Acute and Critical Care

Original Articles

Effects of APACHE II Score and Initial Nutritional Status on Prognosis of the Critically Ill Patients: Seohui Ahn, Se Hee Na, Chul Ho Chang, Hyunsun Lim, Duk Chul Lee, Cheung Soo Shin; Korean J Crit Care Med. 2012;27(2):102-107.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.102

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BACKGROUND
Malnutrition is common in hospitalized patients, especially in critically ill patients and affects their mortality and morbidity. However, the correlation between malnutrition and poor outcome is not fully understood. Our hypothesis is that the nutritional effect on the patient's prognosis would differ depending on the severity of the disease.
METHODS
3,758 patients admitted to the intensive care unit (ICU) were observed retrospectively. Patients were divided into well, moderate and severe groups, according to their nutritional status as assessed by their serum albumin level and total lymphocyte count (TLC). The severity of the disease was assessed by the Acute Physiologic and Chronic Health Evaluation (APACHE II score). All patients were followed clinically until discharge or death and ICU days, hospital days, ventilator days, and mortality rates were recorded.
RESULTS
Depending on the definition used, the prevalence of hospital malnutrition is reported to be 68.3%. Hospital days, ICU days, as well as ventilator days of moderate and severe groups were longer than the well group. In patients exhibiting mild severity of disease, moderate and severe malnutrition groups have 3-5 times the mortality rate than the well group.
CONCLUSIONS
Malnutrition affects the prognosis of patients who have an APACHE II score ranging from 4-29 points. Active nutritional support may be more effective for patients with a disease of mild severity.

Citations

Citations to this article as recorded by

Effects of a video-based enteral nutrition education program using QR codes for intensive care unit nurses: a quasi-experimental study
Won Kee Seo, Hyunjung Kim
Journal of Korean Biological Nursing Science.2024; 26(1): 16. CrossRef
The effect of nutritional supply on clinical outcomes and nutritional status in critically ill patients receiving continuous renal replacement therapy
Ju Yeun Kim, Ji-Myung Kim, Yuri Kim
Journal of Nutrition and Health.2015; 48(3): 211. CrossRef
Comparison of nutritional status indicators according to feeding methods in patients with acute stroke
Sanghee Kim, Youngsoon Byeon
Nutritional Neuroscience.2014; 17(3): 138. CrossRef
Clinical Significance of Postoperative Prealbumin and Albumin Levels in Critically Ill Patients who Underwent Emergency Surgery for Acute Peritonitis
Seung Hwan Lee, Ji Young Jang, Jae Gil Lee
Korean Journal of Critical Care Medicine.2013; 28(4): 247. CrossRef
Nutrition Support in the Intensive Care Unit of 6 Korean Tertiary Teaching Hospitals: A National Multicenter Observational Study
Song Mi Lee, Seon Hyeung Kim, Yoon Kim, Eunmee Kim, Hee Joon Baek, Seungmin Lee, Hosun Lee, Chul Ho Chang, Cheung Soo Shin
Korean Journal of Critical Care Medicine.2012; 27(3): 157. CrossRef

Validation of APACHE II Score and Comparison of the Performance of APACHE II and Adjusted APACHE II Models in a Surgical Intensive Care Unit: Hannnah Lee, Eun Young Choi, Yoon Hee Kim; Korean J Crit Care Med. 2011;26(4):232-237.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.232

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Abstract PDF

BACKGROUND
The ability to accurately adjust for the severity of illness in outcome studies of critically ill patients is essential for clinical audits and trials. Several studies have been carried out to validate the acute physiology and chronic health evaluation (APACHE II) score in Korean ICUs. However, few reports have been presented that compare the performance of the APACHE II score and diagnostic category weighted APACHE II models in the surgical ICU population of Korea. The aim of this study was to validate APACHE II and compare the performance of the APACHE II and adjusted APACHE II models for emergency admission in a surgical intensive care unit (SICU) population.
METHODS
A retrospective analysis of the prospective ICU registry was conducted in the SICU between October 2007 and February 2011. Calibration and discrimination were determined by the Hosmer-Lemeshow test and the area under the receiver operating characteristic (AUC) curve from patients.
RESULTS
This study included 854 patients. SICU mortality was 9.4%. For APACHE II and adjusted APACHE II, AUCs were 0.791 and 0.757, respectively. Hosmer and Lemeshow C statistics showed good calibration for APAHCE II and for adjusted APACHE II (p > 0.05).
CONCLUSIONS
The ability of the APACHE II system in predicting group outcome is validated in a surgical ICU population by a receiver operating characteristic curve and logistic regression analysis. Mortality rates predicted using APACHE II exhibited good calibration and moderate discrimination. Diagnostic category weighted adjusted APACHE II did not improve the mortality prediction.

Citations

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Time-to-surgery paradigms: wait time and surgical outcomes in critically Ill patients who underwent emergency surgery for gastrointestinal perforation
Junghyun Lee, Chami Im
BMC Surgery.2024;[Epub] CrossRef
Acute Physiologic and Chronic Health Examination II and Sequential Organ Failure Assessment Scores for Predicting Outcomes of Out-of-Hospital Cardiac Arrest Patients Treated with Therapeutic Hypothermia
Sung Joon Kim, Yong-Su Lim, Jin Seong Cho, Jin Joo Kim, Won Bin Park, Hyuk Jun Yang
Korean Journal of Critical Care Medicine.2014; 29(4): 288. CrossRef

Evaluating the Relationship between the Scoring Systems of Intensive Care Units (ICUs) and the Duration of Mechanical Ventilation after Liver Transplantation: Jeong Eun Kim, Sang Hoon Lee, Jong Ho Choi; Korean J Crit Care Med. 2009;24(2):69-74.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.69

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Abstract PDF: BACKGROUND
Postoperative mechanical ventilation in liver transplant patient has an important role for reducing respiratory complications and multi-organ failure in intensive care unit (ICU). Yet there are no specific indications for predicting the duration of postoperative mechanical ventilation. Thus, we evaluated the correlation between the duration of mechanical ventilation and scoring systems such as the Acute Physiology and Chronic health Evaluation (APACHE) II score, the Sequential Organ Failure Assessment (SOFA) score, the Model for End-stage Liver Disease (MELD) score and the risk index.
METHODS
We retrospectively studied 183 patients who underwent living donor liver transplantation and we divided them into three groups based on the duration of mechanical ventilation: Group 1: <8 hr, Group 2: 8-12 hr and Group 3: >12 hr. We analyzed the correlation coefficients among the duration of mechanical ventilation, the risk index, and the SOFA, APACHE II and MELD scores.
RESULTS
The MELD and preoperative SOFA scores were significantly higher in group 3 (p = 0.003, p = 0.027). The MELD and SOFA scores were correlated with the duration of mechanical ventilation for all the patients (correlation coefficient = 0.22, 0.20, p = 0.003, 0.007, respectively). Yet the APACHE II score shows no correlation.
CONCLUSIONS
We found that the MELD and SOFA scores were correlated with the duration of mechanical ventilation in liver transplant patients. Thus, these scoring systems may be useful to determine the duration of mechanical ventilation.

Comparing the Usefulness of the Initial Acute Physiologic and Chronic Health Evaluation (APACHE) II Score in the Emergency Department (ED) and the Mortality in Emergency Department Sepsis (MEDS) Score for Predicting the Prognosis of Septic Patients Admitt: Chan Young Koh, Young Sik Kim, Tae Yong Shin, Young Rock Ha; Korean J Crit Care Med. 2008;23(2):90-95.; DOI: https://doi.org/10.4266/kjccm.2008.23.2.90

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Abstract PDF

BACKGROUND
To determine the prognostic value of the initial APACHE II score in the ED compared with the classic APACHE II score in the ICU and to check the usefulness of the MEDS score together for more rapid risk stratification of septic patients admitted to the ICU via the ED.
METHODS
We prospectively checked the initial APACHE II and MEDS scores of all the patients who had systemic inflammatory response syndrome in the ED and the classic APACHE II scores after admission to the ICU, as well 6 months later. We enrolled the only sepsis cases in the final diagnosis after reviewing the medical records. We evaluated the predictive abilities of the initial APACHE II and MEDS scores compared with the classic APACHE II score.
RESULTS
During 6 months, 58 patients diagnosed with sepsis were enrolled. Twenty-four (41.4%) patients died within 28 days of admission and 34 patients survived. The mortality group had a significantly higher mean classic APACHE II score (19 +/- 6.7 vs. 15 +/- 5.0, p < 0.01) and a higher mean MEDS score (16.67 +/- 2.70 vs. 8.91 +/- 3.11, p < 0.01) than the survivor group. The initial APACHE II score at the ED was not significantly different between the two groups. ROC analysis showed the discriminative power of the MEDS score in predicting mortality was much better than the APACHE II score (areas under the curves of the APACHE II score in the ED and ICU, and the MEDS scores were 0.668, 0.807, and 0.967, respectively; p < 0.01).
CONCLUSIONS
The initial APACHE II score in the ED did not predict mortality better than the classic APACHE II score. However, the MEDS score predicted the poor prognosis of septic patients more rapidly and accurately in the ED than the APACHE II model.

Citations

Citations to this article as recorded by

Thrombomodulin is a Strong Predictor of Multiorgan Dysfunction Syndrome in Patients With Sepsis
Dunja M. Mihajlovic, Dajana F. Lendak, Biljana G. Draskovic, Aleksandra S. Novakov Mikic, Gorana P. Mitic, Tatjana N. Cebovic, Snezana V. Brkic
Clinical and Applied Thrombosis/Hemostasis.2015; 21(5): 469. CrossRef
Endocan is useful biomarker of survival and severity in sepsis
Dunja M. Mihajlovic, Dajana F. Lendak, Snezana V. Brkic, Biljana G. Draskovic, Gorana P. Mitic, Aleksandra S. Novakov Mikic, Tatjana N. Cebovic
Microvascular Research.2014; 93: 92. CrossRef
A Case Study of Metastatic Cholangiocarcinoma with Sepsis who Showed Symptomatic Improvement after Treated with Handayeolso-tang, Fel Tauri, and Antibiotics
Soo-Min Lee, Seong-Heon Choi, An-Na Song, Ji-Young Lee, Jin Chae, Eu-Hong Jung, Soo-Kyung Lee
Journal of Sasang Constitutional Medicine.2013; 25(4): 432. CrossRef

Statistical Analysis of the Patients in the ICU by Using the APACHE II Scoring System: Young Joo Lee, Keum Hee Chung, Hyun Jue Gill, Kyung Jin Lee, Sang Hyun Kim, Chang Whan Cho, Young Suk Lee; Korean J Crit Care Med. 1998;13(1):73-78.

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Abstract PDF: Introduction: The APACHE II scoring system has been promulgated as a useful tool in the assessment of the severity of disease and prognosis for patients with acute-on-chronic medical conditions. The purpose of this study was to assess the statistical association of APACHE II score and multiple variables in ICU patients.
METHODS
Prospective data on 803 ICU patients for validation of the APACHE II system were analysed. We evaluated the relationship between APACHE II scores within the first 24 hours of ICU admission and multiple variables that included days in the ICU, mortality rate and age. The patients were classified as operation and nonoperation, survival and nonsurvival groups.
RESULT
1) The APACHE II score was significantly higher in the 153 nonsurvivals (23.97+/-10.98) than in the 651 survivals (11.51+/-6.14) (p<0.05). 2) The mean APACHE II score of the nonoperation group (14.52+/-9.29) was significantly higher than operation group (12.40+/-7.30) (p<0.05). 3) The overall mortality rate was 17.8%. 4) All patients with an APACHE II score over 40 died.
CONCLUSION
The APACHE II score is statistically related with the mortality of critically ill patients.

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