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  • 1
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Scoresysteme ; APACHE III-Score ; APACHE II-Score ; Hospitalmortalität ; Ergebnisforschung ; Key words Scoring systems ; APACHE III score ; APACHE II score ; Hospital mortality ; Outcome research
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Objectives: The aim of the study was to systematically validate the APACHE III scoring system concerning severity of illness classification and prediction of hospital mortality. Such data have not yet been determined in a large population of critically ill patients in germany. Methods: 531 patients (ICU stay 〉4 hours) were prospectively and consecutively investigated. The day-1-scores and risk-of-death predictions of APACHE III and APACHE II were determined. A comparison was performed between both scoring systems, and the correlation with the observed hospital mortality was examined. Results: For both main validation criteria, as were discrimination (areas under the ROC-curves: APACHE III 0.873; APACHE II 0.859) and calibration (goodness-of-fit testings; p〉0.05), both scoring systems provided satisfying results concerning hospital mortality, no system showing a significantly superior performance. Compared to the observed hospital mortality (13.4%), the prediction of APACHE III (13.2%) was extremely accurate, whereas the prediction of APACHE II was higher (16.8%). The standard (mortality index not significantly 〈or〉1.0) provided by APACHE III was fulfilled, while the standard given by APACHE II was surpassed. The mean scores and the mean risk-of-death predictions for non-survivors were significantly higher compared to survivors (p〈0.001). The individual score values of both systems were found to have a strong correlation (r=0.922). Conclusions: APACHE III (like APACHE II) provides a sufficient severity of disease classification and accurately predicts overall hospital mortality in a representatively large german population of a medical ICU. Therefore APACHE III can be regarded as validated for the use in comparable german ICUs. For use as a standard the more recently introduced APACHE III seems to be superior to the established but older APACHE II. However, each user will – depending on the particular questions to be addressed – carefully have to evaluate, if the improvement of prognostic accuracy really justifies the increased amount of workload necessary for calculating APACHE III score and risk prediction.
    Notes: Zusammenfassung Fragestellung: Ziel der Untersuchung war die systematische Validierung des APACHE III Scoringsystems hinsichtlich Klassifikation der Erkrankungsschwere und Prädiktion der Krankenhausletalität. Entsprechende Daten liegen bisher für ein größeres Patientenkollektiv einer deutschen Intensivstation nicht vor. Methodik: Bei 531 konsekutiven Intensivpatienten (Liegezeit 〉4 h) wurde eine prospektive Erhebung der APACHE III Tag-1-Scores und die Berechnung der resultierenden Prädiktionen des Letalitätsrisikos durchgeführt und ein Vergleich mit den entsprechenden ebenfalls erhobenen Daten des etablierten APACHE II und der tatsächlich beobachteten Letalität angestellt. Ergebnisse: Hinsichtlich der primären Validierungskriterien Diskriminationsfähigkeit (Fläche unter der ROC-Kurve für APACHE III 0,873, für APACHE II 0,859) und Kalibration (goodness-of-fit-test jew. p〉0,05) mit dem Bezugspunkt Krankenhausletalität zeigten beide Systeme sehr befriedigende Resultate und unterschieden sich allenfalls marginal. Die tatsächliche Krankenhausletalität des Kollektivs (13,4%) stimmt mit der von APACHE III vorhergesagten (13,2%) nahezu exakt überein, die von APACHE II prognostizierte lag darüber (16,8%). Der durch den APACHE III vorgegebene Standard (Letalitätsindex nicht signifikant 〈oder〉1,0) wurde erfüllt, der durch den APACHE II vorgegebene Standard wurde übertroffen. Die Scoremittelwerte und mittleren Letalitätsprognosen des Gesamtkollektivs unterschieden sich für Überlebende und Verstorbene jeweils hochsignifikant (p〈0,001). Die individuellen Scorewerte beider Systeme zeigten eine enge Korrelation (r=0,922). Schlußfolgerungen: Gruppenbezogen ermöglicht APACHE III (wie auch APACHE II) suffizient die Prädiktion der Krankenhausletalität und die Klassifikation der Erkrankungsschwere bei einem großen Patientenkollektiv einer deutschen internistischen Intensivstation und kann damit für vergleichbare deutsche Intensivpopulationen als validiert gelten. APACHE III scheint als Standard für die moderne Intensivmedizin besser als das etablierte, aber ältere APACHE II-System geeignet zu sein. Ob der Zuwachs an Information und Präzision den deutlichen Mehraufwand zur Scoreerhebung und Risikoberechnung bei Verwendung dieses Systems rechtfertigt, muß im Einzelfall in Abhängigkeit von der jeweiligen Fragestellung abgewogen werden.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 61 (1983), S. 113-117 
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 64 (1986), S. 280-280 
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 61 (1983), S. 769-771 
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 62 (1984), S. 887-890 
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 63 (1985), S. 781-787 
    ISSN: 1432-1440
    Keywords: Bronchoalveolar lavage ; Extra-cellular lining material ; Serum identical proteins ; Lung specific proteins
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Since the discovery of the extra-cellular lining material of the lung and the possibility harvesting this source by endobronchial lavage this material has been the object of many studies directed to analyze its components, function and possible change in the diseased lung. The best known component of the extra-cellular lining material is the phospholipid and its fatty acid composition. But also on the cellular material much emphasis has been taken with the aim using its cytology as diagnostic parameter. However, very few informations were obtained about the protein material also washed out during the endobronchial lavage. As it was demonstrated by immunological methods the proteins of the extra-cellular lining material consist of serum identical proteins and those being obviously specific for the lung tissue. As found, most serum identical proteins occure in the same amounts as found in the blood serum, and the molecular weight in general range up to 160,000 daltons indicating that there must be a restriction in passage of high molecular weight proteins through the lumen walls of the endothelium. Some proteins, IgG, IgA, do occure in a higher level in the extra-cellular lining material leading to the suggestion that these proteins were synthesized and secreted by the lung tissue itself. — The molecular weight of the lung specific proteins range from 16,000–340,000 daltons. Under reducing conditions however, for all species listed, two classes of subunits −36,000 and 12,000 daltons — result, indicating that these proteins might have comparable functions in the different species. The exact function of these specific proteins as well as the serum identical proteins till now is not known. One can only speculate that the serum identical proteins will have the same function in plasma and the lung, and that the specific proteins are involved in the formation in the surfactant system. Different amounts of lung specific proteins in lavage of disease lungs suggest that their estimation might be an additional useful parameter in diagnosis of lung diseases.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 63 (1985), S. 807-811 
    ISSN: 1432-1440
    Keywords: Sleep apnea ; Sleep disturbances ; Coronary risk factors ; Epidemiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The present study reports on polysomnographic findings of sleep apnea syndrome in a representative sample of otherwise healthy middle-aged blue collar workers (age 45.7±8.5) with normal to borderline blood pressure (systolic 135.5±16.1; diastolic: 88.3±10.2), mild overweight (Broca 114.9±14.7) and with reported nocturnal sleep disturbances. The prevalence of sleep apnea in this sample (N=20 out of a total of 78 workers with reported sleep disturbances) is 40%. Mean frequency of apnoeic episodes during night was 97.6±42.7 in the apnea-positive group as compared to 27.1±19.9 in the apnea-negative group (T=5.0;p〈0.0001), with an apnea index of 13.3±6.2 as compared to 3.5±2.3 (T=7.2,p〈0.0001). Left ventricular hypertrophy (mean diameter of end diastolic left ventricle: 64.0±9.5 mm) was found in individuals with apnea although manifest hypertension was absent in most individuals.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 65 (1987), S. 827-827 
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 64 (1986), S. 131-134 
    ISSN: 1432-1440
    Keywords: Sleep apnea ; Pulmonary hypertension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The pulmonary artery pressure values of 65 patients with sleep apnea syndrome were measured at rest and during ergometer exercise up to 100 W. Pulmonary hypertension at rest was found in 13, and during exercise in 31 more patients. Only 8 patients with pathological pressure findings suffered from pulmonary hypertension in combination with a pulmonary or cardiac disease. In the other 36 patients, no indication of a primary cause of pulmonary hypertension apart from sleep apnea syndrome could be found. Out of the 65 patients, 11 with a finding of more than 20 apnea episodes per hour's sleep underwent polysomnographic recordings in the sleep laboratory. The hemodynamic parameters were continuously measured. All 11 patients had a finding of severe sleep apnea with more than 300 apnea episodes during the night of recording. In 6 patients, the appearance of apnea episodes was accompanied by only moderate changes in pulmonary artery pressure. In 5 patients, there were critical increases in pulmonary artery pressure, which went along with increases in cardiac output and in pulmonary capillary wedge pressure. Increases in pulmonary vascular resistance were established in 3 out of these 5 patients, and a slight decrease in 2. The mechanism of hypoxic vasoconstriction of the pulmonary arteries may account for the pressure increases in 3 of our patients, but fails to explain the findings in the other 2 patients. Nocturnal changes in pulmonary artery pressure in patients with sleep apnea may therefore have different causes. Pulmonary hypertension constitutes a severe complication in patients with sleep apnea. As 55% of all sleep apnea patients were found to suffer from pulmonary hypertension without any indication of a primary pulmonary or cardiac disease, the possibility that pulmonary hypertension results should not be underestimated in patients with suspected sleep apnea syndrome. Measurements of the pulmonary artery pressure must therefore be included in the examination regimen of such patients.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 61 (1983), S. 433-434 
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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