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VOLUME 19 , ISSUE 3 ( 2015 ) > List of Articles

RESEARCH ARTICLE

Age influences the predictive value of Acute Physiology and Chronic Health Evaluation II and Intensive Care National Audit and Research Centre scoring models in patients admitted to Intensive Care Units after in-hospital cardiac arrest

D. N. S. Senaratne, T. Veenith

Keywords : Acute Physiology and Chronic Health Evaluation II, in-hospital cardiac arrest, Intensive Care National Audit and Research Centre

Citation Information : Senaratne DN, Veenith T. Age influences the predictive value of Acute Physiology and Chronic Health Evaluation II and Intensive Care National Audit and Research Centre scoring models in patients admitted to Intensive Care Units after in-hospital cardiac arrest. Indian J Crit Care Med 2015; 19 (3):155-158.

DOI: 10.4103/0972-5229.152758

License: CC BY-ND 3.0

Published Online: 01-03-2015

Copyright Statement:  Copyright © 2015; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Outcomes following in-hospital cardiac arrest (IHCA) are generally poor though different patient populations may benefit to different degrees from admission to Intensive Care Units (ICUs). Risk stratification algorithms may be useful in identifying patients who are most likely to benefit from ICU admission and so may aid allocation of this scarce resource. We aimed to compare the performance of the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Intensive Care National Audit and Research Centre (ICNARC) scoring systems in predicting outcome following ICU admission after IHCA in younger (≤69 years) and older (≥70 years) patients. Materials and Methods: We performed a retrospective observational study in two adult ICUs from January 2006 to February 2010 inclusive. Patients were divided into younger (≤69 years) and older (≥70 years) patients. The primary outcome measures were acute hospital mortality and area under the curve (AUC) calculation for receiver operating characteristic (ROC) analysis. Results: Two hundred and sixty-one adult consecutive adult patients admitted following IHCA. Hospital mortality was 58.6%. ROC analysis demonstrated that ICNARC was more accurate than APACHE II in predicting acute hospital outcomes in the adult population (AUC 0.734 vs. 0.706). Both scoring systems performed weaker when predicting outcomes in younger patients compared to older patients (ICNARC AUC 0.655 vs. 0.810; APACHE II AUC 0.660 vs. 0.759). Discussion: Both APACHE II and ICNARC predict outcome well in older patients. In younger patients, their value is less clear, and so they must be used with caution.


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  1. Findlay GP, Shotton H, Kelly K, Mason M. Cardiac Arrest Procedures: Time to Intervene. National Confidential Enquiry into Patient Outcome and Death; 2012.
  2. Kaarlola A, Tallgren M, Pettilä V. Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients. Crit Care Med 2006;34:2120-6.
  3. Chelluri L, Pinsky MR, Donahoe MP, Grenvik A. Long-term outcome of critically ill elderly patients requiring intensive care. JAMA 1993;269:3119-23.
  4. The Office for National Statistics. Historic and Projected Data from the Period and Cohort Life Tables, 2012-based revised. Available from: http://www.ons.gov.uk/ons/rel/lifetables/historic-and-projected-data-from-the-period-and-cohort-life-tables/2012-based-revised/index.html. [Last accessed on 2014 May 08].
  5. Nielsen N. Predictive scores, friend or foe for the cardiac arrest patient. Resuscitation 2012;83:669-70.
  6. Harrison DA, Parry GJ, Carpenter JR, Short A, Rowan K. A new risk prediction model for critical care: The Intensive Care National Audit and Research Centre (ICNARC) model. Crit Care Med 2007;35:1091-8.
  7. Harrison DA, Rowan KM. Outcome prediction in critical care: The ICNARC model. Curr Opin Crit Care 2008;14:506-12.
  8. Knaus WA, Draper EA, Wagner DP, Zimmerman JE, Birnbaum ML, Cullen DJ, et al. Evaluating outcome from intensive care: A preliminary multihospital comparison. Crit Care Med 1982;10:491-6.
  9. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.
  10. Skrifvars MB, Varghese B, Parr MJ. Survival and outcome prediction using the Apache III and the out-of-hospital cardiac arrest (OHCA) score in patients treated in the intensive care unit (ICU) following out-of-hospital, in-hospital or ICU cardiac arrest. Resuscitation 2012;83:728-33.
  11. Donnino MW, Salciccioli JD, Dejam A, Giberson T, Giberson B, Cristia C, et al. APACHE II scoring to predict outcome in post-cardiac arrest. Resuscitation 2013;84:651-6.
  12. Gallagher E, Patel K, Nolan J, Soar J, Harrison D, Rowan K. A new national audit for in-hospital cardiac arrest in the United Kingdom: Implementation and early results from the National Cardiac Arrest Audit. Resuscitation 2012;83:e4.
  13. Nolan JP, Laver SR, Welch CA, Harrison DA, Gupta V, Rowan K. Outcome following admission to UK intensive care units after cardiac arrest: A secondary analysis of the ICNARC Case Mix Programme Database. Anaesthesia 2007;62:1207-16.
  14. Peberdy MA, Ornato JP, Larkin GL, Braithwaite RS, Kashner TM, Carey SM, et al. Survival from in-hospital cardiac arrest during nights and weekends. JAMA 2008;299:785-92.
  15. Murphy DJ, Murray AM, Robinson BE, Campion EW. Outcomes of cardiopulmonary resuscitation in the elderly. Ann Intern Med 1989;111:199-205.
  16. Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS, et al. Trends in survival after in-hospital cardiac arrest. N Engl J Med 2012;367:1912-20.
  17. Merchant RM, Berg RA, Yang L, Becker LB, Groeneveld PW, Chan PS, et al. Hospital variation in survival after in-hospital cardiac arrest. J Am Heart Assoc 2014;3:e000400.
  18. Chan PS, Berg RA, Spertus JA, Schwamm LH, Bhatt DL, Fonarow GC, et al. Risk-standardizing survival for in-hospital cardiac arrest to facilitate hospital comparisons. J Am Coll Cardiol 2013;62:601-9.
  19. Matot I, Shleifer A, Hersch M, Lotan C, Weiniger CF, Dror Y, et al. In-hospital cardiac arrest: Is outcome related to the time of arrest? Resuscitation 2006;71:56-64.
  20. Ransohoff DF, Feinstein AR. Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med 1978;299:926-30.
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