Septic shock
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
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).
The management of major injuries
Ashley W. Blom, David Warwick, Michael R. Whitehouse in Apley and Solomon’s System of Orthopaedics and Trauma, 2017
APACHE II is made up of four basic components: (1) acute physiology score; (2) chronic health evaluation; (3) age; (4) urgency of admission to critical care. The acute physiology score is composed of 12 variables, with the most deranged measurement during the first 24 hours of admission to critical care being used to calculate the score. The original data collection for APACHE II occurred between 1979 and 1982 from ICUs in North America, and the population studied included relatively few surgical and trauma patients. Also, there have been many advances in patient care since the 1980s, which have made APACHE II dated, despite its continued popularity. The latest iteration is the APACHE IV published in 2006. It is the most complex of all the APACHE models with 146 variables and was developed in the USA for the US ICU model.
Critical Care and Anaesthesia
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
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%.
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.
The correlation between feeding intolerance and poor prognosis of patients with severe neurological conditions: a case-control study
Published in Expert Review of Neurotherapeutics, 2019
Jingjing Peng, Guang-Wei Liu, Feng Li, Meizhen Yuan, Yanling Xiang, Deyu Qin
The APACHE II is a currently widely used scale in clinical practice and is used to evaluate the severity of diseases and predict the prognosis of critically ill patients. A study by Li Feng et al [37]. showed that a higher APACHE II score in patients with severe neurological conditions was associated with a higher risk hypoproteinemia complicated with pulmonary infection and a higher mortality rate. The univariate analysis in our current study showed that the APACHE II score was associated with a poor prognosis of patients with severe neurological conditions, although the same result was not found in the multivariate analysis, which is inconsistent with previous studies. The main reason for this inconsistency is the small number of patients in our study. In the future, we will increase the number of cases and conduct a prospective study to achieve optimal results.
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.
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