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Bloria SD, Chauhan R, Sarna R, Gombar S, Jindal S. Comparison of APACHE II and APACHE IV score as predictors of mortality in patients with septic shock in intensive care unit: A prospective observational study. J Anaesthesiol Clin Pharmacol 2023; 39:355-359. [PMID: 38025575 PMCID: PMC10661619 DOI: 10.4103/joacp.joacp_380_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/25/2021] [Accepted: 10/04/2021] [Indexed: 12/01/2023] Open
Abstract
Background and Aims Prediction of outcome in intensive care unit (ICU) patients is of imperative importance. Our aim was to assess and compare the performance of Acute Physiology and Chronic Health Evaluation (APACHE) II and APACHE IV scores in predicting mortality in adult patients suffering from septic shock admitted to our ICU. Material and Methods This was a prospective observational study conducted in a 14-bedded medical ICU of a tertiary care center from January 2019 to March 2020; 128 patients suffering from septic shock were included and APACHE II and IV scores were calculated. We also calculated the predicted and actual mortality rates and standardized mortality ratios. The receiver operating characteristic curves were used to assess discrimination. Results Out of the 128 patients, 63 patients (49.21%) died. The mean (± standard deviation) admission APACHE II score was 16.7 ± 5.53, while the mean APACHE IV score was 67.25 ± 25.99. The non-survivors had significantly higher APACHE II and IV scores when compared to those who survived (P < 0.001). APACHE II had a slightly better discriminative power (with the area under the Receiver operating characteristic (ROC) curve of 0.78) than APACHE IV (with the area under the ROC curve of 0.74). The mean predicted mortality rate (PMR) of the patient population calculated on the basis of the APACHE II scoring system was 22.46 ± 15.76, and the mean PMR calculated as per the APACHE IV scoring system was 11.64 ± 15.59. Conclusion Both APACHE II and APACHE IV underestimated mortality in septic shock patients. Both APACHE II and APACHE IV were comparable in differentiating survivors from non-survivors. However, there was a good correlation between the two models.
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Affiliation(s)
- Summit D. Bloria
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Rajeev Chauhan
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Rashi Sarna
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Satinder Gombar
- Department of Anesthesia and Intensive Care, GMCH, Chandigarh, India
| | - Swati Jindal
- Department of Anesthesia and Intensive Care, GMCH, Chandigarh, India
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Ling L, Ho CM, Ng PY, Chan KCK, Shum HP, Chan CY, Yeung AWT, Wong WT, Au SY, Leung KHA, Chan JKH, Ching CK, Tam OY, Tsang HH, Liong T, Law KI, Dharmangadan M, So D, Chow FL, Chan WM, Lam KN, Chan KM, Mok OF, To MY, Yau SY, Chan C, Lei E, Joynt GM. Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018. J Intensive Care 2021; 9:2. [PMID: 33407925 PMCID: PMC7788755 DOI: 10.1186/s40560-020-00513-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Globally, mortality rates of patients admitted to the intensive care unit (ICU) have decreased over the last two decades. However, evaluations of the temporal trends in the characteristics and outcomes of ICU patients in Asia are limited. The objective of this study was to describe the characteristics and risk adjusted outcomes of all patients admitted to publicly funded ICUs in Hong Kong over a 11-year period. The secondary objective was to validate the predictive performance of Acute Physiology And Chronic Health Evaluation (APACHE) IV for ICU patients in Hong Kong. Methods This was an 11-year population-based retrospective study of all patients admitted to adult general (mixed medical-surgical) intensive care units in Hong Kong public hospitals. ICU patients were identified from a population electronic health record database. Prospectively collected APACHE IV data and clinical outcomes were analysed. Results From 1 April 2008 to 31 March 2019, there were a total of 133,858 adult ICU admissions in Hong Kong public hospitals. During this time, annual ICU admissions increased from 11,267 to 14,068, whilst hospital mortality decreased from 19.7 to 14.3%. The APACHE IV standard mortality ratio (SMR) decreased from 0.81 to 0.65 during the same period. Linear regression demonstrated that APACHE IV SMR changed by − 0.15 (95% CI − 0.18 to − 0.11) per year (Pearson’s R = − 0.951, p < 0.001). Observed median ICU length of stay was shorter than that predicted by APACHE IV (1.98 vs. 4.77, p < 0.001). C-statistic for APACHE IV to predict hospital mortality was 0.889 (95% CI 0.887 to 0.891) whilst calibration was limited (Hosmer–Lemeshow test p < 0.001). Conclusions Despite relatively modest per capita health expenditure, and a small number of ICU beds per population, Hong Kong consistently provides a high-quality and efficient ICU service. Number of adult ICU admissions has increased, whilst adjusted mortality has decreased over the last decade. Although APACHE IV had good discrimination for hospital mortality, it overestimated hospital mortality of critically ill patients in Hong Kong. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-020-00513-9.
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Affiliation(s)
- Lowell Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, Hong Kong, China.
| | - Chun Ming Ho
- Department of Anaesthesia and Intensive Care, Tuen Mun Hospital, Hong Kong, China
| | - Pauline Yeung Ng
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Department of Adult Intensive Care, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | | | - Hoi Ping Shum
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Cheuk Yan Chan
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Alwin Wai Tak Yeung
- Department of Medicine & Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong, China
| | - Wai Tat Wong
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Shek Yin Au
- Department of Intensive Care, Queen Elizabeth Hospital, Hong Kong, China
| | | | | | - Chi Keung Ching
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China
| | - Oi Yan Tam
- Department of Intensive Care, Kwong Wah Hospital, Hong Kong, China
| | - Hin Hung Tsang
- Department of Intensive Care, Kwong Wah Hospital, Hong Kong, China
| | - Ting Liong
- Department of Intensive Care, United Christian Hospital, Hong Kong, China
| | - Kin Ip Law
- Department of Intensive Care, United Christian Hospital, Hong Kong, China
| | - Manimala Dharmangadan
- Department of Intensive Care, Princess Margaret Hospital, Hong Kong, China.,Department of Intensive Care, Yan Chai Hospital, Hong Kong, China
| | - Dominic So
- Department of Intensive Care, Princess Margaret Hospital, Hong Kong, China.,Department of Intensive Care, Yan Chai Hospital, Hong Kong, China
| | - Fu Loi Chow
- Department of Intensive Care, Caritas Medical Centre, Hong Kong, China
| | - Wai Ming Chan
- Department of Adult Intensive Care, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Koon Ngai Lam
- Department of Intensive Care, North District Hospital, Hong Kong, China
| | - Kai Man Chan
- Intensive Care Unit, Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Oi Fung Mok
- Quality and Safety Division, Hospital Authority Head Office, Hong Kong, China
| | - Man Yee To
- Quality and Safety Division, Hospital Authority Head Office, Hong Kong, China
| | - Sze Yuen Yau
- Quality and Safety Division, Hospital Authority Head Office, Hong Kong, China
| | - Carmen Chan
- Quality and Safety Division, Hospital Authority Head Office, Hong Kong, China
| | - Ella Lei
- Quality and Safety Division, Hospital Authority Head Office, Hong Kong, China
| | - Gavin Matthew Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
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Choi JW, Park YS, Lee YS, Park YH, Chung C, Park DI, Kwon IS, Lee JS, Min NE, Park JE, Yoo SH, Chon GR, Sul YH, Moon JY. The Ability of the Acute Physiology and Chronic Health Evaluation (APACHE) IV Score to Predict Mortality in a Single Tertiary Hospital. Korean J Crit Care Med 2017; 32:275-283. [PMID: 31723646 PMCID: PMC6786733 DOI: 10.4266/kjccm.2016.00990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/17/2017] [Accepted: 05/24/2017] [Indexed: 12/16/2022] Open
Abstract
Background The Acute Physiology and Chronic Health Evaluation (APACHE) II model has been widely used in Korea. However, there have been few studies on the APACHE IV model in Korean intensive care units (ICUs). The aim of this study was to compare the ability of APACHE IV and APACHE II in predicting hospital mortality, and to investigate the ability of APACHE IV as a critical care triage criterion. Methods The study was designed as a prospective cohort study. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test respectively. We also calculated the standardized mortality ratio (SMR). Results The APACHE IV score, the Charlson Comorbidity index (CCI) score, acute respiratory distress syndrome, and unplanned ICU admissions were independently associated with hospital mortality. The calibration, discrimination, and SMR of APACHE IV were good (H = 7.67, P = 0.465; C = 3.42, P = 0.905; AUROC = 0.759; SMR = 1.00). However, the explanatory power of an APACHE IV score >93 alone on hospital mortality was low at 44.1%. The explanatory power was increased to 53.8% when the hospital mortality was predicted using a model that considers APACHE IV >93 scores, medical admission, and risk factors for CCI >3 coincidentally. However, the discriminative ability of the prediction model was unsatisfactory (C index <0.70). Conclusions The APACHE IV presented good discrimination, calibration, and SMR for hospital mortality.
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Affiliation(s)
- Jae Woo Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Cheongju St. Mary's Hospital, Cheongju, Korea
| | - Young Sun Park
- Department of Nursing Care, Chungnam National University Hospital, Daejeon, Korea
| | - Young Seok Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yeon Hee Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Chaeuk Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Dong Il Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - In Sun Kwon
- Clinical Trial Center, Chungnam National University Hospital, Daejeon, Korea
| | - Ju Sang Lee
- Department of Nursing Care, Chungnam National University Hospital, Daejeon, Korea
| | - Na Eun Min
- Department of Nursing Care, Chungnam National University Hospital, Daejeon, Korea
| | - Jeong Eun Park
- Department of Nursing Care, Chungnam National University Hospital, Daejeon, Korea
| | - Sang Hoon Yoo
- Division of Pulmonology, Department of Internal Medicine, Chamjoeun Hospital, Gwangju, Korea
| | - Gyu Rak Chon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Cheongju St. Mary's Hospital, Cheongju, Korea
| | - Young Hoon Sul
- Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jae Young Moon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
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