Abstract:
OBJECTIVE:To evaluate the ability of two prognostic systems to predict hospital mortality in adult intensive care patients. DESIGN:Prospective cohort study. SETTING:A mixed medical and surgical intensive care unit (ICU) in the United Kingdom. PATIENTS:A total of 1,144 patients consecutively admitted to the study. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Acute Physiology and Chronic Health Evaluation (APACHE) II and III prognostic systems were applied to assess probabilities of hospital mortality, which were compared with the actual outcome. The overall goodness-of-fit of both models was assessed. Hospital death rates were higher than those predicted by each system. Risk estimates showed a strong positive correlation between both systems (nonsurvivors r2 = 0.756, p < .0001; survivors r2 = 0.787, p < .0001). Calibration of APACHE II (chi 2 = 98.6, Lemeshow-Hosmer) was superior to that of APACHE III (chi 2 = 129.8, Lemeshow-Hosmer). The total correct classification rate of APACHE III was greater for all decision criteria applied; the best overall total correct classification rate was 80.6% for APACHE III and 77.9% for APACHE II (both for a decision criterion of 40%). The areas under the receiver operating characteristic curves were 0.806 and 0.847 for APACHE II and III, respectively, confirming the better discrimination of APACHE III. When patients were classified by diagnostic categories, risk predictions did not fit uniformly across the spectrum of disease groups. For both models, mortality ratios were highest for trauma patients and lowest for the group with respiratory disease. APACHE II predictions for patients with gastrointestinal disease were significantly better. Risk estimates for surgical admissions were superior with APACHE II (MR = 1.27) compared with APACHE III (MR = 1.56), but were similar for medical patients (1.22 vs. 1.28 for APACHE II and III, respectively). Bias induced by factors reflecting the clinical practice in an individual ICU (e.g., admission criteria, treatment before admission) may have considerable impact on risk estimates. The identification of such factors appears to be a prerequisite for the meaningful interpretation of observed and predicted death rates on the individual ICU level. CONCLUSIONS:Both predictive models demonstrated a similar degree of overall goodness-of-fit. APACHE II showed better calibration, but discrimination was better with APACHE III. Hospital mortality was higher than predicted by both models, but was underestimated to a greater degree by APACHE III. Risk estimates by both models showed considerable variation across the disease spectrum of ICU patients. Risk predictions for surgical patients and patients with gastrointestinal disease were better with APACHE II. Factors reflecting the clinical practice of an individual ICU are not accounted for by APACHE II and III. Overall, the performance of APACHE III was not superior to that of its predecessor for a cohort of United Kingdom ICU patients; for certain diagnostic categories, APACHE III performed worse than APACHE II despite an improved system of disease classification.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Beck DH,Taylor BL,Millar B,Smith GBdoi
10.1097/00003246-199701000-00006subject
Has Abstractpub_date
1997-01-01 00:00:00pages
9-15issue
1eissn
0090-3493issn
1530-0293journal_volume
25pub_type
杂志文章abstract:BACKGROUND AND METHODS:Previous studies documented activation of protease enzymes such as the plasma kallikrein-kinin system in endotoxemia and sepsis, both in experimental animals and in patients. We investigated the actions of aprotinin (a protease inhibitor that binds to plasma kallikrein) on systemic hemodynamics a...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199208000-00012
更新日期:1992-08-01 00:00:00
abstract:OBJECTIVES:To determine whether aerosolized antibiotics can be delivered efficiently to the lower respiratory tract in mechanically ventilated patients and to define possible clinical responses to these agents. DESIGN:Prospective serial study with cases as their own control. SETTING:A 10-bed respiratory care unit for...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-199801000-00013
更新日期:1998-01-01 00:00:00
abstract:OBJECTIVE:To determine the influence of a selective, sterile central nervous system surgery on immune reactivity, particularly whether a decrease of monocytic human leukocyte antigen-DR expression, indicating immunodepression, occurs after neurosurgery and if this measurement is useful for identification of patients wi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199512000-00006
更新日期:1995-12-01 00:00:00
abstract:OBJECTIVE:Prognostic information is important to the family members of incapacitated, critically ill patients, yet little is known about what prognostic information physicians provide. Our objectives were to determine the types of prognostic information provided to families of critically ill patients when making major ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.CCM.0000254723.28270.14
更新日期:2007-02-01 00:00:00
abstract:OBJECTIVE:To characterize the endothelium-dependent and endothelium-independent components of abnormal pulmonary vascular tone in canine oleic acid lung injury. DESIGN:Prospective, interventional study. SETTING:University laboratory. SUBJECTS:Twenty anesthetized mongrel dogs. INTERVENTIONS:Right heart catheterizati...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200207000-00028
更新日期:2002-07-01 00:00:00
abstract:OBJECTIVE:To investigate a role of the opiate system during acute hypoxic hypoxia, the effects of naloxone and morphine on hypoxic survival rate were investigated in awake adult mice. DESIGN:Prospective, randomized, animal trial. SETTING:University research laboratory. SUBJECTS:Male dd-Y mice (n = 864 in experiment ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199909000-00035
更新日期:1999-09-01 00:00:00
abstract:OBJECTIVES:To determine the frequency of advance directives or directives disclosed by healthcare agents and their influence on decisions to withdraw/withhold life-sustaining care in neurocritically ill adults. DATA SOURCES:PubMed, Embase, and Cochrane databases. STUDY SELECTION:Screening was performed using predefin...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004388
更新日期:2020-08-01 00:00:00
abstract:OBJECTIVE:To cost adult intensive care by determining inputs to production, resource consumption per patient, and total cost per intensive care unit (ICU) stay. DESIGN:Prospective cost-accounting analysis of each patient stay in the ICU, over a 1-yr period. SETTING:An 11-bed, medical/surgical adult ICU, in a 932-bad ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199607000-00017
更新日期:1996-07-01 00:00:00
abstract:OBJECTIVE:To develop practice parameters for the evaluation of adult patients who develop a new fever in the intensive care unit (ICU) for the purpose of guiding clinical practice. PARTICIPANTS:A task force of 13 experts in disciplines related to critical care medicine, infectious diseases, and surgery was convened fr...
journal_title:Critical care medicine
pub_type: 指南,杂志文章,实务指引,评审
doi:10.1097/00003246-199802000-00046
更新日期:1998-02-01 00:00:00
abstract:OBJECTIVES:Intensive insulin therapy with tight glucose control is known to result in reduced morbidity and mortality in inflammation-related critical illness. Tumor necrosis factor (TNF)-alpha induction in myocardial infarction may trigger inflammation and have detrimental effects on cardiomyocytes. This study was des...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181782335
更新日期:2008-05-01 00:00:00
abstract:OBJECTIVE:Mitochondrial damage and dysfunction are thought to play an important role in the pathogenesis of sepsis-induced organ failures. Unfortunately, specific markers of mitochondrial damage in vital organs do not currently exist. Recently, carbomyl phosphate synthase (CPS)-1, a protein primarily localized to liver...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000230240.02216.21
更新日期:2006-09-01 00:00:00
abstract:OBJECTIVES:Acinetobacter baumannii complex bacteremia has been identified increasingly in critical patients admitted in ICUs. Notably, A. baumannii complex bacteremia has a high mortality rate, yet the risk factors associated with mortality remain unclear and controversial. DESIGN:Retrospective study. SETTING:All adu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000125
更新日期:2014-05-01 00:00:00
abstract:OBJECTIVES:To describe the most common serious adverse effects and organ toxicities associated with emerging therapies for cancer that may necessitate admission to the ICU. DATA SOURCES AND STUDY SELECTION:PubMed and Medline search of relevant articles in English on the management of adverse effects of immunotherapy f...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0000000000004087
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate the relationship of patient care variables to survival and functional outcome in the pediatric population with traumatic brain injury. DESIGN:Retrospective chart review. SETTING:A 16-bed pediatric critical care unit in an academic community children's hospital. PATIENT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200207000-00038
更新日期:2002-07-01 00:00:00
abstract::A patient with neurogenic pulmonary edema was successfully treated with the alpha-blocking agent, chlorpromazine. A pathophysiologic basis for this drug's efficacy is discussed. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198503000-00016
更新日期:1985-03-01 00:00:00
abstract:OBJECTIVE:Liquid lung ventilation has been demonstrated to improve cardiorespiratory function after cardiopulmonary bypass. We hypothesized that liquid lung ventilation (LLV) would decrease the pulmonary inflammatory response after cardiopulmonary bypass (CPB). DESIGN:Prospective, randomized, experimental, controlled,...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200104000-00021
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVES:To identify and appraise articles describing criteria used to prioritize or withhold a critical care admission. DATA SOURCES:PubMed, Embase, Medline, EBM Reviews, and CINAHL Complete databases. Gray literature searches and a manual review of references were also performed. Preferred Reporting Items for Syst...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004624
更新日期:2020-11-01 00:00:00
abstract:OBJECTIVE:Procalcitonin may be associated with reduced antibiotic usage compared to usual care. However, individual randomized controlled trials testing this hypothesis were too small to rule out harm, and the full cost-benefit of this strategy has not been evaluated. The purpose of this analysis was to evaluate the ef...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1097/CCM.0b013e31821201a5
更新日期:2011-07-01 00:00:00
abstract::We analyzed 35 samples of fresh frozen plasma (FFP), finding mean concentrations of 535 mg/dl glucose, 172 mEq/L sodium, 73 mEq/L chloride, 3.5 mEq/L potassium, 15 mEq/L bicarbonate, and 5.5 g/dl protein with 60% albumin. Thus, FFP is a hyperosmolal, hyperglycemic, hypernatremic, and hypochloremic solution which may b...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198602000-00015
更新日期:1986-02-01 00:00:00
abstract:BACKGROUND AND METHODS:In the present study, we evaluated the effect of N-acetylcysteine treatment in a nonseptic shock model induced by zymosan in the rat. Animals were randomly divided into eight groups (ten animals in each group). The first group was treated with ip administration of saline solution (0.90% NaCl) and...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199908000-00021
更新日期:1999-08-01 00:00:00
abstract:OBJECTIVES:In this systematic review and meta-analysis, we assessed whether a high CO2 gap predicts mortality in adult critically ill patients with circulatory shock. DATA SOURCES:A systematic search of MEDLINE and EMBASE electronic databases from inception to October 2019. STUDY SELECTION:Studies from adult (age ≥ 1...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004578
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVES:To outline both the preclinical and clinical data demonstrating surfactant alterations in acute lung injury, which provide the rationale for testing exogenous surfactant administration in this setting. We also review the results of the randomized, controlled clinical trials conducted to date that have evalua...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000057911.19145.9F
更新日期:2003-04-01 00:00:00
abstract:OBJECTIVE:To compare compliance and end-expiratory lung volume during reexpansion of normal and surfactant-deficient ex vivo atelectatic lungs with either gas or total liquid ventilation. DESIGN:Controlled, animal study using an ex vivo lung preparation. SETTING:A research laboratory at a university medical center. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199602000-00015
更新日期:1996-02-01 00:00:00
abstract:OBJECTIVE:Cerebral perfusion pressure<40 mm Hg following pediatric traumatic brain injury has been associated with increased mortality independent of age, and current guidelines recommend maintaining cerebral perfusion pressure between 40 mm Hg-60 mm Hg. Although adult traumatic brain injury studies have observed an in...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31825333e6
更新日期:2012-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the performance at admission to the pediatric intensive care unit (PICU) of five severity scores, two general (the Pediatric Risk of Mortality [PRISM] II and III scores) and three specific for meningococcal septic shock (Leclerc, Glasgow Meningococcal Septicemia Prognostic Score [GMSPS], and Gedde...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/00003246-200008000-00047
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVE:To assess the possible benefits of sympatholytics on uncontrolled hemorrhage in unanesthetized rats. DESIGN:A randomized laboratory study using rats to test the effects of sympatholytics on uncontrolled hemorrhage. SETTING:Research laboratory. SUBJECTS:Forty female Sprague-Dawley rats, randomly assigned in...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199909000-00025
更新日期:1999-09-01 00:00:00
abstract:OBJECTIVES:Extracorporeal cardiopulmonary resuscitation has shown survival benefit in select patients with refractory cardiac arrest but there is insufficient data on the frequency of different types of brain injury. We aimed to systematically review the prevalence, predictors of and survival from neurologic complicati...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004377
更新日期:2020-07-01 00:00:00
abstract:OBJECTIVE:The mortality of critically ill patients associated with intestinal ischemia/reperfusion remains very high, which results from multiorgan dysfunction or failure due to intestinal injury induced by intestinal ischemia/reperfusion. This study was carried out to investigate whether intestinal ischemia/reperfusio...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182546855
更新日期:2012-08-01 00:00:00
abstract:OBJECTIVE:To determine the impact of adding a month of critical care training in the postgraduate year (PGY)-2 on the critical care skills of PGY-3 residents. DESIGN:Prospective, nonrandomized. SETTING:The internal medicine (IM) residency program of a tertiary care medical center. STUDY SUBJECTS:The study subjects i...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31819cc170
更新日期:2009-04-01 00:00:00
abstract::Given the multiple biological, metabolic, and pharmacologic effects of supplemental arginine, much effort has been devoted to defining its role in numerous clinical conditions. Herein, we review the multiple pathways of arginine metabolism with its various enzyme systems; the effect of arginine on nutrition, healing, ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000279188.97421.FE
更新日期:2007-09-01 00:00:00