Severity and prognosis in intensive care: prospective application of the Apache II Index

Costa, Joel Isidoro; Amaral, José Luiz Gomes do; Munechika, Masashi; Juliano, Yára; Filho, José Gomes Bezerra

doi:10.1590/s1516-31801999000500005

Cited by 17 publications

(22 citation statements)

References 27 publications

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“…6,[7][8][9][10][11] There was a higher frequency of trauma (15%) in relation to American and European studies, but this was similar to what has already been found in Brazil, 7,10,12 The patient distribution in the APACHE II score intervals showed highest concentrations in the intermediate ranges, coinciding with what was found by other authors. 8,10,13 However, the percentage of patients with APACHE II scores of less than 10 (22.4%), and thus with less severe illness conditions, was much lower than for the US study, 56%.…”

Section: Discussionsupporting

confidence: 79%

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Evaluation of APACHE II system among intensive care patients at a teaching hospital

Chiavone

Sens

2003

Sao Paulo Med. J.

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CONTEXT: The high-complexity features of intensive care unit services and the clinical situation of patients themselves render correct prognosis fundamentally important not only for patients, their families and physicians, but also for hospital administrators, fund-providers and controllers. Prognostic indices have been developed for estimating hospital mortality rates for hospitalized patients, based on demographic, physiological and clinical data. OBJECTIVE: The APACHE II system was applied within an intensive care unit to evaluate its ability to predict patient outcome; to compare illness severity with outcomes for clinical and surgical patients; and to compare the recorded result with the predicted death rate. DESIGN: Diagnostic test. SETTING: Clinical and surgical intensive care unit in a tertiary-care teaching hospital. PARTICIPANTS: The study involved 521 consecutive patients admitted to the intensive care unit from July 1998 to June 1999. MAIN MEASUREMENTS: APACHE II score, in-hospital mortality, receiver operating characteristic curve, decision matrices and linear regression analysis. RESULTS: The patients' mean age was 50 ± 19 years and the APACHE II score was 16.7 ± 7.3. There were 166 clinical patients (32%), 173 (33%) post-elective surgery patients (33%), and 182 post-emergency surgery patients (35%), thus producing statistically similar proportions. The APACHE II scores for clinical patients (18.5 ± 7.8) were similar to those for non-elective surgery patients (18.6 ± 6.5) and both were greater than for elective surgery patients (13.0 ± 6.3) (p < 0.05). The higher this score was, the higher the mortality rate was (p < 0.05). The predicted death rate was 25.6% and the recorded death rate was 35.5%. Through the use of receiver operating curve analysis, good discrimination was found (area under the curve = 0.80). From the 2 x 2 decision matrix, 72.2% of patients were correctly classified (sensitivity = 35.1%; specificity = 92.6%). Linear regression analysis was equivalent to r² = 0.92. CONCLUSIONS: APACHE II was useful for stratifying these patients. The illness severity and death rate among clinical patients were higher than those recorded for surgical patients. Despite the stratification ability of the APACHE II system, it lacked accuracy in predicting death rates. The recorded death rate was higher than the predicted rate.

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Section: Discussionsupporting

confidence: 79%

“…Mortality rates recorded in other countries have ranged from 16.9% to 36% 1,8,14,17 and in Brazil from 38.1% 16 to 40.5%. 15 Costa et al 11 found a mortality rate of 28.5%, but their study considered intensive care unit mortality only, and not hospital mortality, as in other studies.…”

mentioning

confidence: 92%

Evaluation of APACHE II system among intensive care patients at a teaching hospital

Chiavone

Sens

2003

Sao Paulo Med. J.

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“…The need for blood product transfusions and extracorporeal circulation also affect lung function by deflagrating important inflammatory response. (23) …”

Section: Discussionmentioning

confidence: 99%

Reintubation of patients submitted to cardiac surgery: a retrospective analysis

Shoji¹,

Figuereido²,

Calixtre³

et al. 2017

Revista Brasileira De Terapia Intensiva

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ObjectivesTo analyze patients after cardiac surgery that needed endotracheal reintubation and identify factors associated with death and its relation with the severity scores.MethodsRetrospective analysis of information of 1,640 patients in the postoperative period of cardiac surgery between 2007 and 2015.ResultsThe reintubation rate was 7.26%. Of those who were reintubated, 36 (30.3%) underwent coronary artery bypass surgery, 27 (22.7%) underwent valve replacement, 25 (21.0%) underwent correction of an aneurysm, and 8 (6.7%) underwent a heart transplant. Among those with comorbidities, 54 (51.9%) were hypertensive, 22 (21.2%) were diabetic, and 10 (9.6%) had lung diseases. Among those who had complications, 61 (52.6%) had pneumonia, 50 (42.4%) developed renal failure, and 49 (51.0%) had a moderate form of the transient disturbance of gas exchange. Noninvasive ventilation was performed in 53 (44.5%) patients. The death rate was 40.3%, and mortality was higher in the group that did not receive noninvasive ventilation before reintubation (53.5%). Within the reintubated patients who died, the SOFA and APACHE II values were 7.9 ± 3.0 and 16.9 ± 4.5, respectively. Most of the reintubated patients (47.5%) belonged to the high-risk group, EuroSCORE (> 6 points).ConclusionThe reintubation rate was high, and it was related to worse SOFA, APACHE II and EuroSCORE scores. Mortality was higher in the group that did not receive noninvasive ventilation before reintubation.

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“…Thus, some studies have addressed important issues related to the profile and severity of ICU patients (3)(4) .…”

Section: Introductionmentioning

confidence: 99%

Profile and severity of the patients of intensive care units: prospective application of the APACHE II index

Freitas

2010

Rev. Latino-Am. Enfermagem

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This study aimed to understand the profile and severity of patients in physiotherapy treatment after their admission to the intensive care unit (ICU) by applying the APACHE II index. One hundred and forty six subjects, with a mean age of 60.5 ± 19.2 years, were evaluated. The APACHE II index was applied in the first 24 hours to evaluate the severity and mortality risk score. Patients were monitored until hospital discharge or death. The mean APACHE II score was 20±7.3 with an estimated risk of death of 32.4% and observed mortality of 58.2%. The mean hospital stay was 27.8±25.2 days. The patients in physiotherapy at the institution studied were predominantly male, elderly, from the emergency service for treatment (non-surgical), and had clear severity, suggested by the APACHE II score and the observed mortality.Descriptors: APACHE; Mortality; Intensive Care Units. Perfil y gravedad de los pacientes de las unidades de terapia intensiva: aplicación prospectiva del puntaje APACHE IIEste estudio tuvo como objetivo conocer el perfil y la gravedad de pacientes asistidos por la fisioterapia, después de su ingreso en las unidades de terapia intensiva (UTI), a través de la aplicación del puntaje APACHE II. Se evaluaron 146 individuos con promedio de edad de 60,5±19,2 años. El puntaje APACHE II fue aplicado en las primeras 24h para evaluar la gravedad y dar puntuación al riesgo de mortalidad. Los pacientes fueron acompañados hasta el momento del alta hospitalaria o de la muerte. El puntaje APACHE II promedio fue de 20±7,3 con riesgo estimado de muerte de 32,4% y mortalidad observada de 58,2%. El promedio de permanencia hospitalaria fue de 27,8±25,2 días.En los pacientes asistidos por la fisioterapia de la institución investigada, el predominio fue del sexo masculino, ancianos, provenientes de la atención rápida para tratamiento clínico (no quirúrgico) y que presentan nítida gravedad, sugerida por el puntaje APACHE II y por la mortalidad observada.

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Severity and prognosis in intensive care: prospective application of the Apache II Index

Cited by 17 publications

References 27 publications

Evaluation of APACHE II system among intensive care patients at a teaching hospital

Evaluation of APACHE II system among intensive care patients at a teaching hospital

Reintubation of patients submitted to cardiac surgery: a retrospective analysis

Profile and severity of the patients of intensive care units: prospective application of the APACHE II index

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