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Comparison of Critical Illness Score in Patients Admitted to Intermediate Care Units of a Tertiary Care Hospital: A Comparative Cross-Sectional Study from Karachi, Pakistan Cover

Comparison of Critical Illness Score in Patients Admitted to Intermediate Care Units of a Tertiary Care Hospital: A Comparative Cross-Sectional Study from Karachi, Pakistan

The Journal of Critical Care Medicine
Volume 10 (2024): Issue 1 (January 2024)
By: ,  ,  ,   and    
Open Access
|Jan 2024
Figures & tables

Figures & Tables

Table 1.

Demographic, comorbid and top 10 acute conditions and outcome overall, survivors and non survivors of the patients admitted to Intermediate care medical units (N=923)

CharacteristicN=923 (%)Survivors N=864/923(%)Non-survivors N=59/923 (%)P-value
Age, Mean (SD), years6261.263.60.86
Age Groups
Up to 20 years1.49%1.57%0
20 – 40 years10.46%10.39%7.69%
40 – 60 years34.16%33.96%44.23%
60 – 80 years46.06%55.62%34.61%
80+ years11.86%11.62%13.46%
Gender
Male (%)454 (49.2%)421 (48.7%)33 (55.9%)0.284
Female (%)469 (50.8%)443 (51.3%)26 (44.1%)
Top 10 common diagnosis
Sepsis, septic shock n, (%)130(13.1%)107(12.3%)23(38.9%)0.000
Pneumonia n, (%)265(27.7 %)235(27.1%)30(50.8%)0.009
UTI n, (%)201(21.8%)193(22.33%)8(13.55%)0.142
AKI n, (%)373(40%)350(40.5%)23(38.9%)0.817
MI and Pulmonary Edema n, (%)71(7.7%)62(7.17%)9(15.25%)0.038
Stroke n, (%)28(3.0%)24(2.77%)4(6.77%)0.097
Atrial Fibrillation n, (%)28(3.0 %)24(2.77%)4(6.77%)0.083
Electrolyte Imbalance n, (%)170(18.4%)162(18.75%)8(13.55%)0.387
Exacerbation of Obstructive Airway Disease n, (%)59(6.4 %)53(6.13%)6(10.16%)0.220
Solid Tumors n, (%)26(2.8%)23(2.66%)3(5.08%)0.403
Comorbid n, (%)
Diabetes510 (55.3%)472(54.62%)34(57.62%)0.650
Hypertension648 (70.2%)609(70.48%)39(66.10%)0.470
Ischemic Heart Disease307(33.3%)230(26.62%)21(35.55%)0.134
Chronic Kidney Disease474 (51%)216(25.00%)24(40.67%)
Chronic Liver Disease66 (7.2%)56(6.48%)10(16.94%)0.003
Thyroid Disorders37 (4.0%)36(4.16%)01(1.69%)0.349
Malignancy26 (2.8%)24(2.77%)2(3.38%)0.783
HIV/AIDS7 (0.7%)6(0.69%)01(1.69%)0.391
Length of stay (mean ± SD)5.9 ± 4.7
Mortality rate n, (%)59 (6.4%)

[i] SD: standard deviation; UTI: urinary tract infection; AKI: acute kidney injury; MI: myocardial infarction; HIV/AIDS: human immunodeficiency virus/acquired immunodeficiency syndrome

Table 2.

Comparison of critical illness scores overall, among survivors and non-survivors in patients admitted to intermediate care units

Critical Illness scales Median (interquartile range)Overall (n=923)Survived (n=864)Not survived (n=59)P-value
APACHE II16(11–21)16(11–21)20(13–25)0.002
SOFA4(2–6)4(2–5)7(4–10)0.000
SAPS II36(30–53)35(30–42)44(38–53)0.000
MEWS3(2–4)3(2–4)5(3–6)0.000

[i] APACHE: Acute Physiology and Chronic Health Evaluation; SOFA: Sequential Organ Failure Assessment; SAPS: Simplified Acute Physiology Score; MEWS: Modified Early Warning Score

Fig. 1.

ROC Curve showing four different critical illness scores in patients admitted to IMCU

Table 3.

The area under the characteristic curve, sensitivity, and specificity data of critical illness scores in patients admitted to intermediate care units

ScoresCutoff valuesAUC (95%CI)P valueSensitivity %Specificity %SMR (95%CI)
Acute Physiology and Chronic Health Evaluation II≥ 120.584 (0.52–0.64)0.00470760.25 (0.32–0.19)
Sequential Organ Failure Assessment≥ 60.735 (0.68–0.79)0.00064760.64 (0.80–0.48)
Simplified Acute Physiology Score II≥ 390.763 (0.71–0.81)0.00078620.35 (0.45–0.26)
Modified Early Warning Score≥ 30.714 (0.66–0.77)0.00085400.51 (0.64–0.38)
ScoreCalculationInterpretation
SOFA

  • PiO2/FiO2: (mmHg)

  • <400 = 1 point, <300 = 2 points, <200 = 3 points, <100 = 4 points

ScoreMortality

  • Serum Creatinine: (mg/dl)

  • 1.2–1.9 = 1 point, 2.0–3.4 = 2 points, 3.5–4.9 = 3 points, ≥5 = 4 points

  • 0– 6

  • 7 – 9

  • 10 – 12

  • 13 – 14

  • 15

  • 15– 24

  • <10%

  • 15–20%

  • 40–50%

  • 50–60%

  • >80%

  • >90%

  • Platelets: (× 103/uL)

  • <150 = 1 point, <100 = 2 points, <50 = 3 points, <20 = 4 points

  • GCS: (out of 15)

  • 13–14 = 1 point, 10–12 = 2 points, 6–9 = 3 points, <6 = 4 points

  • MAP/Use of Vasopressor:

  • MAP < 70 mm/Hg = 1 point

  • dopamine ≤ 5 μg/kg/min or dobutamine (any dose) = 2 point

  • dopamine > 5 μg/kg/min OR epinephrine ≤ 0.1 μg/kg/min OR norepinephrine ≤ 0.1 μg/kg/min = 3 points

  • dopamine > 15 μg/kg/min OR epinephrine > 0.1 μg/kg/min OR norepinephrine > 0.1 μg/kg/min = 4 points

  • Bilirubin: (mg/dl)

  • 1.2– 1.9 = 1 point, 2.0– 5.9 = 2 points, 6.0 – 11.9 = 3points, >12 = 4 points

MEWS

  • RR: (breath/min)

  • ≤8 = 2 points, 15–20 = 1 point, 21–29 = 2 points, ≥30 = 3 points

ScorePlan

  • HR: (beats/min)

  • <40 = 2 points, 40–50 = 1 point, 101–110 = 1 point 111–129 = 2 points, >129 = 3points

1–22 hour observation

  • Systolic blood pressure: (mmHg)

  • ≤70 = 3 points, 71–80 = 2 points, 81–100 = 1 point, >200 = 2 points

31–2 hour observation

  • Temperature: (°C)

  • ≤34 = 3 points, 34.1–35 = 2 points, 35.1–36 = 1 point, 38–38.5 = 1 point, ≥38.6 = 2 points

≥41/2hr observe & inform doctor

  • CNS:

  • Unresponsive = 3 points, Respond to pain = 2 points, Respond to voice/New agitation/Confusion = 1 point

  • Urine Output: (ml in 24hr)

  • <480 = 2 points, 480–714 = 1 point, >4800 = 1 point

APACHE II

  • Age: (<44 years = 0 point)

  • 45–54 = 2 points, 55–64 = 3 points, 65–74 = 5 points, >74 = 6 points

ScoreMortality Rate

  • Temperature: (Normal: 36– 38.4°C)

  • ≥ 41 / ≤ 29.9 = 4 points, 39–40.9 / 30–31.9 = 3 points,- / 32–33.9 = 2 points, 38.5–38.9 / 34–35.9 = 1 point

0–44%

  • Mean Arterial Pressure (Normal: 70–109 mmHg)

  • ≥160 / ≤ 49 = 4 points, 130–159 /- = 3 points, 110–129 / 50–69 = 2 points

5–98%

  • Heart Rate (Normal: 70–109 bpm)

  • ≥180 / ≤ 39 = 4 points, 140–179 / 40–54 = 3 points, 110–139 / 55–69 = 2 points

10–1415%

  • Respiratory Rate (Normal: 12–24 breath/min)

  • ≥50 / ≤ 5 = 4 points, 35–49 /- = 3 points,- / 6–9 = 2 points, 25–34 / 10–11 = 1 point

15–1925%

  • Oxygenation (mmHg)

  • If FiO2 ≥ 0.5, use A-a O2: ≥500 = 4 points, 350–499 = 3 points, 200–349 = 2 points, <200 = 0 point

  • If FiO2 < 0.5, use PAO2: <55 = 4 points, 55–60 = 3 points, 61–70 = 1 points, >70 = 0 point

20–2440%

  • Arterial pH (Normal: 7.33–7.49)

  • ≥ 7.7 / ≤ 7.15 = 4 points, 7.6.7.69 / 7.15–7.24 = 3 points,- / 7.25–7.32 = 2 points, 7.5–7.59 /- = 1 point

25–2955%

  • Serum HCO3 (N: 22–31.9 mmol/L) ‘if ABGs unavailable’

  • ≥ 52 / < 15 = 4 points, 41–51.9 / 15–17.9 = 3 points,- / 18–21.9 = 2 points, 32–40.9 /- = 1 point

30–3475%

  • Serum Na (Normal: 130–149 mmol/L)

  • ≥ 180 / ≤ 110 = 4 points, 160–179 / 111–119 = 3 points, 155–159 / 120–129 = 2 points, 150–154 /- = 1 point

>3485%

  • Serum K (Normal: 3.5–5.4 mmol/L)

  • ≥ 7 / ≤ 2.5 = 4 points, 6–6.9 /- = 3 points,- / 2.5–2.9 = 2 points, 5.5–5.9 / 3–3.4 = 1 point

  • Serum Cr (Normal: 0.6–1.4 mg/dL) Score × 2 (if AKI)

  • ≥ 3.5 /- = 4 points, 2–3.4 /- = 3 points, 1.5–1.9 / <0.6 = 2 points

  • Hematocrit (Normal: 30–45.9%)

  • ≥ 60 / < 20 = 4 points, 50–59.9 / 20–29.9 = 2 points, 46–49.9/- = 1 point

  • WBCs (Normal: 3–14.9 ×103/uL)

  • ≥ 40 / < 1 = 4 points, 20–39.9 / 1–2.9 = 2 points, 15–19.9 /- = 1 point

  • GCS = Score: 15 – actual GCS

  • Chronic Health Status:

  • 2 points = elective postoperative patient with immunocompromise or history of severe organ insufficiency

  • 5 points = non-operative patient or emergency postoperative patient with immunocompromise or severe organ insufficiency

SAPS II

  • Temperature (°C)

  • <39 = 0 point, ≥39 = 3 points

ScoreMortality Rate

  • Systolic Blood Pressure (mmHg)

  • <70 = 13 points, 70–99 = 5 points, 100–199 = 0 point, ≥200 = 2 points

2910%

  • Heart Rate (bpm)

  • ≥ 160 = 7 points, 120–159 = 4 points, 70–119 = 0 point, 40–69 = 2 points, <40 = 11 points

4025%

  • PaO2/FiO2 (mmHg) = only if on VENT or CPAP

  • <100 = 11 points, 100–199 = 9 points, ≥200 = 7 points

5250%

  • Urine Output (liter/day)

  • <0.5 = 11 points, 0.5–0.99 = 4 points, ≥ 1 = 0 point

6475%

  • Urea (g/L)

  • <0.6 = 0 point, 0.6–1.7 = 6 points, >1.88 = 10 points

7790%

  • Serum HCO3 (mmol/L)

  • <15 = 6 points, 15–19 = 3 points, >20 = 0 point

  • Serum Na (mmol/L)

  • <125 = 5 point, 125–144 = 0 point, ≥145 = 1 point

  • Serum K (mmol/L)

  • < 3 = 3 points, 3–4.9 = 0 point, ≥ 5 = 2 points

  • WBCs (×103/uL)

  • < 1 = 12 points, 1–19.9 = 0 point, ≥ 20 = 2 points

  • Bilirubin (mg/dL)

  • < 40 = 0 point, 40–59.9 = 4 points, ≥ 60 = 9 points

  • GCS (out of 15)

  • < 6 = 26 points, 6–8 = 13 points, 9–10 = 7 points, 11–13 = 5 points, 14–15 = 0 point

  • Age (years)

  • <40 = 0 point, 40–59 = 7 points, 60–69 = 12 points, 70–74 = 15 points, 75–79 = 16 points, >80 = 18 points

  • Chronic disease

  • Metastatic cancer = 9 points, Hematological malignancy = 10 points, AIDS = 17 points

  • Type of Admission

  • Elective/Surgery = 0 point, Medical = 6 points, Emergency Surgery = 8 points

DOI: https://doi.org/10.2478/jccm-2024-0003 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
Journal RSS Feed
Language: English
Page range: 38 - 48
Submitted on: Aug 9, 2023
Accepted on: Nov 13, 2023
Published on: Jan 30, 2024
Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
APACHE,
critical illness,
early warning score,
simplified acute physiology score,
SOFAS
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Internal medicine, other,
Surgery,
Surgery, other,
Anaesthesiology,
Emergency medicine and intensive-care medicine

© 2024 Amber Sabeen Ahmed, Madiha Iqbal, Sher Muhammad Sethi, Sania Sabir, Aysha Almas, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 10 (2024): Issue 1 (January 2024)
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