Comparison of prognosis predictive value of 4 disease severity scoring systems in patients with acute respiratory failure in intensive care unit

Huang, Wen-Cheng; Xie, Hongjian; Fan, Hong-Tao; Yan, Meihao; Hong, Yuancheng

doi:10.1097/md.0000000000027380

Cited by 13 publications

(9 citation statements)

References 27 publications

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“…In addition, we also included in the regression model of the OASIS the Scr levels as predictors of AKI in diabetes. A study showed that the OASIS had a good predictive effect on the assessment and prognosis of critically ill patients (41). The baseline Scr values could also predict the occurrence and progression of AKI (42).…”

Section: Discussionmentioning

confidence: 99%

Association Between Iron Metabolism and Acute Kidney Injury in Critically Ill Patients With Diabetes

Gao

Deng

et al. 2022

Front. Endocrinol.

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ObjectiveIron overload plays an important role in the pathogenesis of diabetes and acute kidney injury (AKI). The aim of this present study was to explore the relationship between iron metabolism and AKI in patients with diabetes.MethodsThe clinical data of diabetes patients from MIMIC-III database in intensive care unit (ICU) were retrospectively analyzed. Regression analyses were used to explore the risk factors of AKI and all-cause death in critical patients with diabetes. Area under the receiver operating characteristic curves (AUROCs) were used to analyze serum ferritin (SF), and regression model to predict AKI in critical patients with diabetes. All diabetes patients were followed up for survival at 6 months, and Kaplan–Meier curves were used to compare the survival rate in patients with different SF levels.ResultsA total of 4,997 diabetic patients in ICU were enrolled, with a male-to-female ratio of 1.37:1 and a mean age of 66.87 ± 12.74 years. There were 1,637 patients in the AKI group (32.8%) and 3,360 patients in the non-AKI group. Multivariate logistic regression showed that congestive heart failure (OR = 2.111, 95% CI = 1.320–3.376), serum creatinine (OR = 1.342, 95% CI = 1.192–1.512), Oxford Acute Severity of Illness Score (OR = 1.075, 95% CI = 1.045–1.106), increased SF (OR = 1.002, 95% CI = 1.001–1.003), and decreased transferrin (OR = 0.993, 95% CI = 0.989–0.998) were independent risk factors for AKI in critical patients with diabetes. Multivariate Cox regression showed that advanced age (OR = 1.031, 95% CI = 1.025–1.037), AKI (OR = 1.197, 95% CI = 1.011–1.417), increased Sequential Organ Failure Assessment score (OR = 1.055, 95% CI = 1.032–1.078), and increased SF (OR = 1.380, 95% CI = 1.038–1.835) were independent risk factors for 6-month all-cause death in critical diabetic patients. The AUROCs of SF and the regression model to predict AKI in critical patients with diabetes were 0.782 and 0.851, respectively. The Kaplan–Meier curve showed that the 6-month survival rate in SF-increased group was lower than that in SF-normal group (log-rank χ2 = 16.989, P < 0.001).ConclusionCritically ill diabetic patients with AKI were easily complicated with abnormal iron metabolism. Increase of SF is an important risk factor for AKI and all-cause death in critically ill patients with diabetes.

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Section: Discussionmentioning

confidence: 99%

Association Between Iron Metabolism and Acute Kidney Injury in Critically Ill Patients With Diabetes

Gao

Deng

et al. 2022

Front. Endocrinol.

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“…A previous systematic review showed that the SOFA model based on 24 h after ICU admission could be used to predict mortality ( 19 ). Other types of patients were also effectively evaluated by SOFA score, including post-cardiac arrest syndrome ( 20 ), people requiring extracorporeal cardiopulmonary resuscitation ( 21 ), critically ill cirrhotic patients with acute decompensation ( 22 ), patients with acute respiratory failure in intensive care unit ( 23 ), contemporary cardiac intensive care unit population ( 24 ), critically ill elderly patients with acute infective endocarditis ( 25 ), extracorporeal membrane oxygenation (ECMO)-treated acute myocardial infarction (AMI) patients ( 26 )—some of above studies behaved even well. In the cardiac surgery population, the previous literature stated that SOFA score had good discriminative power for hospital mortality ( 27 ); the same observation was also confirmed in Ceriani et al's research ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Performance of Sequential Organ Failure Assessment and Simplified Acute Physiology Score II for Post-Cardiac Surgery Patients in Intensive Care Unit

Zhang

et al. 2021

Front. Cardiovasc. Med.

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Background: The aim of this study is to assess the performance of Sequential Organ Failure Assessment (SOFA) score and Simplified Acute Physiology Score (SAPS II) on outcomes of patients with cardiac surgery and identify the cutoff values to provide a reference for early intervention.Methods: All data were extracted from MIMIC-III (Medical Information Mart for Intensive Care-III) database. Cutoff values were calculated by the receiver-operating characteristic curve and Youden indexes. Patients were grouped, respectively, according to the cutoff values of SOFA and SAPS II. A non-adjusted model and adjusted model were established to evaluate the prediction of risk. Comparison of clinical efficacy between two scoring systems was made by decision curve analysis (DCA). The primary outcomes of this study were in-hospital mortality, 28-day mortality, 90-day mortality, and 1-year mortality after cardiac surgery. The secondary outcomes included length of hospital stay and intensive care unit (ICU) stay and the incidence of acute kidney injury (AKI) within 7 days after ICU admission.Results: A total of 6,122 patients were collected and divided into the H-SOFA group (SOFA ≥ 7) and L-SOFA group (SOFA < 7) or H-SAPS II group (SAPS II ≥ 43) and L-SAPS II group (SAPS II < 43). In-hospital mortality, 28-day mortality, 90-day mortality, and 1-year mortality were higher, the length of hospital and ICU stay were longer in the H-SOFA group than in the L-SOFA group (p < 0.05), while the incidence of AKI was not significantly different. In-hospital mortality, 28-day mortality, 90-day mortality, 1-year mortality, and the incidence of AKI were all significantly higher in the H-SAPS II group than in the L-SAPS II group (p < 0.05). Hospital stay and ICU stay were longer in the H-SAPS II group than in the L-SAPS II group (p < 0.05). According to DCA, the SAPS II scoring system had more net benefits on assessing the long-term mortality compared with the SOFA scoring system.Conclusion: Exceeding the cutoff values of SOFA and SAPS II scores could lead to increased mortality and extended length of ICU and hospital stay. The SAPS II scoring system had a better discriminative performance of 90-day mortality and 1-year mortality in post-cardiac surgery patients than the SOFA scoring system. Emphasizing the critical value of the scoring system is of significance for timely treatment.

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“…31 It is composed of clinical variables collected within the first 24 hours of admission to an ICU and shown to have strong prognostic value in MIMIC-III. 32,33 Higher scores represent worse prognosis and illness severity.…”

Section: Covariatesmentioning

confidence: 99%

Association of Blood Pressure Variability With Death and Discharge Destination Among Critically Ill Patients With and Without Stroke

et al. 2023

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Background/Objective It is unclear if blood pressure variability’s (BPV) association with worse outcomes is unique to stroke patients or a risk factor among all critically-ill patients. We (1) determined if BPV differed between stroke and non-stroke patients, (2) examined BPV’s associations with in-hospital death and favorable discharge destination in stroke and non-stroke patients, and (3) assessed how minimum mean arterial pressure (MAP) – a correlate of illness severity and cerebral perfusion – impacts these associations.Methods:This is a retrospective analysis of adult ICU patients hospitalized between 2001 and 2012 from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Confounder-adjusted logistic regressions determined associations between BPV, measured as standard deviation (SD) and Average real variability (ARV), and a) in-hospital death and b) favorable discharge, with testing of minimum MAP for effect modification.Results:BPV was higher in stroke patients (N=2,248) compared to non-stroke patients (N=9,085) (SD Mean difference: 2.3, 95% CI: 2.1-2.6, p<0.01). After adjusting for minimum tertile of MAP and other confounders, higher SD remained significantly associated (P <0.05) with higher odds of in-hospital death for patients with acute ischemic strokes (AIS, OR 2.7, 95% CI: 1.5-4.8), intracerebral hemorrhage (ICH, OR 2.6, 95% CI: 1.6-4.3), subarachnoid hemorrhage (SAH, OR 3.4, 95% CI: 1.2-9.3), and pneumonia (OR 1.9, 95% CI: 1.1-3.3); and lower odds of favorable discharge destination in patients with ischemic stroke (OR 0.3, 95% CI: 0.2-0.6) and intracerebral hemorrhage (OR 0.4, 95% CI: 0.3-0.6). No interaction was found between minimum MAP tertile with SD (P>0.05). Higher ARV was not significantly associated with increased risk of death in any condition when adjusting for illness severity, but portended worse discharge destination in those with AIS (ORfavorable discharge0.4, 95% CI: 0.3-0.7), ICH (ORfavorable discharge0.5, 95% CI: 0.3-0.7), sepsis (ORfavorable discharge0.8, 95% CI: 0.6-1.0), and pneumonia (ORfavorable discharge0.5, 95% CI: 0.4-0.8).Discussion:BPV is higher and generally associated with worse outcomes among stroke compared to non-stroke patients. BPV in AIS and ICH patients may be a marker of central autonomic network injury, though clinician-driven blood pressure goals likely contribute to the association between BPV and outcomes.

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Comparison of prognosis predictive value of 4 disease severity scoring systems in patients with acute respiratory failure in intensive care unit

Cited by 13 publications

References 27 publications

Association Between Iron Metabolism and Acute Kidney Injury in Critically Ill Patients With Diabetes

Association Between Iron Metabolism and Acute Kidney Injury in Critically Ill Patients With Diabetes

Performance of Sequential Organ Failure Assessment and Simplified Acute Physiology Score II for Post-Cardiac Surgery Patients in Intensive Care Unit

Association of Blood Pressure Variability With Death and Discharge Destination Among Critically Ill Patients With and Without Stroke

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