Predicting outcome in critical care

Kahn, Jeremy M.

doi:10.1097/mcc.0000000000000140

Cited by 9 publications

(4 citation statements)

References 4 publications

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“…Although the APACHE II and SOFA score, as well as age, were independently associated, the authors underlined that the models at best explained 20-40 percent of the variability in utility index score [6]. The limitations of the available predictive models for outcome are generally well-recognised, since they are designed to predict hospital mortality instead of long-term outcome and HRQoL [28].…”

Section: Discussionmentioning

confidence: 99%

Patient-reported physical functioning is limited in almost half of critical illness survivors 1-year after ICU-admission: A retrospective single-centre study

et al. 2020

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Post-intensive care unit (ICU) sequelae, including physical and mental health problems, are relatively unexplored. Characteristics commonly used to predict outcome lack prognostic value when it comes to long-term physical recovery. Therefore, the objective of this study was to assess the incidence of non-recovery in long-stay ICU-patients. In this single-centre study, retrospective data of adults with an ICU stay >48 hours who visited the specialized post-ICU clinic, and completed the Dutch RAND 36-item Short Form questionnaire at 3 and 12 months post-ICU, were retrieved from electronic patient records. In cases where physical functioning scores at 12 months were below reference values, patients were allocated to the physical non-recovery (NR) group. Significantly different baseline and (post-)ICU-characteristics were assessed for correlations with physical recovery at 12 months post-ICU. Of 250 patients, 110 (44%) fulfilled the criteria for the NR-group. Neither the severity of illness, type of admission, nor presence of sepsis did not differ between groups. However, NR-patients had a higher age, were more often female, and had a higher incidence of co-morbidities. Shorter LOS ICU, lower incidence of medical comorbidities, and better physical performance at 3 months were significantly correlated with 1-year physical recovery. Comorbidities and reduced physical functioning at 3 months were identified as independent risk-factors for long-term physical non-recovery. In conclusion, a substantial proportion of long-stay ICU-patients who visited the standard care post-ICU clinic did not fulfil the criteria for full physical recovery at 12 months post-ICU. Commonly used ICU-characteristics, such as severity of illness, do not have sufficient prognostic value when it comes to long-term recovery of health-related quality of life.

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Section: Discussionmentioning

confidence: 99%

Patient-reported physical functioning is limited in almost half of critical illness survivors 1-year after ICU-admission: A retrospective single-centre study

et al. 2020

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“…Indeed, besides use as benchmarking tools and in inter-ICU comparative studies, accurate outcome prediction based on biomarkers could be extremely useful for improving clinical decision-making. For example, biomarkers could help clinicians to dispense relevant treatments to patients who might benefit from them [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Decreased CX3CR1 messenger RNA expression is an independent molecular biomarker of early and late mortality in critically ill patients

Friggeri¹,

Cazalis²,

Pachot³

et al. 2016

Crit Care

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BackgroundChemokine (C-X3-C motif) receptor 1 (CX3CR1) was identified as the most differentially expressed gene between survivors and non-survivors in two independent cohorts of septic shock patients and was proposed as a marker of sepsis-induced immunosuppression. Whether such a biomarker is associated with mortality in the heterogeneous group of critically ill patients is unknown. The primary objective of this study was to evaluate the association between CX3CR1 messenger RNA (mRNA) expression and mortality in intensive care unit (ICU) patients. The secondary objective was to evaluate similar endpoints in the subgroup of septic shock patients.MethodsWe performed a prospective, multicentre, non-interventional study in six ICUs of university hospitals in Lyon, France. Every consecutive adult patient with systemic inflammatory response syndrome and an expected length of stay in the ICU over 2 days was included. Whole-blood CX3CR1 mRNA expression was measured by quantitative real-time polymerase chain reaction at day 1 (D1) and D3 after inclusion.ResultsIn ICU patients (n = 725), decreased CX3CR1 mRNA expression at D1 was associated with high D7 mortality (AUC 0.70, adjusted OR [aOR] 2.03, 95 % CI 1.19–3.46), while decreased expression at D3 was associated with increased D28 mortality (AUC 0.64, aOR 2.34, 95 % CI 1.45–3.77). In septic shock patients (n = 279), similar associations were observed between decreased D1 CX3CR1 mRNA expression and D7 mortality (AUC 0.69, aOR 2.76, 95 % CI 1.32–5.75) as well as decreased D3 expression and D28 mortality (AUC 0.72, aOR 3.98, 95 % CI 1.72–9.23). These associations were independent of lactacidaemia, Simplified Acute Physiology Score II, Sepsis-related Organ Failure Assessment score and Charlson comorbidity index.ConclusionsThis study represents the largest evaluation of such an mRNA marker in a heterogeneous cohort of severely injured patients. Our results show that decreased CX3CR1 mRNA expression is associated with increased mortality in ICU patients. This suggests a link between injury-induced immunosuppression and mortality in critically ill patients. In this context, the monitoring of such a host response molecular biomarker could prove very helpful for the identification of patients at high risk of death in the ICU.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1362-x) contains supplementary material, which is available to authorized users.

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“…[7][8][9] El principal factor de riesgo para desarrollar SDRA es el choque séptico de etiología pulmonar (OR 4.6, IC95% 1.177-17.9) 10 y la ventilación protectora ha demostrado mejorar la supervivencia en los pacientes con ventilación mecánica, reduciendo la mortalidad a 28 días (RR 0.74, IC95% 0.61-0.88). 11,12 Las diferentes escalas pronósticas (APACHE: Acute Physiology and Chronic Health Evaluation, SAPS: Simplified Acute Physiology Score, MPM: Mortality Probability Model) utilizadas en el paciente críticamente enfermo, ayudan al clínico a evaluar, clasificar y predecir resultados; sin embargo, dichas escalas resultan ser muy «generales» para poblaciones «específicas». 13,14 Lung Injury Prediction Score (LIPS) se ha utilizado para predecir SDRA en pacientes críticamente enfermos con ABC 0.8, sensibilidad 90% y especificidad 31%.…”

Section: Introductionunclassified

Puntaje APP (Age, PaO2/FiO2, Plateau) predice mortalidad en choque séptico de etiología pulmonar

Torres García,

Sánchez Díaz,

Peniche Moguel

et al. 2023

Medicina Crítica

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RESUMENIntroducción: cerca de 70% de pacientes con choque séptico requerirá ventilación mecánica (VM), siendo el principal sitio de infección el pulmonar. Las escalas pronósticas ayudan en la toma de decisiones, por lo que deben ser fáciles, reproducibles y particulares de cada patología. El puntaje APP (Age, PaO 2 /FiO 2 , Plateau) es un instrumento que nos puede ayudar a clasificar de manera individual la mortalidad. Objetivo: evaluar la utilidad del puntaje APP para predecir mortalidad en choque séptico pulmonar. Material y métodos: estudio de cohorte, retrospectivo, observacional, analítico. Se realizó en la Unidad de Cuidados Intensivos (UCI) en el periodo comprendido del 5 de mayo de 2015 al 31 de diciembre de 2019. Consistió en la revisión de expedientes médicos. Se clasificó a la población en grupo 1: APP ≤ 6 puntos y grupo 2: APP > 6 puntos; se dio seguimiento al desenlace en la Unidad de Cuidados Intensivos (UCI). Resultados: se incluyeron 35 pacientes. El grupo 1 incluyó 18 pacientes y 17 el grupo 2. La mortalidad en el grupo 1 fue de 39% y de 59% para el grupo 2, p = 0.86. El APP > 6 puntos presentó OR 1.12 (IC95% 1.06-4.24) p = 0.04 para mortalidad. El poder mecánico > 22 J/min reportó AUC 0.77, p = 0.02. Conclusión: en choque séptico pulmonar, presentar un APP > 6 puntos incrementan la mortalidad. Debemos determinar el pronóstico de los pacientes de manera individual, basándonos en el principal órgano involucrado, de otra manera podríamos subestimar la mortalidad al utilizar escalas pronósticas generales. Palabras clave: choque séptico, puntaje APP, ventilación mecánica, mortalidad.

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Predicting outcome in critical care

Cited by 9 publications

References 4 publications

Patient-reported physical functioning is limited in almost half of critical illness survivors 1-year after ICU-admission: A retrospective single-centre study

Patient-reported physical functioning is limited in almost half of critical illness survivors 1-year after ICU-admission: A retrospective single-centre study

Decreased CX3CR1 messenger RNA expression is an independent molecular biomarker of early and late mortality in critically ill patients

Puntaje APP (Age, PaO2/FiO2, Plateau) predice mortalidad en choque séptico de etiología pulmonar

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