Comparison of acute physiology and chronic health evaluation II and acute physiology and chronic health evaluation IV to predict intensive care unit mortality
Bashu Dev Parajuli, Gentle S. Shrestha, Bishwas Pradhan, Roshana Amatya
acute physiology and chronic health evaluation IV, intensive care unit mortality,Acute physiology and chronic health evaluation II
Citation Information :
Parajuli BD, Shrestha GS, Pradhan B, Amatya R. Comparison of acute physiology and chronic health evaluation II and acute physiology and chronic health evaluation IV to predict intensive care unit mortality. Indian J Crit Care Med 2015; 19 (2):87-91.
Context: Clinical assessment of severity of illness is an essential component of medical practice to predict the outcome of critically ill-patient. Acute Physiology and Chronic Health Evaluation (APACHE) model is one of the widely used scoring systems. Aims: This study was designed to evaluate the Performance of APACHE II and IV scoring systems in our Intensive Care Unit (ICU). Settings and Design: A prospective study in 6 bedded ICU, including 76 patients all above 15 years. Subjects and Methods: APACHE II and APACHE IV scores were calculated based on the worst values in the first 24 h of admission. All enrolled patients were followed, and outcome was recorded as survivors or nonsurvivors. Statistical Analysis Used: SPSS version 17. Results: The mean APACHE score was significantly higher among nonsurvivors than survivors (P < 0.005). Discrimination for APACHE II and APACHE IV was fair with area under receiver operating characteristic curve of 0.73 and 0.79 respectively. The cut-off point with best Youden index for APACHE II was 17 and for APACHE IV was 85. Above cut-off point, mortality was higher for both models (P < 0.005). Hosmer-Lemeshow Chi-square coefficient test showed better calibration for APACHE II than APACHE IV. A positive correlation was seen between the models with Spearman′s correlation coefficient of 0.748 (P < 0.01). Conclusions: Discrimination was better for APACHE IV than APACHE II model however Calibration was better for APACHE II than APACHE IV model in our study. There was good correlation between the two models observed in our study.
Palazo M. Severity of illness. In: Vincent JL, Abraham E, Moore FA, Kochanek PM, Fink MP, editors. Text Book of Critical Care. 6 th ed. Albany (NY): Elsevier Publishers; 1996. p. 17-29.
Bouch DC, Thompson JP. Severity score system in critically ill. Oxf J 2008;8:181-5.
Becker RB, Zimmerman JE. ICU scoring systems allow prediction of patient outcomes and comparison of ICU performance. Crit Care Clin 1996;12:503-14.
Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation: A physiologically based classification system. Crit Care Med 1981;9:591-7.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.
Zimmerman JE, Kramer AA, McNair DS, Malila FM. Acute Physiology and Chronic Health Evaluation (APACHE) IV: hospital mortality assessment for today′s critically ill patients. Crit Care Med 2006;34:1297-310.
Gupta R, Arora VK. Performance evaluation of APACHE II score for an Indian patient with respiratory problems. Indian J Med Res 2004;119:273-82.
Faruq MO, Mahmud MR, Begum T, Ahsan TS, Fatema K, Ahmed F, et al. A comparison of severity systems APACHE II and SAPS II in critically ill patients. Bangladesh Crit Care J 2013;1:27-32.
Ayazoglu TA. A comparison APACHE II and APACHE IV scoring systems in predicting outcome in patients admitted with stroke to an intensive care unit. Anaesth Pain Intensive Care 2011;15:7-12.
Yamin S, Vaswani AK, Afreedi M. Predictive efficacy of APACHE IV at ICUs′ of civil hospital Karachi. Pak J Chest Med 2011;17:11-21.
Keegan MT, Gajic O, Afessa B. Comparison of APACHE III, APACHE IV, SAPS 3, and MPM0III and influence of resuscitation status on model performance. Chest 2012;142:851-8.
Kramer A, Zimmerman J, Jing Y. Performance of MPMo-III and APACHE IV mortality predictions in a multi-institutional ICU database: Implications for National Benchmarking. Crit Care Med 2012;40:1-328.
Brinkman S, Bakhshi-Raiez F, Abu-Hanna A, de Jonge E, Bosman RJ, Peelen L, et al. External validation of acute physiology and chronic health evaluation IV in dutch intensive care units and comparison with Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score II. J Crit Care 2011;26:105.e11-8.
Kamal M, Khan NA, Ali G. A comparison of APACHE II and APACHE IV scoring systems in predicting outcome in patients with acute lung injury (ALI) and the adult respiratory distress syndrome (ARDS) in intensive care unit (ICU). RMJ 2013;38:234-8.
Lee H, Shon YJ, Kim H, Paik H, Park HP. Validation of the APACHE IV model and its comparison with the APACHE II, SAPS 3, and Korean SAPS 3 models for the prediction of hospital mortality in a Korean surgical intensive care unit. Korean J Anesthesiol 2014;67:115-22.
Costa e Silva VT, de Castro I, Liaño F, Muriel A, Rodríguez-Palomares JR, Yu L. Performance of the third-generation models of severity scoring systems (APACHE IV, SAPS 3 and MPM-III) in acute kidney injury critically ill patients. Nephrol Dial Transplant 2011;26:3894-901.
Tunnell RD, Millar BW, Smith GB. The effect of lead time bias on severity of illness scoring, mortality prediction and standardised mortality ratio in intensive care - a pilot study. Anaesthesia 1998;53:1045-53.
Dünser MW, Baelani I, Ganbold L. A review and analysis of intensive care medicine in the least developed countries. Crit Care Med 2006;34:1234-42.