İnvaziv Mekanik Ventilasyon Uygulanan Ağır COVID-19 Hastalarında APACHE II ve SOFA Skorlarının Mortalite İle İlişkisi: Retrospektif bir çalışma

Yıl 2023, Cilt: 6 Sayı: 1, 19 - 24, 10.04.2023

Gülbahar Çalışkan , Olgun Deniz , Banu Otlar Can , Nermin Kelebek Girgin

https://doi.org/10.33713/egetbd.1220663

Öz

AMAÇ: Kritik hastalarda organ fonksiyonlarının değerlendirilmesi prognozu tahmin etmeye yardımcıdır. Yoğun bakımda (YB) skorlama sistemleri, tahmin edilen ve gözlemlenen sonuçların karşılaştırılmasında, tedavinin değerlendirilmesine çok önemli bir rol oynar ve YB performansının kıyaslanmasına olanak sağlar. Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi (APACHE) II ve Ardışık Organ Yetmezliği Değerlendirme (SOFA) skorları YB’de yaygın olarak kullanılmaktadır. Çalışmamızda APACHE II ve SOFA skorlarının kritik COVID-19 hastalarında mortaliteyi öngörmedeki etkinliğini değerlendirmeyi amaçladık.
GEREÇ VE YÖNTEM: 1 Nisan 2020-1 Temmuz 2021 tarihleri arasında YB’ye kabul edilen invaziv mekanik ventilasyon uygulanan ağır COVID-19 hastaları (≥18 yaş) retrospektif olarak analiz edildi. APACHE II ve SOFA puanları başvurudan sonraki 24 saat içinde hesaplandı. Hastalar yaşayan (Grup 1) ve yaşamayan (Grup 2) olarak iki gruba ayrılarak APACHE II ve SOFA skorları, demografik, klinik ve laboratuar verileri karşılaştırıldı.
BULGULAR: Çalışmaya 212 hasta dahil edildi. Demografik veriler iki grupta da benzerdi. APACHE II ve SOFA skorları arasında da fark saptanmadı (sırasıyla p=0.393, p=0.957). Ölen hastalarda YB’ye yatış sırasındaki CRP değerleri anlamlı olarak yüksekti (p=0.001). Yaşayan hastalarda trakeal aspirat ve kan kültürlerinde anlamlı olarak daha fazla üreme mevcuttu (sırasıyla p=0.023, p=0.034).
SONUÇ: Kritik hastalarda APACHE II, mortaliteyi öngördüğü kabul edilen bir skorlama sistemidir. Ancak ağır COVID-19 hastalarında mortaliteyi öngörmede etkili olmadığını düşünmekteyiz. SOFA skoru da bu hastalarda ilk YB’ye yatışta prognozu öngörmede etkili değildir, günlük olarak değerlendirilmesi uygun olacaktır. Çalışmamızda yüksek CRP değerleri mortalite ile ilişkili idi. Klinik uygulamalarda rutinde kullanılan skorlama sistemleri COVID-19 hastalarında kullanılacak ise bu skorlara prognostik önemi olan belirteçlerin de eklenmesinin uygun olabileceğini düşünmekteyiz.

Anahtar Kelimeler

Yoğun bakım skorlama sistemleri, APACHE, SOFA, COVID-19, prognoz

Destekleyen Kurum

Yok

Proje Numarası

2022-13/8

Association of APACHE II and SOFA Scores with Mortality in Severe COVID-19 Patients Undergoing Invasive Mechanical Ventilation: A Retrospective Study

Öz

OBJECTIVE: Evaluation of organ functions in critically ill patients helps to predict prognosis. Scoring systems in intensive care units (ICU) play a crucial role in comparing predicted versus observed outcomes, allowing evaluation of treatment and assessment of ICU performance. Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores are widely used in the ICU. In our study, we aimed to evaluate the predictive value of APACHE II and SOFA scores in predicting the mortality of severe COVID-19 patients.
MATERIALS AND METHODS: Severe COVID-19 patients (≥18 years old) undergoing invasive mechanical ventilation admitted to the ICU between April 1, 2020, and July 1, 2021, were retrospectively analyzed. APACHE II and SOFA scores were calculated within 24 hours after admission. The patients were divided into two groups as survived (Group 1) and nonsurvived (Group 2), and their APACHE II and SOFA scores, demographic, clinical and laboratory data were compared.
RESULTS: Totally 212 patients were included. Demographic data were similar in both groups. There was no difference between APACHE II and SOFA scores (p=0.393, p=0.957, respectively). In nonsurvived group, CRP values during admission to the ICU were significantly higher (p=0.001). Conversely, positive tracheal aspirate and blood cultures were higher in survived group (p=0.023, p=0.034, respectively).
CONCLUSION: APACHE II is a scoring system accepted to predict mortality in critically ill patients. However, we think that it is ineffective in predicting mortality in severe COVID-19. In these patients, the SOFA score is also ineffective in predicting the prognosis at the first ICU admission, it would be appropriate to evaluate it daily. In our study, high CRP values are associated with mortality. We think that if the scoring systems routinely used in clinical practice will be used in COVID-19 patients, it may be appropriate to add prognostic markers to these scores.

Anahtar Kelimeler

Yoğun bakım skorlama sistemleri, APACHE, SOFA, COVID-19, prognoz

Proje Numarası

2022-13/8

Kaynakça

• Long B, Carius BM, Chavez S. et al. Clinical update on COVID-19 for the emergency clinician: Presentation and evaluation. Am J Emerg Med. 2022; 54: 46-57.
• World health organization (Web sitesi) WHO Coronavirus (COVID-19) Dashboard [Güncelleme Tarihi 26 Kasım 2022, Erişim Tarihi: 28 Kasım 2022] Erişim adresi: https://covid19.who.int/
• Lim ZJ, Subramaniam A, Ponnapa Reddy M. et al. case fatality rates for patients with COVID-19 requiring invasive mechanical ventilation. A Meta-analysis. Am J Respir Crit Care Med. 2021; 203(1): 54-66.
• Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223): 497-506.
• Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020; 323(11): 1061-1069.
• Vandenbrande J, Verbrugge L, Bruckers L. et al. Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV Score in COVID-19 patients. Crit Care Res Pract. 2021; 2021: 5443083. doi: 10.1155/2021/5443083.
• Beigmohammadi MT, Amoozadeh L, Rezaei Motlagh F. et al. Mortality predictive value of APACHE II and SOFA Scores in COVID-19 patients in the intensive care unit. Can Respir J. 2022; 2022: 5129314. doi: 10.1155/2022/5129314.
• Shang Y, Liu T, Wei Y. et al. Scoring systems for predicting mortality for severe patients with COVID-19. EClinicalMedicine. 2020; 24: 100426. doi: 10.1016/j.eclinm.2020.100426.
• Goldhill DR, Withington PS. The effect of casemix adjustment on mortality as predicted by APACHE II. Intensive Care Med. 1996; 22(5): 415-9. Salluh JI, Soares M. ICU severity of illness scores: APACHE, SAPS and MPM. Curr Opin Crit Care. 2014; 20(5): 557-65.
• Lameden S, Laterre PF, Levy MM, Francois B. The SOFA score-development, utility and challenges of accurate assessment in clinical trials. Crit Care. 2019; 23(1): 374. doi: 10.1186/s13054-019-2663-7.
• Covid19.saglik.gov.tr (Web sistesi) T.C. Sağlık Bakanlığı: Ağır Pnömoni, ARDS, Sepsis ve Septik Şok Yönetimi [Güncellenme Tarihi:27 Mayıs 2021, Erişim Tarihi:15 Eylül 2022] Erişim Adresi:https://covid19.saglik.gov.tr/Eklenti/40781/0/covid19rehberiagirpnomoniardssepsisveseptiksokyontemipdf.pdf
• Thygesen K, Alpert JS, Jaffe AS. et al. Third universal definition of myocardial infarction. J Am Coll Cardiol. 2012; 60(16): 1581-98.
• Wang X, Fang X, Cai Z. et al. Comorbid chronic diseases and acute organ injuries are strongly correlated with disease severity and mortality among COVID-19 patients: a systemic Review and meta-analysis. Research (Wash D C). 2020; 2020: 2402961. doi: 10.34133/2020/2402961.
• Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012; 2012;120(4):c179-84.
• Guan WJ, Ni ZY, Hu Y. et al. China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. NEngl J Med. 2020; 382(18): 1708-1720.
• Grasselli G, Greco M, Zanella A. et al. COVID-19 Lombardy ICU Network. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020; 180(10): 1345-1355.
• Zou X, Li S, Fang M. et al. Acute physiology and chronic health evaluation II score as a predictor of hospital mortality in patients of coronavirus disease 2019. Critical Care Medicine. 2020; 48(8): e657–e665. doi: 10.1097/ccm.0000000000004411.
• Yang X, Yu Y, Xu J. et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir Med. 2020; 8: 475–481
• Stephens JR, Stümpfle R, Patel P. et al. Analysis of Critical care severity of illness scoring systems in patients with coronavirus disease 2019: A retrospective analysis of three U.K. ICUs. Crit Care Med. 2021; 49(1): e105-e107. doi:10.1097/CCM.0000000000004674.
• Chu K, Alharahsheh B, Garg N, Guha P. Evaluating risk stratification scoring systems to predict mortality in patients with COVID-19. BMJ Health Care Inform. 2021; 28(1): e100389. doi: 10.1136/bmjhci-2021-100389.
• Ochani R, Asad A, Yasmin F. et al. COVID-19 pandemic: from origins to outcomes. A comprehensive review of viral pathogenesis, clinical manifestations, diagnostic evaluation, and management. Infez Med. 2021; 29(1): 20-36.
• Martinez AC, Dewaswala N, Tuarez FR. et al. Validation of sofa score in critically ill patients with COVID-19. Chest. 2020; 158(4): p. A613. doi: 10.1016/j.chest.2020.08.577.
• Zhou F, Yu T, Du R. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020; 395(10229):1054-1062.
• Liu Y, Yang Y, Zhang C. et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci. China Life Sci. 2020; 63(3): 364–374.
• Pourbagheri-Sigaroodi A, Bashash D, Fateh F, Abolghasemi H. Laboratory findings in COVID-19 diagnosis and prognosis. Clin Chim Acta. 2020; 510: 475-482.
• Lithander FE, Neumann S, Tenison E. et al. COVID-19 in older people: a rapid clinical review. Age Ageing. 2020; 49(4) :501-515.
• Shahid Z, Kalayanamitra R, McClafferty B. et al. COVID-19 and older adults: What we know. J Am Geriatr Soc. 2020; 68(5): 926-929.
• Liu W, Tao ZW, Wang L. et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J (Engl). 2020; 133(9): 1032-1038.