The state of research on multipurpose severity of illness scoring systems: are we on target?

Apolone, Giovanni

doi:10.1007/s001340000737

Cited by 14 publications

(1 citation statement)

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“…The APACHE II requires collection of data regarding numerous variables over a period of time (during the first 24 hours of ICU admission) taking into account the most abnormal values, relies on laboratory data that may be not uniformly collected, and its use is limited by significant inter- and intraobserver variability [42]. It has been reported that several factors influence the performance of severity of illness scoring system: lead time bias [43], case mix, pre-ICU or ICU management, sampling rate of laboratory and hemodynamic data [44], and novel advances in ICU care and therapy since scoring systems were described [26]. On the other hand, it is important to emphasize that the APACHE II score was developed to predict mortality in general ICU population using data during the first 24 hours of ICU stay.…”

Section: Discussionmentioning

confidence: 99%

Serum Lipopolysaccharide Binding Protein Levels Predict Severity of Lung Injury and Mortality in Patients with Severe Sepsis

et al. 2009

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BackgroundThere is a need for biomarkers insuring identification of septic patients at high-risk for death. We performed a prospective, multicenter, observational study to investigate the time-course of lipopolysaccharide binding protein (LBP) serum levels in patients with severe sepsis and examined whether serial serum levels of LBP could be used as a marker of outcome.Methodology/Principal FindingsLBP serum levels at study entry, at 48 hours and at day-7 were measured in 180 patients with severe sepsis. Data regarding the nature of infections, disease severity, development of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), and intensive care unit (ICU) outcome were recorded. LBP serum levels were similar in survivors and non-survivors at study entry (117.4±75.7 µg/mL vs. 129.8±71.3 µg/mL, P = 0.249) but there were significant differences at 48 hours (77.2±57.0 vs. 121.2±73.4 µg/mL, P<0.0001) and at day-7 (64.7±45.8 vs. 89.7±61.1 µg/ml, p = 0.017). At 48 hours, LBP levels were significantly higher in ARDS patients than in ALI patients (112.5±71.8 µg/ml vs. 76.6±55.9 µg/ml, P = 0.0001). An increase of LBP levels at 48 hours was associated with higher mortality (odds ratio 3.97; 95%CI: 1.84–8.56; P<0.001).Conclusions/SignificanceSerial LBP serum measurements may offer a clinically useful biomarker for identification of patients with severe sepsis having the worst outcomes and the highest probability of developing sepsis-induced ARDS.

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Section: Discussionmentioning

confidence: 99%