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Original Articles
Infection
Application of Sepsis-3 Criteria to Korean Patients with Critical Illnesses
Jae Yeol Kim, Hwan Il Kim, Gee Young Suh, Sang Won Yoon, Tae-Yop Kim, Sang Haak Lee, Jae Young Moon, Jae-Young Kwon, Sungwon Na, Ho Geol Ryu, Jisook Park, Younsuck Koh
Acute Crit Care. 2019;34(1):30-37.   Published online January 29, 2019
DOI: https://doi.org/10.4266/acc.2018.00318
Correction in: Acute Crit Care 2019;34(2):172
  • 8,118 View
  • 173 Download
  • 3 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Background
The 2016 Society of Critical Care Medicine (SCCM)/European Society of Intensive Care Medicine (ESICM) task force for Sepsis-3 devised new definitions for sepsis, sepsis with organ dysfunction and septic shock. Although Sepsis-3 was data-driven, evidence-based approach, East Asian descents comprised minor portions of the project population. Methods: We selected Korean participants from the fever and antipyretics in critically ill patients evaluation (FACE) study, a joint study between Korea and Japan. We calculated the concordance rates for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria and evaluated mortality rates of sepsis, sepsis with organ dysfunction, and septic shock by Sepsis-3 criteria using the selected data. Results: Korean participants of the FACE study were 913 (383 with sepsis and 530 without sepsis by Sepsis-2 criteria). The concordance rate for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria was 55.4%. The intensive care unit (ICU) and 28-day mortality rates of sepsis, sepsis with organ dysfunction, and septic shock patients according to Sepsis-3 criteria were 26.2% and 31.0%, 27.5% and 32.5%, and 40.8% and 43.4%, respectively. The quick Sequential Organ Failure Assessment (qSOFA) was inferior not only to SOFA but also to systemic inflammatory response syndrome (SIRS) for predicting ICU and 28-day mortality. Conclusions: The concordance rates for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria were low. Mortality rate for septic shock in Koreans was consistent with estimates made by the 2016 SCCM/ESICM task force. SOFA and SIRS were better than qSOFA for predicting ICU and 28-day mortality in Korean ICU patients.

Citations

Citations to this article as recorded by  
  • HYPOTENSION AT THE TIME OF SEPSIS RECOGNITION IS NOT ASSOCIATED WITH INCREASED MORTALITY IN SEPSIS PATIENTS WITH NORMAL LACTATE LEVELS
    Ji Hwan Kim, Yong Kyun Kim, Dong Kyu Oh, Kyeongman Jeon, Ryoung-Eun Ko, Gee Young Suh, Sung Yun Lim, Yeon Joo Lee, Young-Jae Cho, Mi-Hyeon Park, Sang-Bum Hong, Chae-Man Lim, Sunghoon Park
    Shock.2023; 59(3): 360.     CrossRef
  • The Surviving Sepsis Campaign: research priorities for the administration, epidemiology, scoring and identification of sepsis
    Mark E. Nunnally, Ricard Ferrer, Greg S. Martin, Ignacio Martin-Loeches, Flavia R. Machado, Daniel De Backer, Craig M. Coopersmith, Clifford S. Deutschman, Massimo Antonelli, Judith Hellman, Sameer Jog, Jozef Kesecioglu, Ishaq Lat, Mitchell M. Levy
    Intensive Care Medicine Experimental.2021;[Epub]     CrossRef
Hematology
Recombinant Activated Factor VII as a Second Line Treatment for Postpartum Hemorrhage
Soon Chang Park, Seok Ran Yeom, Sang Kyoon Han, Young Mo Jo, Hyung Bin Kim
Korean J Crit Care Med. 2017;32(4):333-339.   Published online November 30, 2017
DOI: https://doi.org/10.4266/kjccm.2016.00787
  • 9,917 View
  • 342 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
Severe or massive postpartum hemorrhage (PPH) has remained a leading cause of maternal mortality for decades across the world and it results in critical obstetric complications. Recombinant activated factor VII (rFVIIa) has emerged as a gold standard adjunctive hemostatic agent for the treatment of life-threatening PPH refractory to conventional therapies although it remains off-licensed for use in PPH. We studied the effects of rFVIIa on coagulopathy, transfusion volume, prognosis, severity change in Korean PPH patients.
Methods
A retrospective review of medical records between December 2008 and March 2011 indicating use of rFVIIa in severe PPH was performed. We compared age, rFVIIa treatment, transfusion volume, and Sequential Organ Failure Assessment (SOFA) score at the time of arrival in the emergency department and after 24 hours for patients whose SOFA score was 8 points or higher.
Results
Fifteen women with SOFA score of 8 and above participated in this study and eight received rFVIIa administration whereas seven did not. Patients’ mean age was 31.7 ± 7.5 years. There was no statistically significant difference in initial and post-24 hours SOFA scores between patients administered rFVIIa or not. The change in SOFA score between initial presentation and after 24 hours was significantly reduced after rFVIIa administration (P = 0.016).
Conclusions
This analysis aimed to support that the administration of rFVIIa can reduce the severity of life-threatening PPH in patients. A rapid decision regarding the administration of rFVIIa is needed for a more favorable outcome in severe PPH patients for whom there is no effective standard treatment.

Citations

Citations to this article as recorded by  
  • Role of recombinant factor VIIa in the clinical management of severe postpartum hemorrhage: consensus among European experts
    D. Surbek, J. Blatný, M. Wielgos, N. Acs, H. Edwards, O. Erez, J. L. Bartha, H. Madar, F. J. Mercier, D. Schlembach, G. C. Di Renzo
    The Journal of Maternal-Fetal & Neonatal Medicine.2024;[Epub]     CrossRef
  • Efficacy and Safety Analyses of Recombinant Factor VIIa in Severe Post-Partum Hemorrhage
    Camila Caram-Deelder, Hellen McKinnon Edwards, Jarmila A. Zdanowicz, Thomas van den Akker, Camilla Birkegård, Jan Blatný, Johanna G. van der Bom, Giuseppe Colucci, Derek van Duuren, Nan van Geloven, Dacia D. C. A. Henriquez, Marian Knight, Lars Korsholm,
    Journal of Clinical Medicine.2024; 13(9): 2656.     CrossRef
  • Coagulation management and transfusion in massive postpartum hemorrhage
    Christina Massoth, Manuel Wenk, Patrick Meybohm, Peter Kranke
    Current Opinion in Anaesthesiology.2023; 36(3): 281.     CrossRef
  • Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care
    Sibylle Kietaibl, Aamer Ahmed, Arash Afshari, Pierre Albaladejo, Cesar Aldecoa, Giedrius Barauskas, Edoardo De Robertis, David Faraoni, Daniela C. Filipescu, Dietmar Fries, Anne Godier, Thorsten Haas, Matthias Jacob, Marcus D. Lancé, Juan V. Llau, Jens Me
    European Journal of Anaesthesiology.2023; 40(4): 226.     CrossRef
Neurology/Emergency
Acute Physiologic and Chronic Health Examination II and Sequential Organ Failure Assessment Scores for Predicting Outcomes of Out-of-Hospital Cardiac Arrest Patients Treated with Therapeutic Hypothermia
Sung Joon Kim, Yong Su Lim, Jin Seong Cho, Jin Joo Kim, Won Bin Park, Hyuk Jun Yang
Korean J Crit Care Med. 2014;29(4):288-296.   Published online November 30, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.4.288
  • 6,494 View
  • 45 Download
  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
The aim of this study was to assess the relationship between acute physiologic and chronic health examination (APACHE) II and sequential organ failure assessment (SOFA) scores and outcomes of post-cardiac arrest patients treated with therapeutic hypothermia (TH).
METHODS
Out-of-hospital cardiac arrest (OHCA) survivors treated with TH between January 2010 and December 2012 were retrospectively evaluated. We captured all components of the APACHE II and SOFA scores over the first 48 hours after intensive care unit (ICU) admission (0 h). The primary outcome measure was in-hospital mortality and the secondary outcome measure was neurologic outcomes at the time of hospital discharge. Receiver-operating characteristic and logistic regression analysis were used to determine the predictability of outcomes with serial APACHE II and SOFA scores.
RESULTS
A total of 138 patients were enrolled in this study. The area under the curve (AUC) for APACHE II scores at 0 h for predicting in-hospital mortality and poor neurologic outcomes (cerebral performance category: 3-5) was more than 0.7, and for SOFA scores from 0 h to 48 h the AUC was less than 0.7. Odds ratios used to determine associations between APACHE II scores from 0 h to 48 h and in-hospital mortality were 1.12 (95% confidence interval [CI], 1.03-1.23), 1.13 (95% CI, 1.04-1.23), and 1.18 (95% CI, 1.07-1.30).
CONCLUSIONS
APACHE II, but not SOFA score, at the time of ICU admission is a modest predictor of in-hospital mortality and poor neurologic outcomes at the time of hospital discharge for patients who have undergone TH after return of spontaneous circulation following OHCA.

Citations

Citations to this article as recorded by  
  • Multiorgan failure in patients after out of hospital resuscitation: a retrospective single center study
    Yaacov Hasin, Yigal Helviz, Sharon Einav
    Internal and Emergency Medicine.2024; 19(1): 159.     CrossRef
Case Report
Multiple Organ Dysfunction Syndrome and Quadriplegia due to Acute Methamphetamine Intoxication: A Case Report
Oh Young Kwon, Jong Seok Lee, Han Sung Choi, Hoon Pyo Hong, Young Gwan Ko
Korean J Crit Care Med. 2010;25(1):33-36.
DOI: https://doi.org/10.4266/kjccm.2010.25.1.33
  • 2,508 View
  • 18 Download
AbstractAbstract PDF
Methamphetamine (MA) is an extremely addictive central nervous system stimulant. MA abuse has increased during the past three decades in Korea because it is cheap relatively and easily produced. Acute toxicity can occur via nasal insufflation, intravenous administration and ingestion of liquid formulations. The clinical manifestations include hypertension, tachycardia, hyperthermia, an altered mentality and seizure. Severe complications can occur such as pulmonary edema, rhabdomyolysis, disseminated intravascular coagulation and multiple organ dysfunction syndrome. This case report describes a previously healthy 40-year-old woman who presented to an emergency department with complaints of hyperthermia, an altered mentality and vomiting. This patient was diagnosed as acute MA intoxication by urine toxicology screening, and she showed a variety of clinical manifestations and complications. Physicians should suspect MA intoxication if a patient shows an unknown fever, an altered mentality and hypertension, and they should carefully manage these patients in the ICU.
Review
Inflammation and Sepsis
Ji Young Yoon, Jae Young Kwon
Korean J Crit Care Med. 2010;25(1):1-8.
DOI: https://doi.org/10.4266/kjccm.2010.25.1.1
  • 3,011 View
  • 87 Download
  • 6 Crossref
AbstractAbstract PDF
Despite the development of modern intensive care and new antimicrobial agents, the mortality of the patients with severe sepsis and septic shock remains high. The poor outcome is considered to be a consequence of an overactive systemic inflammatory response. Sepsis is now defined as systemic inflammatory response syndrome (SIRS) in which there is an identifiable focus of infection. As a consequence of the overactive SIRS response, the function of various organ systems may be compromised, resulting in multiple organ dysfunction syndrome (MODS) and death. Systemic inflammation is a consequence of activation of the innate immune system. It is characterized by intravascular release of pro-inflammatory cytokines and other vasoactive mediators, and the concurrent activation of the innate immune cells. In addition to the pro-inflammatory reactions, the host's anti-inflammatory mechanisms are also activated and aimed at counteracting the inflammatory response. The balance between pro- and anti-inflammatory reactions is critical for the outcome of the patient. Understanding the mechanisms of acute inflammatory responses in critical ill patients is necessary for the development of urgently needed therapeutics. The aim of this review is to provide a description of the key components and mechanisms involved in the inflammatory response in patients with SIRS and sepsis.

Citations

Citations to this article as recorded by  
  • A Study on the Relationship Between Sayeok-tang and Systemic Inflammatory Response Syndrome
    Ju-Hyun Lee, Sang-Bae Lee, Eun-Heui Jo, Min-Cheol Park
    Journal of Korean Medicine.2024; 45(2): 1.     CrossRef
  • A Study on the Relationship Between Daeseunggi-tang and Sepsis
    Ju-Hyun Lee, Eun-Heui Jo, Min-Cheol Park
    Journal of Korean Medicine.2023; 44(3): 39.     CrossRef
  • Risk Factors for Unawareness of Obstructive Airflow Limitation among Adults with Chronic Obstructive Pulmonary Disease
    Mirae Jo, Heeyoung Oh
    Journal of Korean Academy of Community Health Nursing.2018; 29(3): 290.     CrossRef
  • The Anti-Inflammatory Effect of Arginine-Vasopressin on Lipopolysaccharide-Induced IκBα/Nuclear Factor-κB Cascade
    Jisoo Park, Eun Young Eo, Kyoung-Hee Lee, Jong Sun Park, Jae-Ho Lee, Chul-Gyu Yoo, Choon-Taek Lee, Young-Jae Cho
    The Korean Journal of Critical Care Medicine.2015; 30(3): 151.     CrossRef
  • Splenic Hemorrhage with Hemoperitoneum Caused by a Snakebite
    Ji Young Yhi, Yoomi Yeo, Ji Yeoun Kim, Il Hwan Oh, Soon Woo Hwang, Sang Ki Lee, Dong Shin Kwak, Ji-Yoon Choi, Jeong Eun Kim, Joon-Sung Park
    Korean Journal of Critical Care Medicine.2013; 28(4): 336.     CrossRef
  • A Case of Systemic Inflammatory Response Syndrome Secondary to an Acute Polyarticular Gout
    Ji Hyun Cheon M.D., Ji Ung Kim M.D., Sun Kwang Kim M.D., Sung Hyun Ko M.D., Jun Ho Jo M.D., Geon Woo Park M.D., Jin Suk Lee M.D., Hyoung Yoel Park M.D.
    Journal of the Korean Geriatrics Society.2012; 16(3): 158.     CrossRef
Original Article
The Effect of Discharge Decision-Making of the Intensivist on Readmission to the Intensive Care Unit
Dong Woo Han, One Chul Kang, So Young Ban, Shin Ok Koh
Korean J Crit Care Med. 2003;18(2):74-79.
  • 1,611 View
  • 17 Download
AbstractAbstract PDF
BACKGROUND
Patients readmitted to intensive care unit (ICU) have significantly higher mortality. The role of intensivists to judge when to discharge from ICU may be important. We performed this study to assess the effect of intensivist's discharge decision-making on readmission to ICU. METHODS: Data were collected prospectively from patients admitted to ICUs (group 1). Another data were collected retrospectively from the patients' record (group 2). Discharge of the patients in group 1 were based on intensivist's discharge decision-making but not in group 2. We encouraged deep breathing and expectoration to patients of group 1 at risk of pulmonary complication during ICU stay and used a guideline for making discharge decisions. Readmission cause, length of ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) III score, and multiple organ dysfunction syndrome (MODS) score of readmitted patients were evaluated. RESULTS: Readmission rate of group 1 was lower than that of group 2 (p<0.05). The mortality of readmitted patients in each group was higher than that of non-readmitted patients (p<0.05). Respiratory disease was the major cause of readmission. In non-survivors of readmitted patients, APACHE III score on initial discharge and readmission, MODS score on initial admission, discharge and readmission were higher than those of survivors (p<0.05). CONCLUSIONS: Readmission rate was lower when intensivists participated in discharge decision- making. ICU readmission was associated with higher hospital mortality and longer ICU stay. MODS and APACHE III score at first discharge and readmission were significant prognostic factors of the outcome in readmitted patients.

ACC : Acute and Critical Care