• 성인간호학회지
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• 제17권3호
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• pp.464-473
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• 2005

Purpose: The purpose of this study was to evaluate and compare the predictive ability of three mortality scoring systems; Acute Physiology and Chronic Health Evaluation(APACHE) III, Simplified Acute Physiology Score(SAPS) II, and Mortality Probability Model(MPM) II in discriminating in-hospital mortality for intensive care unit(ICU) patients with spontaneous intracerebral hemorrhage. Methods: Eighty-nine patients admitted to the ICU at a university hospital in Daejeon Korea were recruited for this study. Medical records of the subject were reviewed by a researcher from January 1, 2003 to March 31, 2004, retrospectively. Data were analyzed using SAS 8.1. General characteristic of the subjects were analyzed for frequency and percentage. Results: The results of this study were summarized as follows. The values of the Hosmer-Lemeshow's goodness-of-fit test for the APACHE III, the SAPS II and the MPM II were chi-square H=4.3849 p=0.7345, chi-square H=15.4491 p=0.0307, and chi-square H=0.3356 p=0.8455, respectively. Thus, The calibration of the MPM II found to be the best scoring system, followed by APACHE III. For ROC curve analysis, the areas under the curves of APACHE III, SAPS II, and MPM II were 0.934, 0.918 and 0.813, respectively. Thus, the discrimination of three scoring systems were satisfactory. For two-by-two decision matrices with a decision criterion of 0.5, the correct classification of three scoring systems were good. Conclusion: Both the APACHE III and the MPM II had an excellent power of mortality prediction and discrimination for spontaneous intracerebral hemorrhage patients in ICU.

• Acute and Critical Care
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• 제33권4호
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• pp.216-221
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• 2018

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 $MPM_0$ 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, $MPM_0$ 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 $MPM_0$ 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 $MPM_0$ 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.

• Tuberculosis and Respiratory Diseases
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• 제40권5호
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• pp.532-539
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• 1993

임상에서 환자의 생존율을 평가하는 것은 순간순간 당면하는 치료를 결정함에 있어 중요하다. 특히 만성 폐쇄성 폐질환에서 급성 호흡부전증은 대부분의 환자들이 궁극적으로 겪게 되는 질병의 경과로 여겨지고 있고 이들을 치료하는 과정에서 질병 자체의 비가역적인 특성과 기계호흡 자체의 부작용으로 인하여 중환자실에서 인공호흡기의 부착여부에 대한 논란이 계속되고 있으나, 아직 이에 대한 뚜렷한 기준이 없는 상태이다. 이에 본 연구에서는 입원 첫 24시간이내에 측정가능한 14개의 임상지표를 이용하여(Simplified Acute Physiology Score, 이하 SAPS) 환자의 중증도와 사망률을 예측해 보는 것이었다. 대상환자는 1980년부터 1992년까지 중앙대학 부속병원에서 입원치료를 받은 74명의 만성 폐쇄성 폐질환에 동반된 급성 호흡부전증 환자들에 대한 후향성 연구로 시행하였고, 결과는 다음과 같다. 1) 사망율은 34%(25/74), 생존율은 66%(49/74)였으며, 나이가 많을수록 유의하게 사망율이 높았다. 2) 기저 폐기능 검사치에 따른 사망율의 차이는 없었다. 3) SAPS는사망군에서 10.8, 생존군에서 6.5로 유의한 차이가 있었고, SAPS와 사망율 사이에는 유의한 상관관계가 있었다. 4) SAPS에 포함되는 14개의 임상지표 이외에 입원당시 악액질, 뇌병증, 혈중 Phosphate와 Creatinine 농도에 따라 유의한 사망율의 차이가 있었다. 결론적으로, SAPS는 만성 폐쇄성 폐질환에 동반된 급성 호흡부전증 환자의 예후와 중증도 평가에 유용하며, 이러한 환자군에서 SAPS에 포함되는 14개의 임상지표 이외에도 혈중 Creatinine 농도, 혈중 Phosphate 농도, 입원 당시 악액질유무, 뇌병변에 의한 신경학적 증상의 유무가 예후에 중요한 영향을 미친다고 사료되며, 적극적인 치료와 인공호흡기 치료의 결정에서 SAPS의 사용이 타당하리라 여겨지나, 향후 대단위 전향적 연구가 필요하리라 여겨진다.

• Journal of Preventive Medicine and Public Health
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• 제38권3호
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• pp.276-282
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• 2005

Objectives : To evaluate the predictive validity of three scoring systems; the acute physiology and chronic health evaluation(APACHE) III, simplified acute physiology score(SAPS) II, and mortality probability model(MPM) II systems in critically ill patients. Methods : A concurrent and retrospective study conducted by collecting data on consecutive patients admitted to the intensive care unit(ICU) including surgical, medical and coronary care unit between January 1, 2004, and March 31, 2004. Data were collected on 348 patients consecutively admitted to the ICU(aged 16 years or older, no transfer, ICU stay at least 8 hours). Three models were analyzed using logistic regression. Discrimination was assessed using receiver operating characteristic(ROC) curves, sensitivity, specificity, and correct classification rate. Calibration was assessed using the Lemeshow-Hosmer goodness of fit H-statistic. Results : For the APACHE III, SAPS II and MPM II systems, the area under the receiver operating characterist ic(ROC) curves were 0.981, 0.978, and 0.941 respectively. With a predicted risk of 0.5, the sensitivities for the APACHE III, SAPS II, and MPM II systems were 81.1, 79.2 and 71.7%, the specificities 98.3, 98.6, and 98.3%, and the correct classification rates 95.7, 95.7, and 94.3%, respectively. The SAPS II and APACHE III systems showed good calibrations(chi-squared H=2.5838 p=0.9577 for SAPS II, and chi-squared H=4.3761 p=0.8217 for APACHE III). Conclusions : The APACHE III and SAPS II systems have excellent powers of mortality prediction, and calibration, and can be useful tools for the quality assessment of intensive care units(ICUs).

• 대한임상독성학회지
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• 제6권1호
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• pp.25-31
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• 2008

Purpose: Acute organophosphate (OP) poisoning may be monitored by measuring the acetylcholinesterase (AChE). It is important to assess severity and establish prognostic tests in the early stage of OP poisoning. The aim of this study was to look at the relationship between various clinical aspects of the OP poisoning, prognostic indicators of OP poisoning including Simplified Acute Physiology Score (SAPS) 3, and the associated changes in AChE levels. Methods: Clinical data and initial AChE levels from thirty-seven patients with OP poisoning were prospectively reviewed from 12 teaching hospitals in South Korea from August 2005 to July 2006. Clinical manifestations at the time of arrival such as miosis, respiratory abnormality, salivation, urinary incontinence, GCS score, AVPU scale, need for intubation, and mechanical ventilation requirements were recorded. SAPS 3 was calculated using clinical data and laboratory results. Results: The median level of AChE was 9.8 (1.3-53.6) U/gHb. There was no significant difference in AChE levels between the groups with and without cholinergic symptoms. The median level of AChE of the patients who required intubation and those who did not were 3.5 U/gHb and it 19.7 U/gHb respectively (Mann-Whitney test; p<0.001). The AChE levels were also significantly different (p=0.007) in patients who needed mechanical ventilation compared to those who did not with AChE levels found to be 3.1 U/gHb and it was 14.8 U/gHb, respectively. Level of consciousness assessed using the AVPU scale was correlated with AChE levels (Kruskal-Wallis test; p=0.013). GCS score were correlated with AChE levels (p=0.007, Spearman's rho = 0.454). In addition, the lower the level of initial AChE, the longer the ICU stay (p=0.029, Spearman's rho=-0.380). SAPS 3 was inversely correlated with the initial AChE (p<0.001, Spearman's rho=-0.633). Conclusion: In the acute OP poisoning, low AChE levels appear to help indicate the severity of poisoning. The initial AChE level may be a useful prognostic parameter for acute OP poisoning.

• Journal of Korean Biological Nursing Science
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• 제22권4호
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• pp.249-259
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• 2020

Purpose: Carbapenemase-producing Enterobacteriaceae (CPE) are associated with considerable mortality. This study was aimed to identify survival factors among medical care unit patients with CPE. Methods: We conducted a retrospective cohort; data were collected from September 2017 to June 2019 through electronic medical records. The data collected were general characteristics, disease-related characteristics, severity-related characteristics, and treatment-related characteristics. Data were analyzed based on frequency, mean, standard deviation, Chi-square test, Fisher's exact test, t-test, Pearson's correlation coefficient, and Cox proportional hazard model using SPSS/WIN 21.0 program. Results: Seventy-seven patients were included (59 survivors and 18 deceased) in the study. Univariate analysis identified factors for survival associated with acquired CPE as age (t= -1.56, p= .037), simplified acute physiology 3 (SAPS3) score of admission date (t= -2.85, p= .006), Glasgow coma scale (GCS) of CPE acquisition date (t= 2.38, p= .020), artery catheter at CPE acquisition date (χ²= 4.58, p= .032), vasoconstrictor agents use at CPE acquisition date (χ²= 6.81, p= .009), platelet at CPE acquisition date (t= 2.27, p= .025), lymphocyte at CPE acquisition date (t= 2.01, p= .048), calcium at CPE acquisition date (t= 2.68, p= .009), albumin at CPE acquisition date (t= 2.29, p= .025), and creatinine at CPE acquisition date (t= 2.24, p= .028). Multivariate Cox proportional hazard model showed that GCS at CPE acquisition date (HR= 1.14, 95% CI= 1.05-1.22), lymphocyte at CPE acquisition date (HR= 1.05, 95% CI= 1.00-1.10), and creatinine at CPE acquisition date (HR= 1.25, 95% CI= 1.04-1.49) were independent survival factors among medical intensive care unit patients with CPE. Conclusion: Based on the study results, it is necessary to develop nursing interventions that can aid in the management of patients with CPE and identify their effects.

• Tuberculosis and Respiratory Diseases
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• 제56권3호
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• pp.280-288
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• 2004

배 경 : 급성호흡곤란증후군의 폐보호전략에서 폐포모집술은 적절한 산소화를 유지하고 반복적인 폐포의 개폐에 의한 폐 손상을 최소화하기 위해 그 중요성이 강조되고 있다. 폐포모집술이 동맥혈 산소화에 미치는 영향에 대해서는 많이 연구되었지만 환자의 예후에 어떠한 영향을 미치는지에 대한 연구는 부족한 실정이다. 본 연구는 폐포모집술을 시행한 급성호흡곤란증후군 환자를 대상으로 폐포모집술의 반응에 따라 초기 생존률의 차이가 있는지 조사하였다. 대상 및 방법 : 2001년 9월부터 2002년 8월까지 급성호흡곤란증후군으로 진단되어 기계호흡을 유지하고 48시간 내에 폐포모집술을 시행한 20명(남;여=12;8, $63{\pm}14$세)의 환자를 대상으로 후향적으로 조사하였다. 폐포모집술은 안정제와 근이완제를 투여한 다음 급작스런 고수준($35-45cmH_2O$)의 지속적양압법 또는 점진적 호기말양압 증가법으로 하였고, 상기 방법에 효과가 없는 경우는 복와위를 시도하였다. 폐포모집술 시행 전과 시행 후 30분, 2시간에 동맥혈 가스검사를 시행하여 $P_aO_2/FiO_2$(P/F) 비가 50%이상 증가한 환자를 반응군으로, 50%이하로 증가한 환자를 비반응군으로 나누어 병일 10일째와 30일째 환자의 생존률을 각각 비교하였다. 결 과 : 1) 폐포모집술 시행 후 P/F 비가 50% 이상 증가한 환자는 12명이었고 시행 전, 후 P/F 비는 각각 $92{\pm}25mmHg$, $244{\pm}86mmHg$으로 의미있게 증가하였다. P/F 비가 50%이하 증가한 경우는8명으로 P/F 비는 각각 $138{\pm}37mmHg$, $163{\pm}60mmHg$이었다. P/F 비가 50% 이하 증가한 8명의 환자 중 2명은 복와위 시도 후 50%이상의 증가를 보였다. 2). 폐포모집술과 복와위 시도 후 P/F 비가 50% 이상 증가를 보인 14명의 반응군 환자의 병일 10일째와 30일째 생존률은 각각 12명(86%), 8명(57%)이었고, 비반응군 환자는 각각 2명(33%), 0명(0%)으로 반응군이 비반응군에 비해 의미있게 높았다(p<0.05). 3). 반응군과 비반응군에서 환자의 연령($71{\pm}11$, $60{\pm}14$), 폐손상점수($2.8{\pm}0.2$, $2.9{\pm}0.45$), SAPS II ($35{\pm}4.6$, $34{\pm}5.7$), 유지한 호기말양압의 정도($15.6{\pm}1.9cmH_2O$, $14.5{\pm}2.1cmH_2O$) 등은 각각 유의한 차이가 없었다(p>0.05). 결 론 : 폐포모집술을 시행한 급성호흡곤란증후군 일부의 환자에서 산소화 호전 반응을 보였으며, 폐포모집술에 호전 반응을 보인 급성호흡곤란증후군 환자가 호전 반응을 보이지 않은 환자에 비해 병일 10일, 30일의 생존률이 의미있게 높았다.