重症监护室患者并发急性肾功能衰竭的临床特点及预后评估

目的 探讨重症监护室(ICU)患者并发急性肾功能衰竭(ARF)的特点及对其预后的评估.方法 回顾性收集2004年12月至2005年4月广东省人民医院ARF患者的临床资料,并对每例患者入住ICU 24 h内进行APACHEⅡ、SAPSⅡ、SOFA和ATN-ISI评分,分析影响患者预后的危险因素.结果 ICU患者并发ARF 41例,占同期ICU患者的19.1%,其中死亡21例(51.2%),机械通气比例65.9%,血管活性药物使用率46.3%,少尿发生率41.5%,平均器官衰竭数目2.16个.APACHEⅡ积分17.3分、SAPSⅡ积分52.0分、SOFA积分9.26分、ATN-ISI积分0.54分.Cox回归分析显示,器官衰竭数目和机械通气是ARF患者ICU 28 d死亡的危险因素,RR值分别为2.54[95%可信区间1.316～4.913)(P=0.006)]和6.0[95%可信区间1.102～32.600(P=0.038)].ROC曲线分析显示,APACHEⅡ、SAPSⅡ、SOFA和ATN-ISI 4个积分系统在预测ARF患者病死率时均有意义,曲线下的面积分别为0.848[95%可信区间0.722～0.974(P＜0.001)]、0.880[95%可信区间0.767～0.994(P＜0.001)]、0.851[95%可信区间0.726～0.976(P＜0.001)]和0.956[95%可信区间0.896～1.026(P＜0.001)].结论 重症监护室患者并发ARF时预后差;器官衰竭数目和机械通气是ARF患者死亡的独立危险因素;APACHEⅡ、SAPSⅡ、SOFA和ATN-ISI 4种积分模型对ARF患者的病死率均有较好的预示作用,ATN-ISI的预测效果可能最优.     

重症急性肾功能衰竭预后影响因素分析

目的了解影响重症急性肾功能衰竭患者预后的主要危险因素。方法总结2008年1月至2009年12月解放军总医院收治的进行肾脏替代治疗的100例重症急性肾功能衰竭患者的临床数据,采用APACHEⅡ评分评估患者病情严重程度,SOFA评分评估患者重要器官功能,采用单因素分析和多因素Lo-gistic回归方法分析影响患者肾功能恢复的因素,应用Kap lan-M e ier生存分析和COX比例风险模型分析患者累积存活率和影响患者生存的主要因素。结果伴有呼吸衰竭的患者存活率低于无呼吸衰竭患者(P=0.016);肝脏SOFA积分≥2的患者存活率低于肝脏SOFA积分<2患者(P=0.011);APACHEⅡ评分>25的患者存活率明显低于APACHⅡ评分≤25患者(P=0.001)。APACHEⅡ评分是影响患者病死率的因素(P<0.01,95%C I:1.048~1.076)。结论 APACHⅡ评分高低是影响重症急性肾功能衰竭患者肾功能恢复和最终死亡的主要因素,避免呼吸衰竭、脓毒症的发生及肝功能的恶化,有利于降低患者病死率。     

两种评分在慢性阻塞性肺疾病急性加重期并呼吸衰竭患者预后中的价值

目的探讨急性生理学与慢性健康状况(APACHEⅡ)评分、慢性阻塞性肺疾病和支气管哮喘生理(CAPS)评分在慢性阻塞性肺疾病急性加重期(AECOPD)并Ⅱ型呼吸衰竭患者预后中的应用价值。方法回顾性分析该院呼吸内科收治的138例AECOPD并Ⅱ型呼吸衰竭患者,在入院24 h内分别进行APACHEⅡ及CAPS评分,根据存活情况分为死亡组与生存组,比较两组患者两种评分分值;对各自评分进行分组,比较各组死亡率;根据Logistic回归模型与ROC曲线分析评估两种评分对AECOPD并Ⅱ型呼吸衰竭预后判断的校准度与分辨度。结果死亡组与生存组在APACHEⅡ及CAPS评分分值之间存在显著差异(P<0.05);当APACHEⅡ分值≥24分,CAPS分值≥35分时患者病死率较高,与低于该分值组比较差异显著(P<0.05);Logistic回归模型显示APACHEⅡ及CPIS评分对AECOPD并Ⅱ型呼吸衰竭生存预后结局的预测均有较好的校准度;APACHEⅡ评分的曲线下面积在0.9以上,CAPS评分的曲线下面积在0.8以上,都具有较高的分辨能力。结论死亡组APACHEⅡ及CAPS评分均值均高于生存组患者;APACHEⅡ分值≥24分,CAPS分值≥35分时患者病死率较高;APACHEⅡ评分对确定AECOPD并Ⅱ呼吸衰竭患者的生存预测的校准度和分辨度优于CAPS评分。     

ICU住院患者急性肾损伤患病现况调查及预后分析

目的:探讨ICU住院患者急性肾损伤(AKI)的患病及预后情况,并对预后相关危险因素进行分析。方法:回顾性分析655例ICU住院患者AKI的发生率、病因、病死率等流行病学情况,并采用Logistic回归分析影响预后的危险因素。结果:655例患者中发生AKI 109例(男87,女22)(16.6%),男女比例(3.95:1)。发生AKI第7天,46例死亡,病死率42.2%;发生AKI患者出院前肾功能完全恢复19例(17.4%),肾功能部分恢复43例(39.4%),肾功能未恢复41例(37.6%)。多因素Logistics回归分析低血压(OR=6.338)、昏迷(OR=4.417)、APACHEⅡ评分(OR=1.453)是患者死亡的独立危险因素。与肾功能预后相关的因素包括年龄、贫血、使用抗生素、出血。结论:AKI是ICU住院患者中越来越普遍且严重的并发症。一旦发生AKI,患者病死率高、肾功能难以完全恢复。昏迷、低血压、APACHEⅡ评分是患者死亡的独立危险因素;年龄、贫血、使用抗生素、出血是患者肾脏功能预后的相关因素。     

老年重症急性肾衰竭患者不同肾脏替代治疗时间的预后差异

目的探讨不同肾脏替代治疗时间对老年重症急性肾衰竭(ARF)患者预后的影响及死亡危险因素。方法 117例老年重症ARF患者,根据连续性肾脏替代治疗(CRRT)时间分为短时组和长时组,比较两组患者肾脏替代治疗前后存活率、生理生化指标、肾功能指标、APACHEⅡ评分等的差异。结果老年重症ARF患者接受肾脏替代治疗后存活率为46.15%,短时组的存活率为50.00%,与长时组(49.06%)差异无统计学意义(P0.05)。两组患者治疗前后血p H值、HCO-3、K+差异均有统计学意义(均P0.05),而Na+、HR、MAP差异均无统计学意义(均P0.05);两组患者治疗后尿素氮(BUN)、肌酐(SCr)均明显降低(均P0.05),但短时组和长时组BUN变化值、SCr变化值比较差异无统计学意义(均P0.05);两组治疗结束后APACHEⅡ评分较治疗前降低,长时组差异有统计学意义(P0.05);经Cox回归分析,慢性肾脏病史(RR=2.642)、糖尿病(RR=1.939)和肾外器官衰竭数(RR=2.152)是影响患者预后的独立危险因素(均P0.05)。结论肾脏替代治疗老年重症ARF患者死亡率较高;短时间CRRT和长时间CRRT对于老年重症ARF患者预后的影响不大;慢性肾脏病史、糖尿病和肾外器官衰竭数是影响患者预后的独立危险因素。     

老年内科危重症患者急性肾衰竭的临床分析

目的 了解老年内科危重症患者发生急性肾衰竭(ARF)的致病因素及转归.方法 对我院内科近10年老年(≥60岁)ARF患者的临床资料进行回顾分析,将老年患者分为院外获得性ARF(院外ARF)组和院内获得性ARF(院内ARF)组,并与同期内科非老年ARF患者进行比较.结果 (1)老年内科ARF患者381例,院外获得性ARF为218例(57.2%),医院获得性ARF为163例(42.8%),其中来自内科重症监护室153例(93.9%);(2)与院外ARF组比较,院内ARF组患者年龄较高.慢性基础疾病较多,伴发感染和/或心力衰竭的比率和病死率较高,ARF的程度较重;(3)院内ARF组的致病因素以感染及心力衰竭或心肌缺血为主;(4)院内ARF组死亡147例,死亡组伴慢性基础疾病、合并严重感染及心力衰竭、伴发老年多器官功能障碍综合征(MODS)者均多于存活组,危霞症程度(APACHEⅡ评分)更高,肾衰竭程度更重;(5)与非老年组比较,老年组院内ARF构成比、伴发MODS、APACHEⅡ评分及病死率均显著增高. 结论 老年危重症患者更易发生ARF,医院获得性ARF的主要诱因为感染,心力衰竭或严重心肌缺血,病死率较高.     

三种评分标准对慢性阻塞性肺疾病急性加重期并Ⅱ型呼吸衰竭患者预后评估价值的探讨

目的 探讨急性生理学与慢性健康状况评分(APACHEⅡ)、临床肺部感染评分(CPIS)和慢性阻塞性肺疾病和支气管哮喘生理评分(CAPS)对慢性阻塞性肺疾病急性加重期(AECOPD)并Ⅱ型呼吸衰竭患者预后评估的应用价值.方法 回顾性分析138例AECOPD并Ⅱ型呼吸衰竭患者的临床资料,在入院24小时内分别进行APACHEⅡ、CPIS及CAPS评分,比较不同预后患者3种评分分值的差别;计算每种评分标准不同分值患者的死亡率;根据Logistic回归模型与ROC曲线评估3种评分标准对AECOPD并Ⅱ型呼吸衰竭患者预后判断的校准度与分辨度.结果 不同预后患者在APACHEⅡ、CPIS和CAPS评分分值之间比较差异有统计学意义(P＜0.05).当APACHEⅡ分值≥24分,CPIS分值≥7分,CAPS分值≥35分时患者病死率较高(P＜0.05).Logistic回归模型显示,3种评分标准对AECOPD并Ⅱ型呼吸衰竭患者生存预后结局的预测均有较好的校准度.结论 死亡组患者APACHEⅡ、CPIS和CAPS评分均值均高于生存组患者;APACHEⅡ分值≥24分、CPIS分值≥7分、CAPS分值≥35分时患者病死率较高;APACHEⅡ评分对确定AECOPD并Ⅱ型呼吸衰竭患者生存预测的校准度和分辨度最高.     

应用APACHE Ⅱ评分和SIRS评分对脓毒症患者预后评估的研究

目的探讨全身炎症反应综合征（SIRS）评分与急性生理和慢性健康状况（APACHE）Ⅱ评分对脓毒症患者预后评估的意义。方法分析我院外科监护室（ICU）收治的112例脓毒症患者临床资料,进行SIRS评分与APACHEⅡ评分,分析SIRS和APACHEⅡ评分与病死率的关系。结果随着SIRS与APACHEⅡ分值的增加,病死率也增加,SIRS评分≥2或A-PACHEⅡ评分≥25时病人病死率明显增加（P〈0.05）。结论 SIRS评分与APACHEⅡ评分一样能够预测脓毒症患者的预后,且简单实用。     

急性呼吸窘迫综合征的预后指标分析

目的分析急性呼吸窘迫综合征(ARDS)高病死率的影响因素,筛选其临床预后指标。方法收集我院急诊科ARDS患者60例的临床资料。采用单因素及多因素logistic回归分析各种因素与病死率之间的关系。结果确诊后28d,死亡35例,病死率为58.3%。联合使用免疫抑制药物(≥3种)患者的病死率高于其他未联用免疫抑制药物的患者;病死组患者PaCO2、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分高于存活组。氧合指数(PaO2/FiO2)≤150mmHg的ARDS患者病死率高于PaO2/FiO2150mmHg的患者。经单因素Logistic回归分析,免疫抑制药物≥3种、PaCO2≥50mmHg、PaO2/FiO2≤150mmHg、APACHEⅡ≥19分等因素与ARDS的病死率相关。多因素Logistic回归分析,提示PaO2/FiO2≤150mmHg+APACHEⅡ≥19分是ARDS患者预后不良的独立危险因素。结论在对ARDS患者进行以治疗原发病为主的综合治疗的前提下,PaO2/FiO2≤150mmHg+APACHEⅡ≥19分可以作为评价ARDS患者预后的指标。     

APACHEⅡ与SAPSⅡ评分系统在大肠癌患者病情危重度评估中的应用

189例大肠癌患者中病死组的急性生理学和慢性健康评估系统（APACHE）Ⅱ和简化急性生理状态评分系统（SAPS）Ⅱ评分均高于存活组（P〈0．01）。大肠癌患者APACHEⅡ评分每增加10分、SAPSⅡ评分每增加20分,患者病死率相应升高。APACHEⅡ评分中、低分段预测病死率高于实际病死率,而高分段的预测病死率则低于实际病死率;SAPSⅡ评分各分段预测病死率都略高于实际病死率。APACHEⅡ评分低的大肠癌患者生活质量优于评分高者;SAPSⅡ评分不能预测大肠癌患者的生活质量。APACHEⅡ和SAPSⅡ两种评分方法都可用于大肠癌患者病情危重度的评估和病死风险预测,APACHEⅡ评分在预测患者生活质量方面较SAPSⅡ占优势,SAPSⅡ评分比APACHEI评分更简便、实用。     

10 Comparison of Four Prognostic Indexes in Severe Acute Renal Failure

Background Several prognostic indexes and models are in use for acute renal failure (ARF) patients in intensive care units (ICU). Some were designed on general ICU populations (like APACHE II) and some were made specifically for ICU patients with ARF. The purpose of our prospective clinical study was to compare APACHE II and three ARF‐specific prognostic indexes in their ability to discriminate survivors and non‐survivors among critically ill ARF patients requiring dialysis. Methods Forty‐four critically ill patients with ARF requiring dialysis were included. Patients with chronic renal insufficiency (creatinine > 200 µmol/L), transplanted kidney or urinary tract obstruction were excluded. Four prognostic indexes were measured at the time of first dialysis: APACHE II score (0–71), Cleveland Clinic Foundation (CCF) score (0–20), predicted mortality by Mehta and by Liano model. Primary end‐points were ICU survival and recovery of renal function. Results Patients were 65 ± 5 years old, 75% were male, 50% recovered renal function (22/44). Mean APACHE II score was 21.9 ± 6.5, CCF score was 9.2 ± 2.5, predicted mortality by Mehta model was 64 ± 5% and by Liano model 47 ± 20%. Patients that recovered renal function and those that died in ARF did not differ significantly in any of the prognostic indexes measured. Intensive Care Unit survival data was available for 32 patients, this group was not significantly different in prognostic indexes from the group for which ICU survival data was not available. Intensive Care Unit mortality was 75% (24/32). There was significant difference in APACHE II value in ICU survivors and non‐survivors (16.6 ± 6.1 vs. 23.4 ± 6.5, P = 0.015), but no difference in the other three indexes. Conclusions Only the APACHE II values measured at first dialysis were significantly different between ICU survivors and non‐survivors, whereas other three prognostic indexes were not.     

Assessment of factors predicting outcome of acute respiratory distress syndrome in North India

OBJECTIVES: Information on the spectrum and outcome of acute respiratory distress syndrome (ARDS) in tropical countries is scanty. This study was designed to assess the factors predicting the outcome of ARDS in North India. METHODOLOGY: Consecutive patients requiring mechanical ventilation for ARDS over a 2 year period at the Respiratory Intensive Care Unit (RICU) of a tertiary referral hospital were studied. Hospital survival was correlated with age, aetiology, disease severity scores (APACHE III, SAPS II, lung injury score) and organ failure using univariate analysis. Factors significantly influencing mortality were examined by multivariate analysis to identify factors independently affecting outcome. RESULTS: Sepsis (28.6%), followed by malaria (21.4%), were the commonest risk factors. Seven out of eight patients (87.5%) with sepsis died. The presence of sepsis, more than three organ failure prior to admission, APACHE III score > 57 and SAPS II score > 39 were significantly associated with mortality. Only APACHE III score > 57 or SAPS II score > 39 were, however, independently predictive of a poor outcome following multivariate analysis. CONCLUSIONS: Sepsis, associated with a very poor outcome, and malaria were important risk factors for the development of ARDS. APACHE III score > 57 or SAPS II score > 39 were associated with increased risk of mortality.     

End-stage renal failure patients requiring renal replacement therapy in the intensive care unit: incidence,clinical features,and outcome

AIMS: To study incidence, clinical features, and outcome of critically ill patients with end-stage renal failure (ESRF) requiring renal replacement therapy (RRT) in the intensive care unit (ICU) and to test the validity of severity scoring systems for these patients. METHODS: Data for ESRF patients treated with RRT were collected from 81 Australian adult ICUs providing RRT. They were compared with matched controls with acute renal failure. RESULTS: Thirty-eight ESRF patients received RRT in the ICU over 3 months. The mean APACHE II score was 21.8 (predicted mortality: 37%) and the SAPS II score 44.7 (predicted mortality: 37%). The hospital mortality was 34%. Receiver operating characteristic curves showed good discrimination ability for hospital mortality for these two scores (AUC: 0.81 for APACHE II and 0.84 for SAPS II). Using admission diagnosis and SAPS II scores, 32 ESRF patients treated with continuous RRT (CRRT) were matched to 32 acute renal failure patients also treated with CRRT. ICU mortality (22 vs. 38%) and hospital mortality (38 vs. 38%) were comparable between the two groups. CONCLUSIONS: ESRF patients requiring RRT in the ICU were relatively frequent. Severity scores could be used to predict the hospital outcome for these patients. Their mortality, when treated with CRRT, was similar to that of diagnosis- and severity-score-matched patients with acute renal failure.     

连续性肾脏替代疗法在重症急性肾功能衰竭治疗中的应用

目的 回顾分析连续性肾脏替代疗法（ＣＲＲＴ）在重症急性肾功能衰竭（ＡＲＦ）治疗中的应用和影响预后的因素。方法 １９８６年５月至１９９９年１月用ＣＲＲＴ治疗重症ＡＲＦ患者１０１例,回顾性分析了患者临床特点、ＣＲＲＴ方法和预后。结果 １０１例患者中６０例（５９．４％）度过疾病的急性期（存活组）,４１例（４０．６％）在急性期死亡（死亡组）,对两组患者的临床统计学资料、肾功能衰竭的特点、疾病严重程度（ＡＰ     

Systemic inflammatory response syndrome in nosocomial bloodstream infections with Pseudomonas aeruginosa and Enterococcus Species: comparison of elderly and nonelderly patients

OBJECTIVES: To determine whether the systemic inflammatory response syndrome (SIRS), clinical course, and outcome of monomicrobial nosocomial bloodstream infection (BSI) due to Pseudomonas aeruginosa or Enterococcus spp. is different in elderly patients than in younger patients. DESIGN: Historical cohort study. SETTING: An 820-bed tertiary care facility. PARTICIPANTS: One hundred twenty-seven adults with P. aeruginosa or enterococcal BSI. MEASUREMENTS: SIRS scores were determined 2 days before the first positive blood culture through 14 days afterwards. Elderly patients (> or =65, n=37) were compared with nonelderly patients (<65, n=90). Variables significant for predicting mortality in univariate analysis were entered into a logistic regression model. RESULTS: No difference in SIRS was detected between the two groups. No significant difference was noted in the incidence of organ failure, 7-day mortality, or overall mortality between the two groups. Univariate analysis revealed that Acute Physiology And Chronic Health Evaluation (APACHE) II score of 15 or greater at BSI onset; adjusted APACHE II score (points for age excluded) of 15 or greater at BSI onset; and respiratory, cardiovascular, renal, hematological, and hepatic failure were predictors of mortality. Age, sex, use of empirical antimicrobial therapy, and infection with imipenem-resistant P. aeruginosa or vancomycin-resistant enterococci did not predict mortality. Multivariate analysis revealed that hematological failure (odds ratio (OR)=8.1, 95% confidence interval (CI)=2.78-23.47), cardiovascular failure (OR=4.7, 95% CI=1.69-13.10), and adjusted APACHE II > or = 15 at BSI onset (OR=3.1, 95% CI=1.12-8.81) independently predicted death. CONCLUSION: Elderly patients did not differ from nonelderly patients with respect to severity of illness before or at the time of BSI. Elderly patients with pseudomonal or enterococcal BSIs did not have a greater mortality than nonelderly patients.     

Outcome of patients with cirrhosis requiring intensive care unit support: Prospective assessment of predictors of mortality

Determinants of outcome and the utility of the Child-Pugh score and the acute physiology and chronic health evaluation (APACHE) II score as predictors of outcome were prospectively assessed in 54 consecutive patients with cirrhosis requiring intensive care unit (ICU) management. Overall mortality in the ICU was 43% (23/54). Child-Pugh scores did not differ between survivors or nonsurvivors (12.8 versus 12.3, P = 0.26), however APACHE II scores (P = 0.007), acute physiology scores (P = 0.006), and Karnofsky scores (P = 0.001) were significant predictors of outcome. By univariate analysis, requirement of mechanical ventilation analysis (P = 0.001), duration of mechanical ventilation (P = 0.001), pulmonary infiltrates (P = 0.0001), infections (P = 0.047), gastrointestinal bleeding (P = 0.005), and serum creatinine ≥1.5 mg/dl (P = 0.0005) were significantly associated with mortality. By logistic regression analysis only pulmonary infiltrates (P = 0.0001) and renal dysfunction (P = 0.041) were independent predictors of mortality. When controlled for the severity of illness (APACHE II scores), the mortality in patients with cirrhosis caused by alcohol was significantly lower than that in patients with liver disease not caused by alcohol (P = 0.01). Our study not only identified predictors of poor outcome in patients with cirrhosis requiring ICU care but also provided data that may have implications for optimal timing for transplantation. Received Feb. 2, 1997; accepted June 27, 1997     

Intensive care for very elderly patients: outcome and risk factors for in-hospital mortality.

OBJECTIVES: To evaluate outcome and risk factors, particularly the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system, for in-hospital mortality in very elderly patients after admission to an intensive care unit (ICU). METHODS: Retrospective chart review of patients > or =85 years admitted to the ICU. We recorded age, sex, previous medical history, primary diagnosis, date of admission and discharge or death, APACHE II score on admission, use of mechanical ventilation and inotropics, and complications during ICU admission. RESULTS: 104 patients > or =85 years (1.3% of all ICU admissions) were studied. The ICU and in-hospital mortality rates for these patients were 22 and 36% respectively. Factors correlated with a greater in-hospital mortality were: an admission diagnosis of acute respiratory failure (chi2; P = 0.007), the use of mechanical ventilation (chi2; P = 0.00005) and inotropes (chi2; P = 0.00001), complications during ICU admission (chi2; P = 0.004), in particular acute renal failure (chi2; P = 0.005), and an APACHE II score > or =25 (chi2; P = 0.001). The APACHE II scoring system and the use of inotropes were independently correlated with mortality. CONCLUSION: ICU and in-hospital mortality are higher in very elderly patients, particularly in those with an APACHE II score > or =25. The most important predictors of mortality are the use of inotropes and the severity of the acute illness.     

APACHE II scores and deaths after upper gastrointestinal endoscopy in hospital inpatients

Advanced age and comorbidity as well as gastrointestinal (GI) disease contribute to the increased mortality after upper GI endoscopy in inpatients when compared to outpatients. The aim of this study was to measure comorbidity in inpatients undergoing endoscopy using the Acute Physiology and Chronic Health Evaluation (APACHE) II severity of disease classification and to assess the usefulness of the APACHE II system in predicting outcome. During a 10-week period, 155 consecutive inpatients undergoing upper GI endoscopy were prospectively scored using APACHE II. They were followed up for 30 days, the measured endpoint being death. Of these, 92 (59%) inpatients were admitted with GI hemorrhage, 14 (9%) were admitted for other reasons but subsequently bled, and 49 (32%) were endoscoped for reasons other than bleeding. The mean (SEM) APACHE II score in patients with GI bleeding was 8.0 (0.5), and in patients without bleeding was 6.5 (0.6; p = 0.07). Eighteen patients (12%) died within 30 days of endoscopy. APACHE scores were higher at 10.5 (1.2) in patients who died, compared to 7.1 (0.4) in those who lived (p < 0.01). Increased acute physiology scores led to this difference. Age and chronic health scores were similar in both groups. In the 18 patients who died, 9 had GI bleeding and their mean APACHE score was 13.8 (1.5); 9 had been endoscoped for other reasons and had a lower score of 7.2 (1.3; p < 0.01). These latter 9 deaths amounted to a 18% mortality in the nonbleeding group, which was greater than expected. APACHE II scores can help predict poor outcome in inpatients referred for endoscopy. However, the APACHE II system has limitations and failed to identify (by means of a high score) some patients without GI bleeding who subsequently died. A tool to measure comorbidity, such as the APACHE II system, is necessary when comparing groups of patients in different settings.     

Predictors of mortality in a cohort of intensive care unit patients with acute renal failure receiving continuous renal replacement therapy

BACKGROUND: Despite the frequent use of continuous renal replacement therapy (CRRT) in the management of acute renal failure (ARF) in the critically ill, predictors of mortality remain unclear. METHODS: A registry of all patients initiated on CRRT at a single institution was assembled over an 18-month period, and a subsequent cross-sectional analysis of selected variables was conducted for associations with mortality. Predictors evaluated were age, gender, diagnosis of sepsis, Apache II score, days between ARF diagnosis and initiation of CRRT, creatinine at initiation of CRRT, change in creatinine from baseline and admission to initiation of CRRT, setting of ARF, and prescribed CRRT dose. The principal outcome was mortality at 30 days. RESULTS: Eighty-one individuals met inclusion criteria. Overall mortality for the study was 50.2%. The mean elevation in creatinine from admission to initiation of CRRT was 1.6 mg/dL (141.4 micromol/L) in those who lived and 2.6 mg/dL (229.8 micromol/L) in those who died (P = 0.023). Patients admitted with normal renal function who developed ARF while in the hospital had mortality of 56.3%. When available, patients with abnormal renal function at presentation were further classified by either abnormal or normal preadmission creatinine. These patients had mortality of 31.3% and 83.3%, respectively. These differences in mortality were statistically significant. CONCLUSIONS: Increased mortality was significantly associated with the magnitude of change in serum creatinine between admission and initiation of CRRT. Also, patient ARF classification was significantly associated with mortality.     

Factors associated with mortality of patients with myxoedema coma: prospective study in 11 cases treated in a single institution

This study was carried out to investigate the clinical and biochemical factors which might be of importance in predicting the outcome of patients with myxoedema coma. Eleven patients (ten female) aged 68.1+/-19.5 years attended our institution over a period of 18 years.Glasgow and APACHE II scores and serum free thyroxine and TSH were measured in all the patients on entry. Patients were selected at random to be treated with two different regimens of l-thyroxine.Four patients died with the mortality rate being 36.4%. The patients in coma at entry had significantly higher mortality rates than those with minor degrees of consciousness (75% vs 14.3% respectively, P=0.04). The surviving patients had significantly higher Glasgow scores than those who died (11.85+/-2.3 vs 5.25+/-2.2 respectively, P<0.001). Comparison of the mean values of APACHE II scores between the surviving group and those who died was significantly different (18.0+/-2.08 vs 31.5+/-2.08 respectively, P<0.0001).The degree of consciousness, the Glasgow score and the severity of the illness measured by APACHE II score on entry were the main factors that determined the post-treatment outcome of patients with myxoedema coma.