The Quarterly journal of medicine
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The survival from acute renal failure requiring renal replacement therapy was studied in 90 critically-ill patients admitted to an intensive care unit. Mean age (+/- SD) was 51 +/- 14.6 (range 17 to 81) years. Mechanical ventilation was required in 88 patients and 71 patients received total parenteral nutrition. ⋯ Pre-existing organ insufficiency or immunosuppression meriting a CHE score of 5 was associated with a very poor survival (1 of 30 patients). APACHE II score is a reliable indicator of severity of illness and likelihood of survival in critically-ill patients with acute renal failure. The widespread adoption of APACHE II scoring for patients with acute renal failure requiring intensive care would facilitate medical audit and comparison of studies from various centres.
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The clinical features, plasma salicylate concentrations, acid-base abnormalities and other biochemical findings are presented for 97 patients who either died from acute salicylate overdosage or survived maximum recorded plasma salicylate concentrations of 700 mg/l or greater. These patients comprised 4 per cent of 2204 cases of salicylate poisoning admitted during the period 1975 to 1985 inclusive. Seven patients died (overall mortality 0.3 per cent); they were significantly older than the survivors, the mortality being as high as 33 per cent in patients over the age of 70 years. ⋯ The prognosis of acute salicylate poisoning cannot be determined from the plasma concentration of the drug alone. Clinical features, particularly impaired consciousness, and the arterial hydrogen ion concentration must be taken into consideration. Haemodialysis is the treatment of choice for severe salicylate intoxication and should be used more liberally than it is at present.
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The relation between quality of life before admission and the outcome of admissions to the intensive care unit (ICU) was studied prospectively among 126 patients in a community hospital with a predominantly geriatric patient population. Fifty-four per cent of our patients were older than 65 years and 66 per cent suffered from chronic ill health. Their mean APACHE score was 18 +/- 8 (mean +/- SD). ⋯ The 12-month survival among patients with four favourable indicators was 59 per cent, with two or three favourable indicators 36 per cent (p less than 0.05), and in patients with no favourable indicators of quality of life or only one 17 per cent (p less than 0.001). Quality of life in patients who survived longer than six months after ICU care was high (Karnofsky index 7.9 +/- 2.0; LASA score 71 +/- 20 (mean +/- SD) and unimpaired when compared with their ratings before admission to the unit. These findings indicate that quality of life before admission is an important predictor of survival and that a high proportion of critically-ill subjects whose quality of life was relatively good before the episode requiring admission will be long-term survivors whose quality of life is comparable to that preceding critical care.
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We report a series of 103 admissions of patients aged 80 years or more with acute upper gastrointestinal haemorrhage to one hospital over a four-year period. A cause was eventually found during 81.5 per cent of admissions and of these, 57 per cent had bled from chronic peptic ulcers. After 64 per cent of admissions, the patient received a blood transfusion and in 25 per cent, the blood transfusion exceeded 5 units. ⋯ Patients who died from haemorrhage, when compared to all others, were more likely to have bled from a peptic ulcer and to have significant co-existing disease, to have ingested non-steroidal antiinflammatory drugs or aspirin before admission, to have raised blood urea level and low systolic blood pressure at admission and to have required blood transfusion of more than 5 units. Our study has shown that upper gastrointestinal haemorrhage secondary to peptic ulceration is a serious and often fatal condition in the elderly. Identification and effective monitoring of those at particular risk of death may be essential if mortality is to be reduced.