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Acute Physiology Score (acute + physiology_score)
Selected AbstractsHyperglycemia as a Predictor of In-Hospital Mortality in Elderly Patients without Diabetes Mellitus Admitted to a Sub-Intensive Care UnitJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2008Intissar Sleiman MD OBJECTIVES: To investigate the association between hyperglycemia and in-hospital and 45-day mortality in acutely ill elderly patients. DESIGN: Retrospective cohort. SETTING: Hospital medical patients admitted to a sub-intensive care unit (sub-ICU) for elderly patients, which is a level of care between ordinary wards and intensive care. PARTICIPANTS: One thousand two hundred twenty-nine patients (mean age 79.6±8.4) admitted to the sub-ICU from January 2003 to January 2006. Forty patients with acute myocardial infarction and 34 patients with extreme fasting glucose values (<60 or >500 mg/dL) were excluded. Eight hundred twenty-two patients without a history of diabetes mellitus (DM) and 333 patients with a diagnosis of DM were selected and subdivided into three categories according to serum fasting blood glucose: 60 to 126 mg/dL (Group A), 127 to 180 mg/dL (Group B), and 181 to 500 mg/dL (Group C). MEASUREMENTS: Age, sex, mental and functional status, Acute Physiology Score, comorbid conditions, serum albumin, serum cholesterol, fasting serum glucose, and length of stay. In-hospital mortality was the primary outcome, and 45-day mortality was the secondary outcome. RESULTS: Total in-hospital mortality was 14.5%. In patients with and without DM, mortality was 8.8% and 11.3%, respectively, in Group A; 13.6% and 17.3% in Group B, and 12.6% and 34.3% in Group C. After controlling for confounders, newly recognized hyperglycemia (>181 mg/dL) was independently associated with in-hospital mortality (adjusted odds ratio=2.7, 95% confidence interval=1.6,4.8). Forty-five-day mortality in newly recognized hyperglycemic patients was 17.5%, 25.7%, and 42% in Groups A, B, and C, respectively, whereas it was 21.2% in patients with DM. CONCLUSION: In elderly patients, newly recognized hyperglycemia was associated with a higher mortality rate than in those with a prior history of DM. These data suggest that further randomized clinical trials are needed to assess the efficacy and the risk of a target glucose of greater than 180 mg/dL. [source] Are Aggressive Treatment Strategies Less Cost-Effective for Older Patients?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2001Aggressive Care for Patients with Acute Respiratory Failure, The Case of Ventilator Support OBJECTIVES: A common assumption is that life-sustaining treatments are much less cost-effective for older patients than for younger patients. We estimated the incremental cost-effectiveness of providing mechanical ventilation and intensive care for patients of various ages who had acute respiratory failure. DESIGN: Retrospective analysis of data on acute respiratory failure from Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). SETTING: Acute hospital. PARTICIPANTS: 1,005 with acute respiratory failure; 963 received ventilator support and 42 had ventilator support withheld. MEASUREMENTS: We studied 1,005 patients enrolled in a five-center study of seriously ill patients (SUPPORT) with acute respiratory failure (pneumonia or acute respiratory distress syndrome and an Acute Physiology Score ,10) requiring ventilator support. For cost-effectiveness analyses, we estimated life expectancy based on long-term follow-up of SUPPORT patients and estimated utilities (quality-of-life weights) using time-tradeoff questions. We used hospital fiscal data and Medicare data to estimate healthcare costs. We divided patients into three age groups (<65, 65,74, and ,75 years); for each age group, we performed separate analyses for patients with a ,50% probability of surviving at least 2 months (high-risk group) and those with a> 50% probability of surviving at least 2 months (low-risk group). RESULTS: Of the 963 patients who received ventilator support, 44% were female; 48% survived 6 months; and the median (25th, 75th percentile) age was 63 (46, 75) years. For the 42 patients for whom ventilator support was withheld, the median survival was 3 days. For low-risk patients (>50% estimated 2-month survival), the incremental cost (1998 dollars) per quality-adjusted life-year (QALY) saved by providing ventilator support and aggressive care increased across the three age groups ($32,000 for patients age <65, $44,000 for those age 65,74, and $46,000 for those age ,75). For high-risk patients, the incremental cost-effectiveness was much less favorable and was least favorable for younger patients ($130,000 for patients age <65, $100,000 for those age 65,74, and $96,000 for those age ,75). When we varied our assumptions from 50% to 200% of our baseline estimates in sensitivity analyses, results were most sensitive to the costs of the index hospitalization. CONCLUSIONS: For patients with relatively good short-term prognoses, we found that ventilator support and aggressive care were economically worthwhile, even for patients 75 years and older. For patients with poor short-term prognoses, ventilator support and aggressive care were much less cost-effective for adults of all ages. [source] A comparison of SAPS II and SAPS 3 in a Norwegian intensive care unit populationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009K. STRAND Background: Simplified Acute Physiology Score (SAPS II) is the most widely used general severity scoring system in European intensive care medicine. Because its performance has been questioned in several external validation studies, SAPS 3 was recently released. To our knowledge, there are no published validation studies of SAPS II or SAPS 3 in the Scandinavian countries. We aimed to evaluate and compare the performance of SAPS II and SAPS 3 in a Norwegian intensive care unit (ICU) population. Method: Prospectively collected data from adult patients admitted to two general ICUs at two different hospitals in Norway were used. Probability of mortality was calculated using the SAPS 3 global equation (SAPS 3 G), the SAPS 3 Northern European equation (SAPS 3 NE), and the original SAPS II equation. Performance was assessed by the standardized mortality ratio (SMR), area under receiving operating characteristic, and the Hosmer and Lemeshow goodness-of-fit , test. Results: One thousand eight hundred and sixty-two patients were included after excluding readmissions, and patients who were admitted after coronary surgery or burns. The SMRs were SAPS 3 G 0.71 (0.65, 0.78), SAPS 3 NE 0.74 (0.68, 0.81), and SAPS II 0.82 (0.75, 0.91). Discrimination was good in all systems. Only the SAPS 3 equations displayed satisfactory calibration, as measured by the Hosmer,Lemeshow test. Conclusion: The performance of SAPS 3 was satisfactory, but not markedly better than SAPS II. Both systems considerably overestimated mortality and exhibited good discrimination, but only the SAPS 3 equations showed satisfactory calibration. Customization of these equations based on a larger cohort is recommended. [source] Characteristics associated with discharge to home following prolonged mechanical ventilation: A signal detection analysis,RESEARCH IN NURSING & HEALTH, Issue 6 2006Yookyung Kim Abstract The objective of study was to identify characteristics associated with being home at 6 months in 80 patients on prolonged mechanical ventilation (PMV) (,7 days). At 6 months, 47.5% were home, 13.8% institutionalized, and 38.8% deceased and classified "not home." Using signal detection methodology (SDM), four mutually exclusive groups at high and low probability of being home were identified. The best outcome (94.4% home) was achieved by patients with an admission Charlson Comorbidity Score ,3 and an Acute Physiology Score (APS) ,21 and the worst outcome (23.4% home) by patients with an admission Charlson Comorbidity Score >3 and Health Assessment Questionnaire score >2.7. SDM provided an effective means of identifying subgroups likely to be discharged home using available information. © 2006 Wiley Periodicals, Inc. Res Nurs Health 29: 510,520, 2006 [source] Ampicillin + sulbactam vs. clindamycin ± cephalosporin for the treatment of aspiration pneumonia and primary lung abscessCLINICAL MICROBIOLOGY AND INFECTION, Issue 2 2004M. Allewelt Abstract Aspiration pneumonia, necrotising pneumonia and primary lung abscess are complications arising from the aspiration of infectious material from the oral cavity or stomach. There is limited information on optimal antibacterial therapeutic regimens. Patients with pulmonary infection following aspiration (n = 95) were included in a prospective, open, randomised, comparative multicentre trial to compare the safety, clinical and bacteriological efficacy of ampicillin + sulbactam vs. clindamycin ± cephalosporin. Treated patients (n = 70) received sequential antibiotic therapy with either ampicillin + sulbactam (n = 37) or clindamycin (n = 33), with or without a second- or third-generation cephalosporin, administered until the complete resolution of clinical and radiological abnormalities. Definite or presumptive pathogens were isolated from 58 patients. Mean duration of therapy was 22.7 days for ampicillin + sulbactam and 24.1 days for clindamycin. In patients treated with ampicillin + sulbactam, the clinical response was 73.0% at the end of therapy and 67.5% 7,14 days after therapy. For clindamycin, the rates were 66.7% and 63.5%, respectively. Bacteriological response was similar in both treatment arms. Nine patients died (12.9%), with a Simplified Acute Physiology Score of >,30 points being the only significant predictive factor for therapeutic failure. Ampicillin + sulbactam and clindamycin ± cephalosporin were both well-tolerated and proved equally effective in the treatment of aspiration pneumonia and lung abscess. [source] Risk factors of mortality for nosocomial pneumonia: importance of initial anti-microbial therapyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2005S-C Lee Summary Nosocomial pneumonia is a common nosocomial infection and has high mortality rate. Risk factors of mortality of nosocomial pneumonia were studied in 132 hospitalised patients who developed nosocomial pneumonia. The overall mortality rate was 64/132, 48.5%. Of the 11 risk factors univariately associated with mortality due to nosocomial pneumonia, only the inappropriate initial anti-microbial therapy, high simplified acute physiology score and multiple organ failures remained significant after stepwise logistic regression. Gram-negative bacilli were still the most pre-dominant causative microbiologic agents of nosocomial pneumonia with Pseudomonas aeruginosa (20.3%), Acinetobacter baumannii (18.6%) and Escherichia coli (5.9%) being the three most predominant pathogens. A. baumannii were significantly more predominant among non-survivors than survivors (13.56 vs. 5.08%, p = 0.0418). The incidence rate of methicillin-resistant Staphylococcus aureus was 19.5% higher than previous reports. We conclude that inappropriate initial anti-microbial therapy for nosocomial pneumonia is associated with the mortality rate of nosocomial pneumonia, and appropriate anti-microbial therapy improves outcome of nosocomial pneumonia. [source] Ventilator treatment in the Nordic countries.ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2002A multicenter survey Background: A 1-day point prevalence study was performed in the Nordic countries to identify ventilator-treatment strategies in the region. Material and methods: On 30 May 30 2001 all mechanically ventilated patients in 27 intensive care units (ICUs) were registered via the internet. The results are shown as medians (25th, 75th percentile). Results: ,One hundred and eight patients were included (69% male) with new simplified acute physiology score (SAPS) 48 (37,57) and 4.5 d (2,11) of ventilator treatment. The most frequent indication for ventilator treatment was acute respiratory failure (73%). Airway management was by endotracheal tube (64%), tracheostomy (32%) and facial mask (4%). Pressure regulated ventilator modes were used in 86% of the patients and spontaneous triggering was allowed in 75%. The tidal volume was 7 ml/kg (6,9), peak inspiratory pressure 22 cmH2O (18,26) and positive end-expiratory pressure (PEEP) 6 cmH2O (6,9). FiO2 was 40% (35,50), SaO2 97% (95,98), PaO2 11 kPa (10,13), PaCO2 5.4 kPa (4.7,6.3), pH 7.43 (7.38,7.47) and BE 2.0 mmol/l (, 0.5,5). The PaO2/FiO2 ratio was 220 mmHg (166,283). The peak inspiratory pressure (r=0.37), mean airway pressure (r=0.36), PEEP (r=0.33), tidal volume (r=0.22) and SAPS score (r=0.19) were identified as independent variables in relation to the PaO2/FiO2 ratio. Conclusion: The vast majority of patients were ventilated with pressure-regulated modes. Tidal volume was well below what has been considered conventional in recent large trials. Correlations between the parameters of gas exchange, respiratory mechanics, ventilator settings and physiological status of the patients was poor. It appears that blood gas values are the main tool used to steer ventilator treatment. These results may help to design future interventional studies of ventilator treatment. [source] | ||||||||||