treatment, and scores of 90-100 may be taken as an indication for CBP. (3) High blood sugar and fibrinogen levels may be potential risk factors, in particular, a high fibrinogen level implies a poor prognosis.

Adult↗
PubMed1999

Relationship of systemic inflammatory response syndrome to organ dysfunction, length of stay, and mortality in critical surgical illness: effect of intensive care unit resuscitation.

BACKGROUND: A systemic proinflammatory response has been implicated in the pathogenesis of organ dysfunction. The effects of surgery, surgical stress, anesthesia, and subsequent intensive care unit (ICU) resuscitation may affect the components of the systemic inflammatory response syndrome (SIRS) score (temperature, heart rate, respiratory rate, and white blood cell count). Any SIRS scores calculated within 24 hours after surgery or at the onset of nonoperative resuscitation may overestimate the proinflammatory response itself, making quantitation of SIRS at that time potentially too sensitive. We hypothesized that SIRS attributable to ICU resuscitation can be quantitated, and that SIRS after the first day of therapy in the ICU correlates with several outcomes. METHODS: Prospective analysis of 2300 surgical ICU admissions during a 49-month period. Acute Physiology and Chronic Health Evaluation III (APACHE III) scores were recorded after 24 hours. Daily and cumulative multiple organ dysfunction scores (0-4 points for each of 6 organs, 24 points total) and SIRS scores (1 point for each parameter, 4 points total) were recorded. Defined end points were hospital mortality, days in the ICU, and organ dysfunction. RESULTS: On day 1, 49.4% of patients had SIRS (score > or =2), whereas 34.5% of patients who remained in the ICU had SIRS (score > or =2) on day 2 (P<.001). The SIRS score decreased by a mean of 0.8 points from day 1 to day 2, regardless of the type of admission. A SIRS score that decreased on day 2, in comparison with the score on day 1, resulted in less mortality than a unchanged or higher score on day 2 (11% vs. 18% vs. 22%, P<.001). Systemic inflammatory response scores were higher for nonsurvivors than survivors on each of the first 7 days in the ICU. The day 2 SIRS score correlated well with the admission APACHE III score (P<.001) and all defined end points (all P<.001). The day 2 SIRS score also correlated with the day 2 multiple organ dysfunction score (P<.001). By multiple logistic regression, APACHE III (P<.001), day 2 SIRS score (P<.01) (but not day 1 SIRS score, P = .99), and day 2 multiple organ dysfunction score (P<.001) (but not day 1 multiple organ dysfunction score, P = .81) predicted mortality. CONCLUSIONS: Systemic inflammatory response syndrome attributable to surgery or surgical stress can be quantitated. Twenty-four hours of ICU resuscitation results in a decline in the SIRS score. The magnitude of the proinflammatory response on the second ICU day may be a useful predictor of outcome in critical surgical illness.

APACHE↗
PubMed1995

Scoring systems for predicting outcomes of critically ill patients in northeastern Thailand.

The Acute Physiology and Chronic Health Evaluation System (APACHE) III, the APACHE II, the Simplified Acute Physiology Score (SAPS), and the Therapeutic Intervention Scoring System (TISS), calculated within the first 24 hours of admission, were compared in 209 critically ill patients admitted to the regional hospital in northeastern Thailand. Eighty-five (40.7%) patients subsequently died. The nonsurvivors had significantly higher APACHE III, APACHE II, SAPS and TISS scores than the survivors. ROC curves drawn for each severity index were in a discriminating position. There were no significant differences either among the areas under the ROC curves drawn for APACHE III, APACHE II, SAPS, and TISS, or among the overall accuracies of these indices. All four scoring system correlated well with the short-term prognosis, ie the mortality outcome, of critically ill patients. APACHE III, APACHE II, SAPS, and TISS appeared to be comparable to predictors of severity of critical illness. Selection of a severity indicator will depend on the resources available.

APACHE↗
PubMed1995

Comparison of APACHE II and III scoring systems for mortality prediction in critical surgical illness.

OBJECTIVE: To determine whether the Acute Physiology and Chronic Health Evaluation III (APACHE III), an updated version of APACHE II that contains a larger number of postoperative patients in the normative database, offers better prediction in critical surgical illness. DESIGN: Prospective cohort study. SETTING: Surgical intensive care unit of an urban, tertiary-care university hospital. PARTICIPANTS: Eight hundred forty-four consecutive patients in the surgical intensive care unit. Overall scores were determined, as well as scores for survivor, nonsurvivor, trauma, nontrauma, postoperative, and nonoperative patient subgroups. MAIN OUTCOME MEASURES: Survival to hospital discharge, and survival compared with published normative APACHE II and III databases. RESULTS: Mean age was 65.1 +/- 0.5 years. Overall mortality was 7.0% in the surgical intensive care unit and 9.1% in the hospital. The relationship between APACHE II and APACHE III scores for individual patients was linear and correlated significantly (P < .0001) (range of correlation coefficients, .72 to .86) overall and in all subgroups. Both scoring systems overestimated our mortality, but estimations made by APACHE III were significantly (P < .01) higher overall and in all subgroups. CONCLUSIONS: In institutions or groups of patients where APACHE II underestimates mortality, APACHE III may be corrective. However, the differences are subtle and may be difficult to detect in smaller studies.

APACHE↗
PubMed1997

Prognoses of seriously ill hospitalized patients on the days before death: implications for patient care and public policy.

Troubling aspects of the experiences of patients at the ends of their lives have fueled interest in special benefits or privileges for this group. There is a presumption that being "at the end of life" is discernible. This study examines this presumption using data from two previously collected databases: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) and the Acute Physiology and Chronic Health Evaluation III (APACHE III). Both studies generated multivariable estimates of survival prognosis for hospitalized patients. SUPPORT included 9,105 patients with one of nine serious illnesses in five hospitals over 4 yrs, of whom 2,360 died in the hospital and 4,537 died within 180 days of entry into the study. The APACHE III database describes 2,750 deaths in 16,622 ICU patients in 40 hospitals. The relationship of median estimates with time to death were examined for each source of data, for different diseases, and for ICU settings of care. In SUPPORT, the median predicted chance of survival for 2 months on the day before actual death was .17 (interquartile range, .02-.40) and was .51 (.31-.66) 1 wk before death. Median prognoses varied substantially among diseases: the median for congestive heart failure patients was a .62 chance of living 2 months on the day before death, while lung cancer had only a .17 chance and coma patients only an .11 chance. Median prognostication estimates were not much different when given by physicians and were only a little more pessimistic in APACHE (median estimate for hospital survival on the day before death was .14 and 7 days before was .45). To make plans about care and to optimally support most dying persons and families, conversations must occur while the patient still has a considerable chance of surviving the current episode of illness. Using statistical estimates of prognosis to designate a category of "terminally ill" patients for public policy purposes is unavoidably arbitrary, will often be contested, and will have differential effects upon those dying with differing diseases.

APACHE↗
PubMed2006

[Risk factors for renal failure during the early period after standard orthotopic liver transplantation without veno venous bypass].

OBJECTIVE: To study the risk factors for renal failure during the early period after standard orthotopic liver transplantation (SOLT) without veno venous bypass (VVBP). METHODS: Clinical data of 100 cases in whom SOLT without VVBP was performed were reviewed. They were divided into two groups according to serum creatine level just after operation. In both groups, Child-Turcotte-Pugh (CTP) score, model for end stage liver disease (MELD) score, acute physiology and chronic health evaluation III (APACHE III) scores, 8 laboratory variables before operation and 10 variables during the operation were analyzed, in order to screen presumable risk factors. RESULTS: With univariate analysis, it was found that there was significant difference between the two groups in the following variables: CTP score, MELD score, APACHE III score, duration of operation and anhepatic phase, amount of blood loss, lowest mean artery pressure, and duration of low blood pressure. With logistic regression analysis, it was revealed that CTP score, volume of blood loss, and duration of anhepatic phase and low blood pressure were risk factors for development of acute renal failure. CONCLUSION: CTP score, volume of blood loss, duration of anhepatic phase and low blood pressure are risk factors for development of acute renal failure after SOLT without VVBP.

Acute Kidney Injury↗
PubMed2000

HIV-associated bacteremia: how it has changed in the highly active antiretroviral therapy (HAART) era.

To evaluate the changing characteristics of HIV-associated bacteremia in the highly active antiretroviral therapy (HAART) era, we conducted a prospective case control study, comparing two periods of time, before (period A) and after (period B) the introduction of HAART. In total, 174 patients with bacteremia and 348 controls were studied. By comparing incidence in periods A and B, a statistically significant reduction of bacteremia, from 11.8 to 6.3/100 person-years (PY), was observed (p = .0001). Incidence of hospital-acquired bacteremia decreased from 5.8 episodes/100 PY in period A to 2.4/100 PY in period B (p = .0005). A similar trend was also observed for community-acquired episodes of bacteremia, with a value close to statistical significance. Logistic regression analysis indicated that intravenous drug abuse, central venous catheter (CVC) use, high value on APACHE III score, and neutropenia were independent risk factors for bacteremia in both the study periods. Interestingly, comparing the prevalence of bacteremia risk factors in the two study periods, we observed a significant reduction in the use of CVC (p = .04, period A versus period B) and in neutropenia (p = .04). The crude mortality rate was 31% in period A and 23% in period B (p = not significant [ns]). Logistic regression analysis indicated that an high value of Acute Physiology and Chronic Health Evaluation III (APACHE III) score (p < .001) predicted an increased risk of death. Analysis of prognostic factors of bacteremia did not significantly differ in both the study periods. We conclude that HAART has determined a significant reduction of the incidence and a modification of the characteristics of bacteremia. This reduced incidence may produce a substantial impact on future morbidity and health care costs of patients with HIV.

AIDS-Related Opportunistic Infections↗
PubMed2002

Integration of APACHE II and III scoring systems in extremely high risk patients with acute renal failure treated by dialysis.

OBJECTIVE: Acute physiology, age, chronic health evaluation II and III (APACHE II and III) scoring systems obtained on the day of the initiation of dialysis were compared the mortality rate among in critically ill patients with acute renal failure requiring dialysis. DESIGN: Retrospective study. SETTING: Intensive care units in a tertiary care university hospital in Taiwan. PATIENTS: 100 patients diagnosed with acute renal failure and requiring dialysis were admitted to intensive care units from January 1997 through December 1998. INTERVENTIONS: Information deemed necessary to compute the APACHE II and APACHE III score on the day of dialysis initiation was collected. MEASUREMENTS AND RESULTS: The overall hospital mortality rate was 71%. The relationship between APACHE II and APACHE III scores for patients was linear and correlated significantly in all subgroups. Goodness-of-fit was good for APACHE II and APACHE III models. Both reported good areas under receiver operating characteristic curve. Death in most patients was related to a higher APACHE II or APACHE III score during the 24 h immediately preceding the initiation of acute hemodialysis. Our results indicated a significant rise in mortality rates associated with higher APACHE II or III scores among all patients. Although less than 60%, the mortality rates markedly increased extent when APACHE II score of 24 or higher or APACHE III score above 90 had mortality rates exceeding 85%. CONCLUSION: Both predictive models demonstrated a similar degree of overall goodness-of-fit. Although APACHE II showed better calibration, APACHE III was better in terms of discrimination. The prediction accuracy of the APACHE II score for extremely high-risk patients is further enhanced by specific utility of APACHE III scoring as a second prediction model when the AII score is 24 or higher.

APACHE↗