Acute physiology and chronic health evaluation II

The outcome from intraabdominal infection is not determined solely by what transpires in the abdomen. Unsatisfactory outcomes in patients with intraabdominal infections may result from complications that arise in other organ systems. A complication commonly associated with mortality after intraabdominal infection is pneumonia.26 A high APACHE (Acute Physiology And Chronic Health Evaluation) II score, a low serum albumin, and a high New York Heart Association cardiac function status were significantly and independently associated with increased mortality from intraabdominal infection.27... 

APACHE II Acute Physiology and Chronic Health Evaluation II a severity of disease classification system using a point score based on initial values of 12 routine physiologic measurements, age, and previous health status used to provide a general measure of disease severity. 

Administration of activated protein C (drotrecogin) to promote fibrinolysis and associated antiinflammatory mechanisms may be beneficial in patients with an APACHE II (Acute Physiology and Chronic Health Evaluation II) score greater than 25. This agent reduced mortality in severe sepsis but poses an increased risk of serious bleeding. 

Abbreviations. APACHE II, acute physiology and chronic health evaluation II SAPS, simplified acute physiology score. 

A three-month prospective cohort study of 26 Italian RICUs reported on 756 patients (14). Of all patients receiving invasive mechanical ventilation, 61% were tracheotomized and therefore considered ventilator dependent. According to the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, the predicted mortality was 22%, while the actual mortality rate was 16%. The results indicate that units with a level of care below ICU can successfiilly manage patients with acute-on-chronic respiratory failure. 

There are various severity of illness scoring systems for sepsis and trauma (R11). Severity scoring can be used, in conjunction with other risk factors, to anticipate and evaluate outcomes, such as hospital mortality rate. The most widely used system is the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) classification system (K12). The APACHE III was developed to more accurately predict hospital mortality for critically ill hospitalized adults (K13). It provides objective probability estimates for critically ill hospitalized patients treated in intensive care units (ICUs). For critically ill posttrauma patients with sepsis or SIRS, another system for physiologic quantitative classification and severity stratification of the host defense response was described recently (R11). However, this Physiologic State Severity Classification (PSSC) has yet not been applied routinely in ICU setting. 

AMS acute myocardial syndrome ANC absolute neutrophil count ANS autonomic nervous system APACHE Acute Physiologic and Chronic Health Evaluation ICU illness severity scoring system APAP acetaminophen [N-acetyl-p-aminophenol] aPTT activated partial thromboplastin time ARB angiotensin II receptor blocker ARDS adult respiratory distress syndrome... 

The Acute Physiology and Chronic Health Evaluation (APACHE II) system (K12) is another scoring system, which was validated in a number of prospective clinical studies on acute pancreatitis (D6, K10, M7, 03, W8). A score of at least... 

Patients should be categorized into either prognostically mild or severe disease using any one of a number of validated multiple-factor scoring systems (Table 39 ). " Two widely used measures include Ranson s criteria and the Acute Physiology and Chronic Health Evaluation (APACHE II). The APACHE II (>8 points) system is more sensitive and specific than Ranson s criteria (>3 criteria), but it is also more complex. The APACHE II system uses 14 indicators of physiological and biochemical function that can be readily calculated upon admission to an intensive care unit. Ranson s criteria includes 11 variables that must be monitored at the time of admission and during the initial 48 hours of hospitalization. Patients with fewer than three Ranson criteria have a mortality rate of less than 1%, while... 

In critically ill patients with AKI, urinary KIM-1 along with N-acetyl-[beta]-(D)-glucosaminidase activity (NAG) showed increasing trends with increasing severity of illness as assessed by Acute Physiology, Age, Chronic Health Evaluation (APACHE) II and multiple organ failure scores and could be correlated to the odds for both renal replacement therapy and hospital death, suggesting these biomarkers have some predictive ability for clinical outcomes in patients with AKI [308]. 

Nervous system The impact of tranexamic acid on seizures after cardiac surgery was evaluated [67. Tranexamic acid has proconvulsant properties that may be associated with postoperative seizures. A retrospective analysis of 5958 consecutive cardiac surgery patients identified several factors significantly associated with an increas risk of postoperative seizures tranexamic acid exposure, preoperative cardiac arrest, preoperative neurological disease, open chamber surgery, cardiopulmonary bypass time >150 min., previous cardiac surgery and an Acute Physiology, Age, and Chronic Health Evaluation II (APACHE) score >20. Thus, tranexamic acid use may present a readily modifiable risk factor for postoperative seizures. 

Patients at greatest risk for mortality from acute pancreatitis are those who have multi-organ failure (e.g., hypotension, respiratory failure, or renal failure), pancreatic necrosis, obesity, volume depletion, greater than 70 years of age, and an elevated APACHE II score.3,4 The Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II score is a rating scale of disease severity in critically ill patients. 

---