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Septic shock
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Bryan E. Freeman, Michael R. Foley
Activated protein C therapy [also known as recombinant human activated protein C (rhAPC), drotrecogin alfa] should be based upon the diagnosis of the patient and their Acute Physiology and Chronic Health Evaluation (APACHE) II score. The APACHE II score is a tool used to assess the severity of disease in adults admitted to intensive care units and is based upon physical assessment of patients during the first 24 hours of their admission. Patients with severe sepsis, an APACHE II score >25 or multiple organ failure, and who are deemed to be at high risk of death should receive rhAPC, assuming that they have no contraindications. On the other hand, patients with severe sepsis, an APACHE II score <20 or single organ failure, and who are at low risk for death should not receive rhAPC therapy (12). These recommendations are consistent with conclusions from the Administration of Drotrecogin Alfa (Activated) in Early Stage Severe Sepsis (ADDRESS) Study Group, published in 2005 (16).
Critical Care and Anaesthesia
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rajkumar Rajendram, Alex Joseph, John Davidson, Avinash Gobindram, Prit Anand Singh, Animesh JK Patel
What is the most commonly used disease severity scoring system in the UK?The acute physiology and chronic health evaluation II system (APACHE II).It combines 12 physiological parameters with age and a chronic health score.Physiological parameters include temperature, blood pressure, heart rate, respiratory rate, oxygen therapy required, arterial pH, serum sodium, potassium, creatinine, packed cell volume, white cell count and neurological score.Data are entered on admission to intensive care and then reassessed after 24 hr.The resulting score provides an index of disease severity and risk of death.Predicted risk of death with an apache score >40 is 100%.
Peptic ulcer disease
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Erik AJ Rauws, Guido NJ Tytgat
These are potent acid suppressive drugs but there are limited data on their use in this setting. As stress ulcers are uncommon if the intragastric pH remains continuously above 4, PPIs may be beneficial in critically ill patients. Levy et al95 compared intravenous ranitidine 150 mg daily with omeprazole 40 mg daily given orally or by nasogastric tube. Eleven patients (31%) given ranitidine and two patients (6%) given omeprazole developed a clinically important bleeding (p > 0.05). The mortality was not different and only related to an increased APACHE II score. The apparent superiority of omeprazole might be the result of its greater potency; however, it is uncertain whether the mean pH is important in the prevention of bleeding stress ulcers. More data are needed before further recommendations can be given.
Characteristics and risk factors for renal recovery after acute kidney injury in critically ill patients in cohorts of elderly and non-elderly: a multicenter retrospective cohort study
Published in Renal Failure, 2023
Xiujuan Zhao, Chengjian Li, Yunwei Lu, Shu Li, Fuzheng Guo, Haiyan Xue, Zhenzhou Wang, Yulan Jiang, Shaoguang Liu, Mingming Chai, Tonghai Du, Fengxue Zhu
The APACHE II score was currently in widespread clinical use to predict outcomes in critically ill patients. To avoid the influence of age on APACHE II score, we calculated APACHE II of non age. In this study, we used these two scores as possible risk factors associated with renal nonrecovery, and we found that these two scores in the age <63 years cohort were significantly different in univariate analysis, but neither score was a risk factor for renal nonrecovery in multivariate analysis. However, it was different in the age ≥63 years cohort, and the APACHE II and APACHE II of non age scores were independent risk factor for renal nonrecovery. Mehta et al. [22] suggested that higher APACHE III scores were associated with a lower rate of renal recovery in acute renal failure patients. This illustrated that older patients aged ≥63 years may have lower rates of renal recovery with greater disease severity.
Platelet-albumin-bilirubin score and neutrophil-to-lymphocyte ratio predict intensive care unit admission in patients with end-stage kidney disease infected with the Omicron variant of COVID-19: a single-center prospective cohort study
Published in Renal Failure, 2023
Yufen Zhou, Muyin Zhang, Xiaojing Wu, Xin Li, Xu Hao, Lili Xu, Hao Li, Panpan Qiao, Ping Chen, Weiming Wang
End stage kidney disease (ESKD) and COVID-19 infection are associated with increased inflammatory burden [11]. Patients with COVID-19 often develop concurrent liver injury. Evaluating the clinical features of patients with ESKD is essential during the Omicron variant epidemic. We hypothesize that the inflammatory burden and liver injury may contribute to clinical deterioration. Therefore, we selected clinical scores related to liver disease and systemic inflammation to predict the risk of intensive care unit (ICU) admission in ESKD patients with COVID-19. These scores include the following: Aminotransferase-to-platelet ratio index (APRI), albumin-bilirubin score (ALBI), aminotransferase-to-alanine aminotransferase ratio (AAR), platelet-albumin-bilirubin score (PALBI), monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and disseminated intravascular coagulation score (DIC score). Acute Physiology and Chronic Health Evaluation II (APACHE-II) is a commonly used clinical score to assess the critical condition of ICU patients. In this study, we compared the above clinical scores with APACHE-II [12]. Therefore, the primary objective of this study was to analyze the clinical features and liver function changes in patients with ESKD and Omicron infection and develop clinical scores to predict the risk of ICU admission.
Serum myoglobin as predictor of acute kidney injury and 90-day mortality in patients with rhabdomyolysis after exertional heatstroke: an over 10-year intensive care survey
Published in International Journal of Hyperthermia, 2022
Ming Wu, Conglin Wang, Li Zhong, Zhifeng Liu
On multivariate logistic regression analysis, APACHE II score, SOFA score, and GCS score were all identified as independent risk factors for 90-day mortality in EHS patients. However, SOFA score had the best AUC for the prediction of mortality in patients with sMb ≥ 1000 ng/mL and not APACHE II score. The APACHE II score is an important scoring system for prognostic assessment of critically ill patients, which factors age and chronic health. However, our patients were previously healthy and the median age in our cohort was 21 years. In addition, because the APACHE II score excludes some vital acute organ functions including coagulation function and liver function, it is not as comprehensive as the SOFA score. The optimal cutoff level of SOFA score for predicting 90-day mortality was 9.5 points (95.5% sensitivity and 87.5% specificity). This suggests that the follow-up treatment with the primary aim of protecting key organ function, especially kidney, is an important way to reduce mortality.