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Anjana, Devee
- A Comparative Study of APACHE II and SOFA Scoring Systems in Critically Ill Patients with Sepsis
Abstract Views :264 |
PDF Views:93
Authors
Affiliations
1 Department of Medicine, Gauhati Medical College and Hospital, Guwahati, Bhangagarh, Guwahati-781032, Assam, IN
2 Department of Emergency Medicine, Gauhati Medical College and Hospital, Guwahati-781032, Assam, IN
1 Department of Medicine, Gauhati Medical College and Hospital, Guwahati, Bhangagarh, Guwahati-781032, Assam, IN
2 Department of Emergency Medicine, Gauhati Medical College and Hospital, Guwahati-781032, Assam, IN
Source
International Journal of Health Research and Medico Legal Practice, Vol 3, No 1 (2017), Pagination: 20-22Abstract
There are several well recognized scoring systems for evaluation and prognostication of critically ill patients. While the APACHE II (Acute Physiology and Chronic Health Evaluation II) scoring system uses a point score based on physiologic parameters, age and previous health status, the SOFA (Sequential Organ Failure Assessment) scoring system takes into account the organ failure in critically ill patients. In the assessment of critically ill patients with suspected multi-organ dysfunction admitted in ICU, the role of SOFA in predictive validity for in-hospital mortality is being widely discussed. The present study is undertaken to prognosticate the patients by using two different established and defined scoring systems like SOFA and APACHE II, and to make attempt to establish early diagnosis of sepsis by using SOFA scoring in 50 critically ill patients with suspected multi-organ dysfunction admitted over a period of one year. The results showed that serial measurement of SOFA score during first week is a very useful tool in predicting the outcome especially on the day 3. The APACHE II score on day of admission, though reliable, was not very effective in predicting the mortality rate in our set up.Keywords
APACHE II, SOFA, qSOFA, MODS, Sepsis, Septic Shock.Full Text
References
- Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Critical Care Medicine 1985;13(10):818–29.
- Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM et al. Use of the SOFA scores to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med 1998;26(11):793-800.
- Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS et al. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock. JAMA 2016;315(8):775-787.
- Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315(8):801-810.
- Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock. Crit Care Med 2013; 41(2):580-637.
- Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med 2013;369(9):840-851.
- Wiersinga WJ, Leopold SJ, Cranendonk DR, van der Poll T. Host innate immune responses to sepsis. Virulence 2014;5(1):36-44.
- Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A et al. Assessment of Clinical Criteria for Sepsis for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA2016;315(8):762-774.
- Adverse Drug Reactions with Drugs used in Pulmonary Medicine:A Pharmacovigilance Study
Abstract Views :161 |
PDF Views:80
Authors
Affiliations
1 Gauhati Medical College, Bhangagarh, Guwahati-781032, Assam, IN
2 Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Guwahati-781032, Assam, IN
3 Department of Pharmacology, Gauhati Medical College, Guwahati-781032, Assam, IN
4 Department of Pulmonary Medicine, Gauhati Medical College, Guwahati-781032, Assam, IN
1 Gauhati Medical College, Bhangagarh, Guwahati-781032, Assam, IN
2 Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Guwahati-781032, Assam, IN
3 Department of Pharmacology, Gauhati Medical College, Guwahati-781032, Assam, IN
4 Department of Pulmonary Medicine, Gauhati Medical College, Guwahati-781032, Assam, IN
Source
International Journal of Health Research and Medico Legal Practice, Vol 3, No 2 (2017), Pagination: 7-10Abstract
World Health Organization defines Adverse Drug Reaction (ADR) as "Any response to a drug which is noxious and unintended, and which occurs at doses normally used in human beings for the prophylaxis, diagnosis or therapy for a disease, or for the modification of physiological functions".1 ADR is considered to be responsible for 2.9 to 5.6% of all hospital admissions, either directly or due to ADR related events. It is associated with significant morbidity, disability and it may cause financial burden on patients due to prolonged hospitalization. A hospital based pharmacovigilance study on ADR with drugs used in the Pulmonary Medicine Department of Gauhati Medical College Hospital was undertaken over a period of six months. Criteria for identifying ADR were based on spontaneous reporting by physicians in Pulmonary Medicine department. Case records having incomplete patient information were excluded from this study. The causality of the reported ADRs was carried out using Naranjo's scale, and the severity of ADR was assessed with Hartwig's scale. Hospital records of 214 consecutive patients admitted to the Pulmonary Medicine department were analyzed for the reports of ADR. A total of 44 patients (20.56%) were found to have some type of ADR. The highest incidence of ADR was reported in the age group of 50 - 69 years. Hepatitis, nausea, vomiting, chest pain, loss of appetite, vertigo, dryness of mouth and sore throat were the prominent manifestations of ADR in this study. The drugs causing ADRs were classified as (a) First line of anti-tubercular drugs, (b) Corticosteroids, and (c) Other drugs used as supportive therapy. Out of the 44 patients with ADR, 5 patients improved with change of drugs, 24 patients improved without any change of drugs, and 15 patients improved with addition of other drugs. Analysis of the causality using Naranjo's scale showed that 20 (45.4%) ADRs were "Definite", 16(36.4%) were "Possible", and 8(18.2%) were "Probable". In analysis of the severity using Hartwig's scale, 32 (72.8%) of ADRs were mild, 7(15.9%) were moderate, and only 5(11.3%) were severe. There was no patient with ADR resulting permanent disability or death.Keywords
Pharmacovigilance, Adverse Drug Reaction, ADR.Full Text