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Study on the relationship between the common clinical index changes of emergency critically ill patients and the APACHE II score and prognosis.

Objective: To study the relationship between the changes of blood lactic acid (LAC) levels, serum Creactive protein (CRP) levels, red cell distribution width (RDW) levels of emergency critically ill patients and the APACHE II score and prognosis.

Methods: Data were collected prospectively on 228 EICU admissions from March 2011 to December 2011. The Acute Physiology And Chronic Health Evaluation (APACHE) score was calculated within the first 24 hours after admission and monitored LAC, CRP, RDW levels on admission to 0 hour, 24 hours, 48 hours, 72 hours. Also recording the LAC, CRP, RDW levels in the end (patients leave hospital or die), defining these values as the end point values in this study. 228 patients were divided into three groups according to their APACHE scores: Group I 15 points (n=50); Group II 16 to 30 points (n=84); Group III>30 points (94 cases). And according to 28 days whether death, divided into the death group (n=124) and the survival group (n=104). Through the statistical methods, analyzing the clinical value of early dynamic changes of LAC, CRP, RDW in pathogenic condition and prognosis assessment of critically ill patients.

Results: The mortality rates were increased with the increasing of APACHE score. Pearson correlation analysis found that: At different time points, LAC levels and APACHE scores are positively correlated (r=0.602, 0.552, 0.523, 0.494, P all<0.01); At different time points, CRP levels and APACHE scores are positively correlated (r=0.198, 0.287, 0.346, 0.384, P all<0.01); At different time points, RDW-CV levels and APACHEscores are not correlated (P all>0.05). The tendency charts of LAC, CRP, RDW-CV levels on admission to 0 hour, 24 hours, 48 hours, 72 hours and in the end of critically-ill patients: The LAC levels on admission to 0 hour are the most highest, and then gradually declined, the end to the lowest; The CRP levels after admission gradually raised, the peak on admission to 48 hours, and then gradually declined, the end to the lowest; The RDW-CV levels after admission gradually raised, the peak on admission to 72 hours, the end to the lowest. ICU mortality in Critically-ill patients further on-line multivariate logistic analysis, the results showed that: among the age, sex, APACHE score and the LAC, CRP, RDW-CV levels on admission to 0 hour, 24 hours, 48 hours, 72 hours, the variables that have a significant influence on death are APACHE score, the LAC levels on admission to 72 hours, the CRP levels on admission to 48hours. (PAPACHE=0.000, PLac=0.002, PCRP=0.002).

Conclusion: Blood LAC, serum CRP level and APACHE score arepositively correlated. They are good indicators of evaluating the severity and prognosis in critically-ill patients. Dynamic monitoring blood LAC, serum CRP levels may be more meaningful than a single monitoring, helps to find the disease twist. RDW level and APACHE score have no linear relationship, cannot be used to evaluate critical illness, but this research affirms the significance that apply to the cardiovascular system diseases and the blood system diseases.

Author(s): Li Jiang, Dong Na Gao, Shuai Deng, Yu Zhang