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내과계 중환자실에 입원한 객혈 환자들에 있어 APACHE 3 점수 체계의 예후적 가치에 관한 연구
양성연(Sung Yeun Yang),고윤석(Youn Suck Koh),임채만(Chae Man Lim),이무송(Moo Song Lee),유미란(Mi Ran Yoo),최강현(Gang Heun Choi),이상도(Sang Do Lee),김우성(Woo Sung Kim),김동순(Dong Soon Kim),김원동(Won Dong Kim) 대한내과학회 1997 대한내과학회지 Vol.53 No.3
Background: Massive hemoptysis is one of the major medical emergency with high risk of mortality. Though the best predictor of mortality associated with hemoptysis appears to be the amount of bleeding within the first 24 hours, catastrophic hemorrhage could be occurred to the patients who were apparently in a stable condition with scanty hemoptysis at the time of admission. We evaluated APACHE III score system to find if it could be a prognostic index that can predict the mortality of the patients with hemoptysis. Methods : We identified all the patients who had admitted with hemoptysis in the Medical Intensive Care Unit of Asan Medical Center between May 25, 1989, and July 31, 1995. A retrospective analysis was done in 66 patients with hemoptysis on APA- CHE III score. Results: The overall mortality rate was 17.4% (12/69). In univariate analysis of possible prognostic factors, independent predictors of mortality were age(P=0.016), amount of hemoptysis(P=0.012), AaDO2 (P=0.017), requirement of transfusion(P=0.036), mechanical ventilatory care(P<0.05) and APACHE III score(P=0.02), In multivariate analysis with sex, age, amount of hemoptysis, AaDO2, requirement of transfusion and APACHE III score, APACHE III score was the only independent predictor of mortality(P=0.015, odd ratio=19.3, 95% confidence interval, 3.4 to 249.7) Conclusion: APACHE IU score may be a clinically significantly important independent predictor of outcome in the patients with hemoptysis. In addition, invasive procedure, such as bronchial artery embolizaticn or operation, could be considered in advance in the patients with more than 30 points of APACHE III.
뇌사환자의 갑상선 기능, 전신대사 및 중증도에 관한 연구
이영주,정금희,왕희정,문봉기,한연희,이영석 아주대학교 의과학연구소 1999 아주의학 Vol.4 No.1
Background and Objectives : Brain death may lead to hormonal depletion, metabolic derangement and multiple organ dysfunction. We have carried out present study to examine the effects of brain death on the thyroid function, metabolic indices, and the severity scoring systems. Methods : 13 adults patients admitted for organ donation or brain death evaluation were examined after brain death was confirmed. Thyroid hormones measured were .thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), and free thyroxine (FT4). The metabolic indices measured were arterial ketone body ratio (AKBR), lactic acid (LA), and base defiat (BD). as for reference to the severity scoring systems, APACHE Ⅲ and multiple organ failure score (MOFS) were assessed on the day of brain death confirmation. Arterial blood was drawn for all measurements. Results : As for the thyroid function, there were significant decreases in T3 (40.48±20.96 ng/dL) and T4 (3.47±2.15 ㎍/dL), but no significant change in FT4 (0.75±0.31 ng/dL) and TSH (1.12±1.37 uIU/mL) compared to the normal range. Significant decreases in AKBR (0.39±0.31) and BD (-9.46±5.83 m㏖/L), and significant increase in LA (2.57±2.46 m㏖/L) In metabolic indices, were shown, as for severity scoring systems, APACHE Ⅲ score (101.54±19.41) and MOF score (9.11±2.57) indicated a high mortality. There were significant correlation between thyroid hormones (r=0.565 -0.781) but no correlation among other indices. Also, significant inverse correlations were shown between base deficit and lactic acid (r=-0.660), APACHE Ⅲ score (r=-0.726) and MOF score (r=-0.604). The highest correlation was observed between APACHE Ⅲ score and MOF score (r=0.851). Conclusions : As for the thyroid function, significant decrease in T3 and T4, and almost normal range of FT4 and TSH imply the euthyroid sick syndrome. Abnormal finding of the metabolic parameters indicates an inhibition of the aerobic metabolic rate of the body as a whole. And the severity scoring parameters are compatible with high mortality.
패혈증환자에서 APACHE 3 Scoring System의 예후적 가치
임채만 ( Chae Man Lim ),이재균 ( Jae Kyun Lee ),이성순 ( Sung Soon Lee ),고윤석 ( Youn Suck Koh ),김우성 ( Woo Sung Kim ),김동순 ( Dong Soon Kim ),김원동 ( Won Dong Kim ),박평환 ( Pyung Hwan Park ),최종무 ( Jong Moo Choi ) 대한결핵 및 호흡기학회 1995 Tuberculosis and Respiratory Diseases Vol.42 No.6
Validation of the Simplified Acute Physiology Score 3 Scoring System in a Korean Intensive Care Unit
So Yeon Lim,Gee Young Suh,함초롬,박소영,김수현,박맹렬,전경만,엄상원,정만표,김호중,권오정 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.1
Purpose: The Simplified Acute Physiology Score (SAPS) 3 was recently proposed to reflect contemporary changes in intensive care practices. SAPS 3 features customized equations for the prediction of mortality in different geographic regions. However, the usefulness of SAPS 3 and its customized equation (Australasia SAPS 3) have never been externally validated in Korea. This study was designed to validate SAPS 3 and Australasia SAPS 3 for mortality prediction in Korea. Materials and Methods: A retrospective analysis of the prospective intensive care unit (ICU) registry was conducted in the medical ICU of Samsung Medical Center. Calibration and discrimination were determined by the Hosmer-Lemeshow test and area under the receiver operating characteristic (aROC) curve from 633 patients. Results: The mortalities (%) predicted by SAPS 3, Australasia SAPS 3, and SAPS II were 42 ± 28, 39 ± 27 and 37 ± 31, respectively. The calibration of SAPS II was poor (p = 0.003). SAPS 3 and Australasia SAPS 3 were appropriate (p > 0.05). The discriminative power of all models yielded aROC values less than 0.8. Conclusion: In Korea,mortality rates predicted using general SAPS 3 and Australasia SAPS 3 exhibited good calibration and modest discrimination. However, Australasia SAPS 3 did not improve the mortality prediction. To better predict mortality in Korean ICUs, a new equation may be needed specifically for Korea.
APACHE 3 를 이용한 내과 중환자실 환자의 질병 중증도 평가
유진홍(Jin Hong Yoo),김연근(Yeon Keun Kim),신완식(Wan Shik Shin),강문원(Moon Won Kang) 대한내과학회 1996 대한내과학회지 Vol.50 No.3
Objectives : In order to quantify the risk for medical intensive care unit (ICU) patients and to establish the guideline for decision making by using Acute Physiology and Chronic Health Evaluation (APACHE) III score. Methods : Total 204 medical ICU patients from July-1993 to September-1993 were enrolled to this study. Patients were categorized into subgroups by major disease cateogories, We measured acute physiologic variables, age, comorbidities, and chronic health status according to the APACHE III scoring system. Logistic regression analysis was done to determine the relationship between APACHE III score and death risk. Results : The overall mortality rate of 204 medical ICU patients was 28.4% (58/204). The majority of patients showed standard distribution over 17~72 APACHE III points. The main APACHE III point of survived group(n=146) was significantly lower than that of non-survived group(n=58), 43.6 vs 69.4, respectively(p<0.01). Logistic regression analysis about the relationship between APACHE III score and death risk gave the equation like this: logn R/1-R= 0.04314×(APACHE III)-3.488 According to this equation, the estimated risk of death was over 50% at the point range of 80~85 and over 90% at 130~135. Conclusion: APACHE IU scoring system could be a useful guideline to predict and to evaluate the outcome in medical ICU patients and it would aid us in clinical decision making and proper management of ICU patients.
중환자실에 입원한 환자의 장기부전 및 예후 평가를 위한 SOFA 점수체계의 의의
김수호 ( Su Ho Kim ),이명구 ( Myung Goo Lee ),박상면 ( Sang Myeon Park ),박용범 ( Young Bum Park ),장승훈 ( Seung Hun Jang ),김철홍 ( Cheol Hong Kim ),전만조 ( Man Jo Jeon ),신태림 ( Tae Rim Shin ),엄광석 ( Kwang Seok Eom ),현인규 대한결핵 및 호흡기학회 2004 Tuberculosis and Respiratory Diseases Vol.57 No.4
급성 췌장염으로 내과계 중환자실에 입원한 환자들의 급성호흡곤란 증후군 발생에 연관된 인자에 관한 연구
유미란 ( Mi Ran Yoo ),고윤석 ( Youn Suck Koh ),임채만 ( Chae Man Lim ),이문규 ( Moon Gyu Lee ),이홍재 ( Hong Jae Lee ),이무송 ( Moo Song Lee ),안종준 ( Jong Jun An ),이성구 ( Sung Koo Lee ),김명환 ( Myung Hwan Kim ),이상도 ( Sang 대한결핵 및 호흡기학회 1997 Tuberculosis and Respiratory Diseases Vol.44 No.4