Prediction of outcome and prognosis of patients on mechanical ventilation using body mass index, SOFA score, C-Reactive protein, and serum albumin
Akila Prashant, Prashant Vishwanath, Barnamoy Bhattacharya, M. N. Suma, B. Nataraj
Body mass index, C-reactive proteins, mechanical ventilation, SOFA score, serum albumin
Citation Information :
Prashant A, Vishwanath P, Bhattacharya B, Suma MN, Nataraj B. Prediction of outcome and prognosis of patients on mechanical ventilation using body mass index, SOFA score, C-Reactive protein, and serum albumin. Indian J Crit Care Med 2011; 15 (2):82-87.
Context: Body mass index (BMI), serum albumin, and C-reactive protein (CRP) appear to be major determinants of hospitalization. Aim: To determine the predictive ability of BMI, Sequential Organ Failure Assessment (SOFA score), serum albumin, and CRP to assess the duration and outcome of mechanical ventilation (MV). Materials and Methods: Thirty patients aged >18 years who required mechanical ventilation (MV) were enrolled for the study. They were divided into two groups; patients who improved (Group 1), patients who expired (Group 2). Group 1 was further divided into two groups: patients on MV for <5 days (Group A), and patients on MV for >5days (Group B). BMI and SOFA score were calculated, and serum albumin and CRP were estimated. Results and Discussion: Out of the 30 patients, 18 patients successfully improved after MV (Group 1) and 12 patients expired (Group 2). Among the 18 patients in group 1, ten patients improved within 5 days (Group A) and 8 patients after 5 days (Group B). SOFA score and CRP were significantly increased (P value 0.0003 and 0.0001, respectively) in group 2 when compared to group 1. CRP >24.2 mg/L or SOFA score >7 at the start of MV increases the probability of mortality by factor 13.08 or 3.92, respectively The above parameters did not show any statistical difference when group A was compared to group B. Conclusion: Simple, economic and easily accessible markers like CRP and assessment tools of critically ill patients with SOFA score are important determinants of possible outcomes of a patient from MV.
Bott J, Carroll MP, Conway JH, Keilty SE, Ward EM, Brown AM, et al. Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet 1993;341:1555-7.
Stauffer JL, Fayter NA, Graves B, Cromb M, Lynch JC, Goebel P. Survival following mechanical ventilation for acute respiratory failure in adult men. Chest 1993;104:1222-9.
Schlossmacher P, Hasselmann M, Meyer N, Kara F, Delabranche X, Kummerlen C, et al. The prognostic value of nutritional and inflammatory indices in critically ill patients with acute respiratory failure. Clin Chem Lab Med 2002;40:1339-43.
Plummer AL, Gracey DR. Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest 1989;96:178-80.
Durand M, Combes P, Eisele JH, Contet A, Blin D, Girardet P. Pulmonary function tests predict outcome after cardiac surgery. Acta Anaesth Belg 1993;44:17-23.
Cano NJ, Pichard C, Roth H, Court-Fortuné I, Cynober L, Gérard-Boncompain M, et al. C-reactive protein and body mass index predict outcome in end-stage respiratory failure. Chest 2004;126:540-6.
Kony S, Zureik M, Driss F, Neukirch C, Leynaert B, Neukirch F. Association of bronchial hyperresponsiveness and lung function with C-reactive protein (CRP): A population based study. Thorax 2004;59:892-6.
Liu CY, Huang LJ, Lai CH, Chen HP, Chen TL, Fung CP, et al. Clinical characteristics, management and prognostic factors in patients with probable severe acute respiratory syndrome (SARS) in a SARS center in Taiwan. J Chin Med Assoc 2005;68:110-7.
Hutter DA, Holland BK, Ashtyani H. The effect of body mass index on outcomes of patients receiving noninvasive positive-pressure ventilation in acute respiratory failure. Respir Care 2004;49:1320-5.
Chailleux E, Fauroux B, Binet F, Dautzenberg B, Polu JM. Predictors of survival in patients receiving domiciliary oxygen therapy or mechanical ventilation. A 10-year analysis of ANTADIR observatory. Chest 1996;109:741-9.
Gray-Donald K, Gibbons L, Shapiro SH, Macklem PT, Martin JG. Nutritional status and mortality in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996;153:961-6.
Chailleux E, Laaban JP, Veale D. Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy: Data from the ANTADIR observatory. Chest 2003;123:1460-6.
Honarmand A, Safavi M. Do C-reactive protein and body mass index predict duration of mechanical ventilation in critically ill trauma patients? Ulus Travma Acil Cerrahi Derg 2008;14:284-91.
Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, et al. Consensus Statement for Diagnosis of Obesity, Abdominal Obesity and the Metabolic Syndrome for Asian Indians and Recommendations for Physical Activity, Medical and Surgical Management. J Assoc Physicians India 2009;57:163-70.
Angus DC, Wax RS. Epidemiology of sepsis: An update. Crit Care Med 2001;29:S109-16.
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348:1546-54.
Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004;350:1005-12.
Tremblay A, Bandi V. Impact of body mass index on outcomes following critical care. Chest 2003;123:1202-7.
Menzies R, Gibbons W, Goldberg P. Determinants of weaning and survival among patients with COPD who require mechanical ventilation for acute respiratory failure. Chest 1989;95:398-405.
Safavi M, Honarmand A. The impact of admission hyperglycemia or hypoalbuminemia on need ventilator, time ventilated, mortality and morbidity in critically ill trauma patients. Ulus Travma Acil Cerrahi Derg 2009;15:120-9.
Malo O, Sauleda J, Busquets X, Miralles C, Noguera A. Systemic inflammation during exacerbations of chronic obstructive pulmonary disease. Arch Bronconeumol 2002;38:172-6.
Levi M, ten Cate H, van der Poll T. Endothelium: Interface between coagulation and inflammation. Crit Care Med 2002;30:S220-4.
Aird WC. The role of the endothelium in severe sepsis and multiple organ dysfunction syndrome. Blood 2003;101:3765-77.