To see the other types of publications on this topic, follow the link: Scoring outcome.
Dissertations / Theses on the topic 'Scoring outcome'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 16 dissertations / theses for your research on the topic 'Scoring outcome.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Ho, Kwok Ming. "Use of prognostic scoring systems to predict outcomes of critically ill patients." University of Western Australia. School of Medicine and Pharmacology, 2008. http://theses.library.uwa.edu.au/adt-WU2009.0101.
Full textAbstract:
[Tuncated abstract] This research thesis consists of five sections. Section one provides the background information (chapter 1) and a description of characteristics of the cohort and the methods of analysis (chapter 2). The Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system is one of commonly used severity of illness scoring systems in many intensive care units (ICUs). Section two of this thesis includes an assessment of the performance of the APACHE II scoring system in an Australian context. First, the performance of the APACHE II scoring system in predicting hospital mortality of critically ill patients in an ICU of a tertiary university teaching hospital in Western Australia was assessed (Chapter 3). Second, a simple modification of the traditional APACHE II scoring system, the 'admission APACHE II scoring system', generated by replacing the worst first 24-hour data by the ICU admission physiological and laboratory data was assessed (Chapter 3). Indigenous and Aboriginal Australians constitute a significant proportion of the population in Western Australia (3.2%) and have marked social disadvantage when compared to other Australians. The difference in the pattern of critical illness between indigenous and non-indigenous Australians and also whether the performance of the APACHE II scoring system was comparable between these two groups of critically ill patients in Western Australia was assessed (Chapter 4). Both discrimination and calibration are important indicators of the performance of a prognostic scoring system. ... The use of the APACHE II scoring system in patients readmitted to ICU during the same hospitalisation was evaluated and also whether incorporating events prior to the ICU readmission to the APACHE II scoring system would improve its ability to predict hospital mortality of ICU readmission was assessed in chapter 10. Whilst there have been a number of studies investigating predictors of post-ICU in-hospital mortality none have investigated whether unresolved or latent inflammation and sepsis may be an important predictor. Section four examines the role of inflammatory markers measured at ICU discharge on predicting ICU re- 4 admission (Chapter 11) and in-hospital mortality during the same hospitalisation (Chapter 12) and whether some of these inflammatory markers were more important than organ failure score and the APACHE II scoring system in predicting these outcomes. Section five describes the development of a new prognostic scoring system that can estimate median survival time and long term survival probabilities for critically ill patients (Chapter 13). An assessment of the effects of other factors such as socioeconomic status and Aboriginality on the long term survival of critically ill patients in an Australian ICU was assessed (Chapter 14). Section six provides the conclusions. Chapter 15 includes a summary and discussion of the findings of this thesis and outlines possible future directions for further research in this important aspect of intensive care medicine.
2
Zhang, Yin, and 張銀. "Validation of the new knee society knee scoring system for outcome assessment after total knew arthroplasty." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193564.
Full textAbstract:
Introduction:
This retrospective comparative study was to define the validity and reliability of a translated, culturally adapted Chinese version questionnaire of the New Knee Society Knee Scoring System (NKSS).
This study is aim to investigate the validity and reliability of the translated Chinese version of the NKSS and assess its feasibility of measuring the scale on Chinese patients by performing its cross-cultural adaptation for patients after Total Knee Arthroplasty (TKA) in Hong Kong.
Methods:
A total of 104 knees from 64 Chinese patients performed TKA were included in the study using the translated, culturally adapted Chinese version of the NKSS. All Patients were operated on from October 2010 to May 2013 at Queen Mary Hospital. Patients who participated in this study have been clinically screened and established a set of including criteria. The outpatients were evaluated by completing the five questionnaires containing the NKSS, the Knee Society Clinical Rating System (KSS), Medial Outcomes Study 36+Item Short Form (SF-36), Bristol Knee Score and Oxford Knee Score.
Reliability was evaluated using the Split-half reliability, Chronbach's α coefficient and inter-item correlation. To assess validity, all patients filled in the same NKSS questionnaire, and previously validated Chinese version of the SF-36, Bristol Knee Score and Oxford Knee Score. The validity was determined with Content Validity and Contract Validity.
Results:
The NKSS showed ideal split-half reliability as evidenced by the high correlation coefficient (R>0.7, P<0.05). Chronbach's α coefficient for five major domains demographics, objective knee score, expectations, satisfaction and function was high (α>0.7. P<0.05). Also, the inter-item correlation was also excellent for all domains. For validity, the NKSS was found to have excellent correlation with Bristol Knee Score and Oxford Knee Score, good correlation with KSS and SF 36
Discussion:
The NKSS as a validated approach is adapted to the diverse health-related quality of lives and activities of contemporary patients with TKA. Orthopaedics surgeons are allowed to appreciate differences in the priorities of individual patients and the interplay among function, expectation, symptoms, and satisfaction after TKA using this assessment instrument.
Conclusion:
The results of this study show that the NKSS as a functional status questionnaire has been translated into Chinese without missing any psychometric properties of the original version. This culturally and linguistics adapted Chinese version of the NKSS outcome assessment has satisfactory internal consistency and good validity. It is an adequate and helpful instrument for the evaluation of Chinese speaking patients after TKA in clinical studies.<br>published_or_final_version<br>Medical Sciences<br>Master<br>Master of Medical Sciences
3
Hassanin, Alaa-eldien Bahaa Ghareeb [Verfasser], and Alexander [Akademischer Betreuer] Brawanski. "Cerebral aneurysms - Facts and Conflicts: State-of-the-Art-Outcome (New Scoring System) / Bahaa Ghareeb Hassanin Alaa-eldien ; Betreuer: Alexander Brawanski." Regensburg : Universitätsbibliothek Regensburg, 2019. http://d-nb.info/1186968923/34.
Full text
4
Karlsson, Michaela, and Alexandra Sandéhn. "Role of timeouts in table tennis examined." Thesis, Högskolan i Halmstad, Akademin för hälsa och välfärd, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-38896.
Full textAbstract:
The purpose of the present study was to examine the role of timeouts in competitive elite table tennis in relation to psychological momentum (PM). To that end, archival data from elite top-international matches (N= 48) was firstly examined to gather information on when timeouts are most taken, and whether these have any objective influence on subsequent performance (set outcome and ultimately match outcome). Secondly, similar archival data for Swedish League matches (N= 36) was examined and interviews with elite coaches from the highest Swedish league (N= 6) at these given matches were carried out to gain further knowledge and understanding on the role and use of timeouts in competitive elite table tennis. Findings showed that timeouts were mostly called following a sequence of three consecutive lost points; that is, coaches used timeouts to break negative PM. However, findings also showed that these given timeouts had no objective impact on neither set nor match outcomes; that is, sets and matches were ultimately lost. Future research examining the subjective coach-player experience revolving around timeouts is needed to comprehend potential ‘secondary’ purposes when calling timeouts and, subsequently, understand timeouts role in table tennis fully.
5
Terrell, Shane Patrick. "Feedlot lameness: industry perceptions, locomotion scoring, lameness morbidity, and association of locomotion score and diagnosis with case outcome in beef cattle in Great Plains feedlots." Diss., Kansas State University, 2016. http://hdl.handle.net/2097/34470.
Full textAbstract:
Doctor of Philosophy<br>Department of Diagnostic Medicine/Pathobiology<br>Daniel U. Thomson<br>In current literature, there is a limited amount of large scale data available demonstrating lameness morbidity in beef cattle feedlots, the subsequent outcomes of individuals exhibiting lameness, the morbidity and mortality of various lameness diagnoses, or the effect of locomotion score at the time of first morbidity and its effect on outcome. In addition, current perceptions of lameness by feedlot industry participants are not known and a reliable locomotion scoring system fit for use in a feedlot setting has not been developed. Consequently, the objectives of this research were three-fold. First, to obtain a baseline of the perception of lameness within the feedlot industry. Second, to develop a functional locomotion scoring system for use in feedlots and to test a training program implementing this locomotion scoring system for inter-rater reliability. Third, determine the association of lameness diagnosis and locomotion score at time of initial lameness diagnosis with case outcome in feedlot cattle and provide beef cattle feedlot lameness morbidity, mortality, and realizer incidence rates due to different lameness etiologies in a large scale, multisite study. One hundred forty-seven consulting nutritionists, veterinarians, and feedlot managers participated in the feedlot cattle lameness survey. The median response of estimated lameness incidence in the feedyard was 2%, with a mode of 1% and a mean of 3.8%. Participants indicated that footrot, injury, and toe abscesses were the most common causes of lameness.
A locomotion scoring system was developed to clinically assess locomotion of beef cattle. The scoring system consisted of 4 categories: normal movement (0), slightly affected gait (1), obviously shortened stride or bobbing of head (2), and reluctance to move or apply weight to the limb while walking or standing (3). A total of 50 commercial feedlot employees and agricultural students were trained to use the scoring system in either English or Spanish. The scoring system was tested for inter-rater agreement and rater agreement against a cooperative standard based on consensus score by a team of individuals involved in the development of the scoring system, which included beef cattle veterinarians and welfare experts. Intra-class correlation coefficient (ICC) and Fleiss’s kappa were used to evaluate inter-rater agreement and rater agreement against the cooperative standard. Inter-rater agreement using ICC was 0.85 (95% CI; 0.75 to 0.93) while the mean kappa value was 0.52 (moderate agreement). Rater agreement with the cooperative standard resulted in mean kappa value of 0.64 (substantial agreement). A dynamic population longitudinal study with an initial study population of 245,494 head of feedlot cattle, with 524,780 animal arrivals and 527,220 animal departures recorded over the 12-month study was conducted over a year by trained personnel in six participating feedlots located in Kansas and Nebraska. Lameness morbidity incidence was 1.04 cases per 100 animal-years; lameness mortality was 0.397 cases per 100 animal-years. Cattle locomotion score (LMS; scale of 0 to 3 at time of initial diagnosis) were LMS1(22% of lameness cases), LMS2 (31%), and LMS3(22%). 24% of the lameness cases were not assigned a locomotion score (NS). Mortality risks were greatest for LMS3 (33.0%) and NS (31.3%), and were least for LMS1 (10.0%) with LMS2 (19.1%) being intermediate (P < 0.05).
6
Dakovic, Igor [Verfasser], and Marcus [Akademischer Betreuer] Treitl. "Outcome der Scoring-Balloon Angioplastie der pAVK der unteren Extremitäten im Vergleich zur herkömmlichen Ballonangioplastie mit besonderem Augenmerk auf Reststenosen und Stentquote / Igor Dakovic ; Betreuer: Marcus Treitl." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2020. http://d-nb.info/1226092403/34.
Full text
7
Coumbe, Kelly Lynn. "Effects of environmental factors present during the administration of the California High School Exit Exam on students' outcome scores." CSUSB ScholarWorks, 2004. https://scholarworks.lib.csusb.edu/etd-project/2597.
Full textAbstract:
This study looked at the environmental factors present during testing for the spring 2004 administration of the California High School Exit Exam (CAHSEE) in an attempt to quantify some of the factors that were previously only qualitatively reported. Five factors were examined for their ability to predict passing percentages of students on the CASHSEE at the school level. The results indicated that socioeconomic status was the only significant predictor.
8
Kurbaan, Arvinder Singh. "The utility of coronary scoring systems in assessing the influence of immediate post revascularisation coronary disease and its interplay with coronary restenosis on the one year outcome of coronary revascularisation." Thesis, Imperial College London, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343803.
Full text
9
Goldhill, David Raymond. "Identifying priorities in intensive care : a description of a system for collecting intensive care data, an analysis of the data collected, a critique of aspects of severity scoring systems used to compare intensive care outcome, identification of priorities in intensive care and proposals to improve outcome for intensive care patients." Thesis, Queen Mary, University of London, 1999. http://qmro.qmul.ac.uk/xmlui/handle/123456789/1405.
Full textAbstract:
This thesis reviews the requirements for intensive care audit data and describes the development of ICARUS (Intensive Care Audit and Resource Utilisation System), a system to collect and analyse intensive care audit information. By the end of 1998 ICARUS contained information on over 45,000 intensive care admissions. A study was performed to determine the accuracy of the data collection and entry in ICARUS. The data in ICARUS was used to investigate some limitations of the APACHE II severity scoring system. The studies examined the effect of changes in physiological values and post-intensive care deaths, and the effect of casemix adjustment on mortality predicted by APACHE II. A hypothesis is presented that excess intensive care mortality in the United Kingdom may be concealed by intensive care mortality prediction models. A critical analysis of ICARUS data was undertaken to identify patient groups most likely to benefit from intensive care. This analysis revealed a high mortality in critically ill patients admitted from the wards to the intensive care unit. To help identify critically ill ward patients, the physiological values and procedures in the 24 hours before intensive care admission from the ward were recorded: examination of the results suggested that management of these patients could be improved. This led to the setting up of a patient at risk team (PART). Two studies report the effect of the PART on patients on the wards and on the patients admitted from the wards to the intensive care unit. Additional care for surgical patients on the wards is suggested as a way of improving the management of high-risk postoperative patients. The thesis concludes by discussing the benefits of the ICARUS system and speculating on the direction that should be taken for intensive care audit in the future.
10
Stemmet, Megan. "Prevalence and characterization of Gardnerella vaginalis in pregnant mothers with a history of preterm delivery." Thesis, University of the Western Cape, 2012. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_4430_1373278573.
Full textAbstract:
<p>Risk factors such as intrauterine and vaginal infection put pregnant women at risk for delivering preterm. Bacterial vaginosis (BV) is a polymicrobial clinical syndrome commonly diagnosed in women of reproductive age, with women of African descent with low socioeconomic status and previous preterm delivery at high risk. Although frequently isolated from healthy women, <br>Gardnerella vaginalis has been most frequently associated with BV. There is limited data available on the prevalence of BV in Southern Africa<br>therefore, we embarked on a study to determine the <br>prevalence of BV and G. vaginalis in predominantly black communities in the Western Cape, in order to establish the role of G. vaginalis in BV. Women attending various Maternity and Obstetrics <br>units (MOU) in the Cape Peninsula with and without a history of pre-term delivery (PTD) were invited to participate in the study. Several factors were statistically associated with pregnancy history, <br>including location of study population, parity, smoking and presence of clinical symptoms. The presence of G. vaginalis was determined by culture in 51.7% of the preterm delivery group (PTDG) <br>and 44% of the full-term delivery group (FTDG) women. BV was detected in 31.13% of PTDG and 23.67% of FTDG by Gram stained analysis according to Nugent scoring criteria, with age and HIV <br>status posing as risk factors. When comparing PTDG and FTDG for an association between the presence of G. vaginalis and BV, a stronger association was observed in the PTDG but it was not statistically significant. In both PTDG and FTDG, G. vaginalis was isolated significantly more often in women diagnosed with BV at 24.5% (p <<br>0.05). Antibiogram studies revealed both Metronidazole and Clindamycin resistant strains of G. vaginalis. G. vaginalis Biotype 7 is specifically associated with BV, while Biotype 2 appears to be associated with BV in women with a history <br>of PTD. Accuracy of diagnostic tools were tested and it was determined that Nugent scoring is more sensitive in diagnosing BV (76.04%), but culture for G. vaginalis is more specific (83.21%). Although this study was limited in that we were unable to follow-up pregnancy outcomes, we were able to confirm the perceived role of G. vaginalis in BV. <br></p>
11
Alder, Kayla Michelle. "Day-of-Injury Computed Tomography (CT) and Longitudinal Rehabilitation Outcomes: A Comparison of the Marshall and Rotterdam CT Scoring Methods." BYU ScholarsArchive, 2018. https://scholarsarchive.byu.edu/etd/7251.
Full textAbstract:
Both individual patient-related and injury-related factors predict functional outcomes following moderate-to-severe traumatic brain injury (M/S TBI). Other than binary outcomes such as death, little is known about the role of day-of-injury neuroimaging in predicting long- term outcomes. Classification systems for assessing the severity of injury using computerized tomography (CT) scans, such as the Marshall Classification System (MCS) or Rotterdam scale, have not been systematically studied to see how they relate to long-term rehabilitation and functional outcomes following M/S TBI. The MCS consists of six categories based on information about midline shift, basal cistern compression, surgery evacuation, and lesion size. The Rotterdam scale, however, is a summed score ranging from 1-6 based on the extent of basal cistern compression, extent of midline shift, presence/absence of an epidural lesion, and presence/absence of traumatic subarachnoid hemorrhage (tSAH) or intraventricular blood. The differences between these two CT scales suggest the possibility that MCS and Rotterdam scales may differ in their ability to predict subsequent rehabilitation outcomes. Thus, we compared the relative predictive value of MCS and Rotterdam scores on long-term rehabilitation functional outcomes using the Functional Independence Measure (FIM) at rehabilitation discharge and nine-month post-discharge follow up. The study included 88 participants (25 females, mean age: 42.0 [SD: 21.3]) with M/S TBI. Day-of-injury CT images were scored using both MCS and Rotterdam criteria. Functional outcomes were measured by the cognitive and motor subscales on the FIM at discharge and after nine-month follow up, and length of stay in rehabilitation. Data were analyzed using multiple linear regression models. Neither MCS nor Rotterdam scores nor rehabilitation length of stay significantly predicted motor or cognitive outcomes at discharge or nine-month follow-up. MCS and Rotterdam scales may have limited utility in predicting long- term functional outcome in a rehabilitation setting, but instead appear to be good predictors of acute outcomes, especially regarding mortality and elevated intracranial pressure (ICP). Future research could focus on CT characteristics such as midline shift to predict long-term rehabilitation outcomes to guide treatment instead of CT rating scales.
12
Tilley, Jack Lucas. "Can in-prison interventions affect post-release outcomes? Evidence from correctional education programs based on an econometric analysis of recidivism." Oberlin College Honors Theses / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=oberlin1354550128.
Full text
13
Kalsi-Ryan, Sukhvinder. "The Graded Redfined Assessment of Strength, Senssibility and Prehension (GRASSP): Development of the Scoring Approach, Evaluation of Psychometric Properties and the Relationship of Upper Limb Impairment to Function." Thesis, 2011. http://hdl.handle.net/1807/29768.
Full textAbstract:
Upper limb function is important for individuals with tetraplegia because upper limb function supports global function for these individuals. As a result, a great deal of time and effort has been devoted to the restoration of upper limb function. Appropriate outcome measures that can be used to characterize the neurological status of the upper limb have been one of the current barriers in substantiating the efficacy of interventions. Techniques and protocols to evaluate changes in upper limb neurological status have not been applied to the SCI population adequately. The objectives of this thesis were to develop a measure; which is called the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP). Development of the scoring approach, testing for reliability and construct validity, and determining impairment and function relationships specific to the upper limb neurological were established. The GRASSP is a clinical measure of upper limb impairment which incorporates the construct of “sensorimotor upper limb function”; comprised of three domains which include five subtests. The GRASSP was designed to capture information on upper limb neurological impairment for individuals with tetraplegia. The GRASSP defines neurological status with numerical values, which represent the deficits in a predictive pattern, is reliable and valid as an assessment technique, and the scores can be used to determine relationships between impairment and functional capability of the upper limb. The GRASSP is recommended for use in the very early acute phases after injury to approximately one year post injury. Use of the GRASSP is recommended when a change in neurological status is being assessed.
14
Roorda, L. D., J. R. Green, A. Houwink, et al. "Item hierarchy-based analysis of the Rivermead Mobility Index resulted in improved interpretation and enabled faster scoring in patients undergoing rehabilitation after stroke." 2012. http://hdl.handle.net/10454/6163.
Full textAbstract:
OBJECTIVE: To enable improved interpretation of the total score and faster scoring of the Rivermead Mobility Index (RMI) by studying item ordering or hierarchy and formulating start-and-stop rules in patients after stroke. DESIGN: Cohort study. SETTING: Rehabilitation center in the Netherlands; stroke rehabilitation units and the community in the United Kingdom. PARTICIPANTS: Item hierarchy of the RMI was studied in an initial group of patients (n=620; mean age +/- SD, 69.2+/-12.5y; 297 [48%] men; 304 [49%] left hemisphere lesion, and 269 [43%] right hemisphere lesion), and the adequacy of the item hierarchy-based start-and-stop rules was checked in a second group of patients (n=237; mean age +/- SD, 60.0+/-11.3y; 139 [59%] men; 103 [44%] left hemisphere lesion, and 93 [39%] right hemisphere lesion) undergoing rehabilitation after stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mokken scale analysis was used to investigate the fit of the double monotonicity model, indicating hierarchical item ordering. The percentages of patients with a difference between the RMI total score and the scores based on the start-and-stop rules were calculated to check the adequacy of these rules. RESULTS: The RMI had good fit of the double monotonicity model (coefficient H(T)=.87). The interpretation of the total score improved. Item hierarchy-based start-and-stop rules were formulated. The percentages of patients with a difference between the RMI total score and the score based on the recommended start-and-stop rules were 3% and 5%, respectively. Ten of the original 15 items had to be scored after applying the start-and-stop rules. CONCLUSIONS: Item hierarchy was established, enabling improved interpretation and faster scoring of the RMI.
15
"Factor scoring methods affected by response shift in patient-reported outcomes." Thesis, 2014. http://hdl.handle.net/10388/ETD-2014-07-1626.
Full textAbstract:
Objective: Patient-reported outcomes (PROs) are measures collected from a patient to determine how he/she feels or functions in regards to a health condition. Longitudinal PROs, which are collected at multiple occasions from the same individual, may be affected by response shift (RS). RS is a change in a person’s self-evaluation of a target construct. Latent variable models (LVMs) are statistical models that relate observed variables to latent variables (LV). LVMs are used to analyze PROs and detect RS. LVs are random variables whose realizations are not observable. Factor scores are estimates of LVs for each individual and can be estimated from parameter estimates of LVMs. Factor scoring methods to estimate factor scores include: Thurstone, Bartlett, and sum scores. This simulation study examines the effects of RS on factor scores used to test for change in the LV means and recommend a factor scoring method least affected by RS.
Methods: Data from two time points were fit to three confirmatory factor analysis (CFA) models. CFA models are a type of LVM. Each CFA model had different sets of parameters that were invariant over time. The unconstrained (Uncon) CFA model had no invariant parameters, the constrained (Con) model had all the parameters invariant, and the partially constrained (Pcon) model had some of the parameters invariant over time. Factor scores were estimated and tested for change over time via paired t-test. The Type I error, power, and factor loading (the regression coefficient between an observed and LV) and factor score bias were estimated to determine if RS influenced the test of change over time and factor score estimation.
Results: The results depended on the true LV mean. The Type I error and power were similar for all factor scoring methods and CFA models when the LV mean was 0 at time 1. For LV mean of 0.5 at time 1 the Type I error and power increased as RS increased for all factor scores except for scores estimated from the Uncon model and Bartlett method. The biases of the factor loadings were unaffected by RS when estimated from an Uncon model. The factor scores estimated from the Uncon model and the Bartlett and sum scores method had the smallest factor score biases.
Conclusion: The factor scores estimated from the Uncon model and the Bartlett method was least affected by RS and performed best in all measures of Type I error, statistical power, factor loading and factor score bias. Estimating factor scores from PROs data that ignores RS may result in erroneous (or biased) estimates.
16
Yang, Kuang-Yao, and 陽光耀. "Biomarkers and clinical scoring indices predict outcomes of patients with severe pneumonia." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/72572432612492587136.
Full textAbstract:
博士<br>國立陽明大學<br>臨床醫學研究所<br>99<br>Introduction:
Pneumonia is the common infectious disease reported among patients receiving hospitalization and severe pneumonia causes relative organ dysfunction and hospital death. Despite recent advances in the management of severe pneumonia with septic shock, mortality rates are still unacceptably high. Early identification of the high-mortality risk group for early intervention remains an issue under exploration. VEGF, sVEGFR1, and uPA have diverse effects in the pathogenesis of sepsis. Their roles in predicting mortality and organ dysfunction remain to be clarified. Healthcare-associated pneumonia (HCAP) is a relatively new category of pneumonia. It usually has severe course. There is currently no scoring index to predict the outcomes of HCAP patients. We applied and compared different community acquired pneumonia (CAP) scoring indices to predict 30-day mortality and 3-day and 14-day intensive care unit (ICU) admission in patients with HCAP.
Methods:
I. Pneumonia-related septic shock patients from medical ICUs were enrolled for this prospective observational study. We also included 20 patients with pneumonia without organ dysfunction for comparison. Plasma levels of VEGF and sVEGFR1 and uPA activity within 24 hours of shock onset were measured. We compared plasma levels of these biomarkers with APACHE II scores between subgroups of patients, and evaluated their predictive value for 28-day mortality and organ dysfunction.
II. We conducted another retrospective cohort study based on an inpatient database from 6 medical centers, recruiting a total of 444 patients with HCAP between January 1, 2007 and December 31, 2007. Pneumonia severity scoring indices including pneumonia severity index (PSI), CURB 65, modified ATS rule, ATS/IDSA, SCAP, SMART-COP, SMRT-CO, and SOAR were calculated for each patient. Patient characteristics, comorbidities, pneumonia pathogen culture results, length of hospital stay (LOS), and length of ICU stay were also recorded.
Results:
I. A total of 101 patients, including 81 with pneumonia-related septic shock and 20 with pneumonia without organ dysfunction, were enrolled. Non-survivors of septic shock had significantly higher plasma sVEGFR1 levels and uPA activity (p=0.001) as compared with those of the survivors. Kaplan-Meier survival analysis demonstrated significantly higher mortality in patients with higher levels of sVEGFR1 (p&lt;0.001) and uPA activity (p=0.031). In Cox regression analysis, plasma sVEGFR1 level was independently associated with, and best predicted, the 28-day mortality of septic shock (HR: 1.55, 95% CI: 1.05-2.30). Plasma sVEGFR1 level and uPA activity had good correlation with renal dysfunction, metabolic acidosis, and hematologic dysfunction; their levels significantly increased when the number of organ dysfunctions increased. In multivariate analysis, plasma sVEGFR1 level (HR: 2.82, 95% CI: 1.17-6.81) and uPA activity (HR: 2.75, 95% CI: 1.06-7.13) were independent predictors of the presence of concomitant multi-organ dysfunction.
II. PSI (>90) has the highest sensitivity in predicting mortality of HCAP, followed by CURB-65 (≥2) and SCAP (>9) (SCAP score (AUC: 0.71), PSI (AUC: 0.70) and CURB-65 (AUC: 0.66)). Compared to PSI, modified ATS, ATS/IDSA, SCAP, and SMART-COP were easy to calculate. For predicting ICU admission (day 3 and day 14), Modified ATS (AUC: 0.84, 0.82), SMART-COP (AUC: 0.84, 0.82), SCAP (AUC: 0.82, 0.80) and IDSA/ATS (AUC: 0.80, 0.79) performed better (statistically significant difference) than PSI, CURB-65, SOAR and SMRT-CO.
Conclusions: High plasma sVEGFR1 level in the early stage of pneumonia-related septic shock independently predicted 28-day mortality and multi-organ dysfunction. The utility of the scoring indices for risk assessment in patients with healthcare-associated pneumonia shows that the scoring indices originally designed for CAP can be applied to HCAP.