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1991 Fiscal Year Final Research Report Summary

Evaluation of the Severity of Patients Admitted to ICU in Japan

Research Project

Project/Area Number 02304046
Research Category

Grant-in-Aid for Co-operative Research (A)

Allocation TypeSingle-year Grants
Research Field 麻酔学
Research InstitutionOsaka University

Principal Investigator

YOSHIYA Ikuto  Osaka University Medical School, Professor, 医学部, 教授 (80028505)

Co-Investigator(Kenkyū-buntansha) SAKANISHI Nobue  Tokyo Medical and Dental University, Assistant Professor, 講師 (90126227)
TAJIMI Kimitaka  Teikyo University School of Medicine, Assistant Professor, 医学部, 講師 (20101727)
HIRASAWA Hiroyuki  Chiba University Hospital, Associated Professor, 助教授 (80114320)
KATSUYA Hirotada  Nagoya City Medical School, Professor, 医学部, 教授 (20040561)
TAENAKA Nobuyuki  Osaka University Hospital, Assistant Professor, 講師 (10127243)
Project Period (FY) 1990 – 1991
KeywordsAPACHE-II / Critical care medicine / Intensive care medicine / Intensive care unit / severity / prognosis
Research Abstract

The purpose of this study is to establish a scoring system by which we can evaluate the severity of ICU patients in Japan.
First, we used the APACHE-II scoring system which has been widely used in many foreign countries for evaluating the severity of ICU patients and for predicting their subsequent prognosis. The subjects of the study were patients admitted to our ICUs. Their severity and predicted mortality were evaluated by using the APACEH-II scoring system. As a whole, APACHE-II scores were proportionally correlated with actual observed mortality (OM), and the overall calculated predicted mortality (PM) also fit with the OM. However, discrepancies were found between the APACHE-II scores and the OM and between the PM and the OM especially in septic patients with multiple organ failure (MOF). The reason why the discrepancies were found in septic patients was considered that the APACHE-II scoring system does not have scores evaluating liver dysfunction which was frequently observed in septic patients and was an important cause of death of the patients.
Next, we modified the APACHE-II scoring system and designed the APACHE-HEPATIC scoring system (APACHE-H), which included the scores to evaluate the liver function by using an arterial blood ketone body ratio (AKBR), an osmolality gap, a prothrombin time and a hepaplastin time. The accuracy and predictive power of the APACHE-H were superior to the APACHE-II in MOF patients. However, because the added items such as AKBR were not always easy to examine, the APACHE-H was considered necessary to be improved its simplicity.
In conclusion, the APACHE-II scoring system seemed to be a useful index to classify the severity of ICU patients except for some subgroups of patients such as septic ones with MOF. The APACHE-H scoring system was superior to the APACHE-II for evaluating the severity of MOF patients.

  • Research Products

    (5 results)

All Other

All Publications (5 results)

  • [Publications] 坂西 信映: "APACHE IIによるICU収容患者の予後予測に関する問題点" ICUとCCU. 15. 269-277 (1991)

    • Description
      「研究成果報告書概要(和文)」より
  • [Publications] 平澤 博之: "侵襲の重症度の指標" 外科治療. 63. 621-629 (1990)

    • Description
      「研究成果報告書概要(和文)」より
  • [Publications] 八木 正晴: "APACHE IIによるわれわれのICU収容患者の重症度評価" ICUとCCU. 15. 955-959 (1991)

    • Description
      「研究成果報告書概要(和文)」より
  • [Publications] Takahiko Kamibayashi: "Enhancement by propofol of epinephrine-induced arrhythmias in dogs." Anesthesiology.75. 1035-1040 (1991)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Yukio Hayashi: "Selective betal and beta2 adrenoceptor blockade on epinephrine-induced arrhythmias in halothane anaesthetized dogs." Canadian Journal of Anaesthesia.39. 873-876 (1992)

    • Description
      「研究成果報告書概要(欧文)」より

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Published: 1994-03-18  

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