Background Nutritional status is associated with mortality. The modified Nutrition Risk in the Critically Ill (mNUTRIC) score is one of the most commonly used nutritional risk assessment tools in intensive care units (ICUs). The purpose of this study was to compare the mortality predictive ability of the mNUTRIC score to that of the mNUTRIC-S2 score, which uses the Simplified Acute Physiology Score (SAPS) II instead of the Acute Physiology and Chronic Health Evaluation (APACHE) II.
Methods This retrospective cohort analysis included patients admitted to the ICU between January and September 2020. Each patient’s electronic medical records were reviewed. The model discrimination for predicting ICU mortality was assessed by the area under the receiver operating characteristic (ROC) curve, and a Cox regression model was performed to confirm the relationship between the groups and mortality.
Results In total, 220 patients were enrolled. The ROC curve for predicting ICU mortality was 0.64 for the mNUTRIC score versus 0.67 for the mNUTRIC-S2 score. The difference between the areas was 0.03 (95% confidence interval [CI], –0.01 to 0.06; P=0.09). Patients with mNUTRIC-S2 score ≥5 had a greater risk of ICU mortality (hazard ratio [HR], 3.64; 95% CI, 1.85–7.14; P<0.001); however, no such relationship was observed with mNUTRIC score (HR, 1.69; 95% CI, 0.62–4.62; P=0.31).
Conclusions The mNUTRIC-S2 score was significantly associated with ICU mortality. A cutoff score of 5 was selected as most appropriate.
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Background In this study, we analyze the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE IV, Simplified Acute Physiology Score (SAPS) 3, and Mortality Probability Model (MPM)0 III in order to determine which system best implements data related to the severity of medical intensive care unit (ICU) patients.
Methods The present study was a retrospective investigation analyzing the discrimination and calibration of APACHE II, APACHE IV, SAPS 3, and MPM0 III when used to evaluate medical ICU patients. Data were collected for 788 patients admitted to the ICU from January 1, 2015 to December 31, 2015. All patients were aged 18 years or older with ICU stays of at least 24 hours. The discrimination abilities of the three systems were evaluated using c-statistics, while calibration was evaluated by the Hosmer-Lemeshow test. A severity correction model was created using logistics regression analysis.
Results For the APACHE IV, SAPS 3, MPM0 III, and APACHE II systems, the area under the receiver operating characteristic curves was 0.745 for APACHE IV, resulting in the highest discrimination among all four scoring systems. The value was 0.729 for APACHE II, 0.700 for SAP 3, and 0.670 for MPM0 III. All severity scoring systems showed good calibrations: APACHE II (chi-square, 12.540; P=0.129), APACHE IV (chi-square, 6.959; P=0.541), SAPS 3 (chi-square, 9.290; P=0.318), and MPM0 III (chi-square, 11.128; P=0.133).
Conclusions APACHE IV provided the best discrimination and calibration abilities and was useful for quality assessment and predicting mortality in medical ICU patients.
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BACKGROUND Patients with decompensated liver cirrhosis usually resulted in admission to the intensive care unit (ICU) during hospitalization. When admitted to the ICU, the mortality was high. The aim of this study is to identify multiple prognostic factors for mortality and to analyze the significance of prognostic survival model with each scoring system in patients with decompensated liver cirrhosis who was admitted to the ICU. METHODS From January 2008 to December 2008, 60 consecutive patients with decompensated liver cirrhosis were admitted in the ICU and retrospectively reviewed. Prognostic models used were Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), model for end-stage liver disease with incorporation of serum sodium (MELD-Na), acute physiology and chronic health evaluation (APACHE) II, and sequential organ failure assessment (SOFA). The predictive prognosis was analyzed using the area under the receiver's operating characteristics curve (AUC). RESULTS The median follow up period was 20 months, and ICU mortality was 17% (n = 10). A total of 24 patients (40%) died during the study period. The average survival of five prognostic models was related with the severity of the disease. All of the five systems showed significant differences in the cumulative survival rate, according to the scores on admission, and the MELD-Na had the highest AUC (0.924). Multivariate analysis showed that bilirubin and albumin were significantly related to mortality. CONCLUSIONS The CPT, MELD, MELD-Na, APACHE II, and SOFA may predict the prognosis of patients with decompensated liver cirrhosis. The MELD-Na could be a better prognostic predictor than other scoring systems.
BACKGROUND Pumpless interventional lung assist (iLA) uses an extracorporeal gas exchange system without any complex blood pumping technology, and has been shown to reduce CO2 tension and permit protective lung ventilation. The feasibility and safety of iLA were demonstrated in previous studies, but there has been no experience with iLA in Korea.
The purpose of this study was to evaluate the feasibility of the iLA device in terms of physiologic efficacy and safety in Korean patients with acute respiratory failure. METHODS iLA was implemented in patients with acute respiratory failure who satisfied the predefined criteria of our study. Initiation of iLA followed an algorithm for implementation, ventilator care, and monitoring. Following insertion of arterial and venous cannulas under ultrasound guidance, the physiologic and respiratory variables and incidence of adverse events were monitored. RESULTS iLA was implemented in 5 patients and the duration of iLA ranged from 7 hours to 171 hours. At 24 hours after implementation, the mean changes in pH, PaCO2, and PaO2/FiO2 ranged from 7.204 to 7.393, from 68.4 mm Hg to 33 mm Hg, and from 128.7 mm Hg to 165 mm Hg, respectively. During iLA therapy, one adverse event was observed, which presented with hematochezia without hemodynamic change. CONCLUSIONS iLA treatment produced effective removal of carbon dioxide and allowed for protective ventilation in severe respiratory failure. An iLA system can easily be installed by percutaneous cannulation, without procedural complications, and without significant adverse events necessitating discontinuation of iLA after implementation.
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A Case of Pumpless Extracorporeal Interventional Lung Assist for Severe Respiratory Failure - A Case Report - Young-Jae Cho, Ji Yeon Seo, Yu Jung Kim, Jae-Ho Lee, Choon-Taek Lee Korean Journal of Critical Care Medicine.2012; 27(2): 120. CrossRef
A Case of iLA Application in a Patient with Refractory Asthma Who Is Nonresponsive to Conventional Mechanical Ventilation - A Case Report - Young Seok Lee, Hyejin Joo, Jae Young Moon, Jin Won Huh, Yeon-Mok Oh, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong Korean Journal of Critical Care Medicine.2012; 27(2): 108. CrossRef
BACKGROUND The prognosis of hemato-oncology (HMO) patients admitted to the intensive care unit (ICU) is poor and predicting the mortality is important for decision making at the time of ICU admission and for administering aggressive treatment. METHODS We retrospectively reviewed 309 patients who were admitted to the medical ICU (MICU) at Samsung Medical Center from July in 2005 to June in 2006. We calculated their Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA) score at the time of ICU admission and we investigated the relationship between the two scoring systems and the hospital mortality. RESULTS Among the 309 patients, the hospital mortality was 41.2%, and the mean SAPS II/SOFA score at ICU admission was 45.4 +/- 19.5/8.1 +/- 4.6. Seventy-nine (25.6%) patients had hemato-oncological diseases. Their hospital mortality was 65.8%, and the mean SAPS II/SOFA score at the time of ICU admission was 53.9 +/- 18.6/9.7 +/- 4.4, which was higher than that of the non-HMO patients (p = 0.00). The area under the receiver operating characteristic (ROC) curves for the SAPS II/SOFA score for predicting the mortality was 0.794 +/- 0.05/0.785 +/- 0.051 (p = 0.00/p = 0.00) for the HMO patients. There was no significant difference in discrimination ability between the two scoring systems (p > 0.05). None of the HMO patients with a SAPS II/SOFA score of 70/14 or higher survived. CONCLUSIONS Both the SAPS II and SOFA scores at the time of ICU admission were similarly effective for predicting the hospital mortality. The two scoring systems could be useful tools for decision making at the time of ICU admission and for administering aggressive treatment.
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Association of Peripheral Lymphocyte Subset with the Severity and Prognosis of Septic Shock Jin Kyeong Park, Sang-Bum Hong, Chae-Man Lim, Younsuck Koh, Jin Won Huh The Korean Journal of Critical Care Medicine.2011; 26(1): 13. CrossRef
BACKGROUND The purpose of this study was to evaluate the factors of cardiopulmonary resuscitation (CPR) outcome for in-hospital adult patients, acquiring data with standardized reporting guideline of in-hospital cardiopulmonary resuscitation in Korea. METHODS All adult cardiac arrest patients from July 2004 to December 2006 in this general hospital were included. Their clinical spectrums were reviewed retrospectively using Utstein-style based template. RESULTS For the study time period, one hundred and forty-two patients underwent cardiac arrest in this hospital. 136 patients were performed CPR. Return of spontaneous circulation (ROSC) occurred in 42 cases, and 15 patients were survived to hospital discharge. A shorter CPR time and a lower Simplified Acute Physiology Score II (SAPS II) were significant for survivor to hospital discharge (p<0.01). Sex, age, and location in cardiac arrest were not attributed to survival to hospital discharge. CONCLUSIONS In-hospital CPR patients, the high rate of ROSC and survival to hospital discharge were associated to the cause of arrest, shorter time of CPR, and lesser severity of disease (SAPS II). This result can be a great implication of survivor from CPR in-hospital adult patients in Korea.
Further evaluation with consistent data acquisition of CPR using Utstein-style would contribute to improve CPR practice and outcome.
Because inhaled nitric oxide (NO) induces selective vasodilation of well-ventilated lung regions diverting pulmonary artery blood flow towards these well-ventilated alveoli, it has been applied to some of ARDS patients, who show severe hypoxemia despite of positive pressure ventilation with moderate to high positive end-expiratory pressure. The beneficial effect of inhaled NO on oxygenation was lower than 5 ppm of inhaled NO and the maximum effect was about 10 ppm in patients with ARDS according to the studies. Combinations of inhaled NO with various therapies, such as the use of intravenous almitrine or phenylephrine, and prone positioning may produce additive effects on oxygenation. Approximately 65% of patients had response to inhaled NO in studies of critically ill patients with ARDS who were ventilated with less than 40 ppm of inhaled NO.
However, there was no survival benefit by inhaled NO in a multicenter phase 2 trial with 177 patients of non-septic ARDS. It is unclear whether inhaled NO exerts detrimental or beneficial effects in the pathogenesis of ARDS. Laboratory studies suggest that inhaled NO has important effects in reducing some forms of lung and tissue injury. If these effects are clinically significant, early and continued therapy with inhaled NO could potentially reduce the severity of some forms of lung injury. In contrast, NO and nitrite interacted with neutrophil myeloperoxidase to stimulate oxidative reactions during inflammation. In summary, NO inhalation would be acceptable as a rescue therapy in severe ARDS without serious complications related to the application. In addition, the effect of inhaled NO on the pathophysiology of ARDS should be elucidated.