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PubMed2000

Validation of severity scoring systems SAPS II and APACHE II in a single-center population.

OBJECTIVE: To validate two severity scoring systems, the Simplified Acute Physiology Score (SAPS II) and Acute Physiology and Chronic Health Evaluation (APACHE II), in a single-center ICU population. DESIGN AND SETTING: Prospective data collection in a two four-bed multidisciplinary ICUs of a teaching hospital. PATIENTS AND METHODS: Data were collected in ICU over 4 years on 1,721 consecutively admitted patients (aged 18 years or older, no transferrals, ICU stay at least 24 h) regarding SAPS II, APACHE II, predicted hospital mortality, and survival upon hospital discharge. RESULTS: At the predicted risk of 0.5, sensitivity was 39.4 % for SAPS II and 31.6 % for APACHE II, specificity 95.6 % and 97.2 %, and correct classification rate 85.6 % and 85.5 %, respectively. The area under the ROC curve was higher than 0.8 for both models. The goodness-of-fit statistic showed no significant difference between observed and predicted hospital mortality (H = 7.62 for SAPS II, H = 3.87 for APACHE II; and C = 9.32 and C = 5.05, respectively). Observed hospital mortality of patients with risk of death higher than 60 % was overpredicted by SAPS II and underpredicted by APACHE II. The observed hospital mortality was significantly higher than that predicted by the models in medical patients and in those admitted from the ward. CONCLUSIONS: This study validates both SAPS II and APACHE II scores in an ICU population comprised mainly of surgical patients. The type of ICU admission and the location in the hospital before ICU admission influence the predictive ability of the models.

APACHE↗
PubMed2001

Inter-observer variability in APACHE II scoring: effect of strict guidelines and training.

OBJECTIVE: To assess the effect of strict guidelines and a rigorous training program on variability in scoring the revised Acute Physiology and Chronic Health Evaluation (APACHE II). DESIGN AND SETTING: Prospective survey and intervention in the surgical ICU of a university teaching hospital. MEASUREMENTS: Seven experienced intensivists and nine residents determined APACHE II scores in one set of patients before and in another set 4 months after a rigorous training program, following strict guidelines for using the APACHE II. RESULTS: APACHE II scores were 14.3+/-4.4 before the training program (n=12) and 18.9+/-2.4 after (n=11). Interobserver agreement rates increased significantly from 59.7% to 76.5% and the interobserver reliability coefficient (weighted kappa) from 0.72 to 0.85 after our training program was implemented. The changes were significantly greater in experienced intensivists than in less experienced residents, indicating that more experienced physicians profited to a greater degree from our training program. CONCLUSION: Interobserver variability in APACHE II scoring decreases markedly when strict guidelines and a regular training program are implemented, particularly among more experienced physicians. However, in our study a degree of variability (10-15%) persisted even in experienced intensivists with similar training, experience, and background, suggesting that a degree of variability is inherent in APACHE II scoring.

APACHE↗
PubMed2004

Admission lactate level and the APACHE II score are the most useful predictors of prognosis following torso trauma.

BACKGROUND: Markers of dysoxic metabolism and scoring systems for triage have been widely used in critically injured patients. However, so far, no model is sufficiently reliable to predict the outcome in trauma victims. The purposes of the present study, therefore, were to determine whether a correlation exits between the main trauma scoring systems and the markers of dysoxic metabolism. Moreover, to assess if any of the admission parameters can be used to indicate outcome. METHODS: Sixty-four patients were included in this study. Admission data, including arterial lactate level, base deficit (BD), pH, revised trauma score (RTS), injury severity score (ISS), shock index (SI), and Acute Physiology and Chronic Health Evaluation (APACHE II), were collected and analysed by logistic regression analysis. Degree of association between continuous variables were calculated by either Pearson's or Spearman's correlation coefficient, where applicable. The dependence of lactate on two or more other variables was evaluated by multiple linear regression analysis. RESULTS: Logistic regression analysis showed that the fatal outcome following major torso trauma was principally associated with the APACHE II score and lactate. The specificity and the sensitivity of this logistic regression model was 94.6 and 79.2%, respectively. According to standardised linear regression coefficients, BD was the best single predictor of lactate, and APACHE II added a small amount of predictive power. The proportion of total variation in lactate level explained by base deficit, APACHE II and age is R2=85.2%. CONCLUSION: APACHE II score and the arterial lactate level are the most important determinants of clinical outcome in critically injured patients. A correlation exits between lactate and APACHE II and between lactate and base deficit.

APACHE↗
PubMed1999

APACHE II and ISS scores as predictors of nosocomial infections in trauma patients.

BACKGROUND: Nosocomial infections affect more than 2 million patients annually in the United States at a cost of $4.5 billion. The aim of this study is to identify the role of the APACHE II score and the Injury Severity Scale (ISS) as independent predictors of nosocomial infections in trauma patients admitted to the intensive care unit (ICU). METHODS: A retrospective chart review of 113 trauma patients admitted to the ICU was conducted by an infectious disease physician. Demographic data and incidence of nosocomial infections were recorded. Multivariate logistic regression analysis was used to determine variables that are predictive of the occurrence of nosocomial infections. RESULTS: Presence or absence of intubation, ICU length of stay, APACHE II score, and ISS were related to the presence of infections; however, only the ICU length of stay was an independent predictor of a nosocomial infection, with an odds ratio of 1.81. By linear regression, 17% of the variance in the ICU duration of stay was a result of the APACHE II score in patients with a score >/=5. CONCLUSION: APACHE II score and ISS score were not good predictors of the incidence of nosocomial infections in trauma patients admitted to the ICU, but the APACHE II score has a modest correlation with the duration of stay in the ICU. A stratified cohort study could identify the subset of patients for which the APACHE II score predicts a prolonged stay in the ICU, thus an increased risk of infection.

APACHE↗
PubMed2004

ICU nurses' knowledge of, and attitudes towards, the APACHE II scoring system.

AIMS AND OBJECTIVES: This study was undertaken to determine whether intensive care unit nurses possess adequate knowledge to implement the Acute Physiological and Chronic Health Evaluation (APACHE) II scoring system and to understand nurses' attitudes towards this scoring system. DESIGN: A questionnaire, which contained 20 multiple-choice questions to test knowledge of the scoring system and 27 statements with a five-points Likert type scale to assess attitude, was developed by researchers for this study. METHODS: The participants consisted of 102 intensive care unit nurses working in adult, emergency, or coronary intensive care units in a large teaching hospital (Veterans General Hospital) in Taiwan, where the APACHE II scoring system is used routinely by nurses. RESULTS: On the knowledge section of the questionnaire, 76% of the questions were answered correctly. However, more than 50% of the nurses were uncertain about how to score a patient's chronic history status, only 44.1% of the nurses knew that APACHE II total scores range from 0 to 71, and only 37.3% understood that the value for bicarbonate in venous samples could replace the arterial pH value. The results of the attitude questionnaire revealed that nurses believed APACHE II was useful mainly for statistical purposes by the administration rather than for patient care, but acknowledged that the scores could provide a reference for more aggressive treatment. CONCLUSIONS: The questionnaire answers indicated that greater knowledge concerning the APACHE II is needed. RELEVANCE TO CLINICAL PRACTICE: Information and training concerning the proper use and purpose of APACHE II needs to be provided, especially for those intensive care unit nurses using this evaluation tool to score patients' conditions routinely.

APACHE↗
PubMed2001

Outcomes and APACHE II predictions for critically ill patients with acute renal failure requiring dialysis.

BACKGROUND: Despite the widespread availability of dialytic and intensive care unit technology, the probability of early mortality in critically ill patients with acute renal failure (ARF) is still high, and the evaluation of the patients' prognosis has been difficult. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score is a reliable indicator of severity of illness and likelihood of survival in critically ill patients with ARF. We have attempted to determine whether the APACHE II scoring system can be used to predict prognosis. METHODS: A retrospective cohort study evaluated the medical records of 100 consecutive patients in intensive care units with acute renal failure who required dialysis from January 1997 through December 1998. RESULTS: Of the 100 patients studied, 65 were men and 35 were women. The mean age of survivors and nonsurvivors was 59.4 +/- 20.3 years and 58.3 +/- 20.0 years. The overall mortality rate was 71%. There were no significant differences between survivors and nonsurvivors in age, gender, or indication for dialysis. The cause of death in the majority of patients was related to higher APACHE II score during the 24 hours immediately preceding the initiation of acute hemodialysis, and carry mortality rates exceeding 85% with an APACHE II score of 24 or higher. CONCLUSION: We conclude that mortality rate for acute renal failure in intensive care unit patients continues to be high. The use of the APACHE II score determined at the time of initiation of dialysis for patients with ARF is a statistically significant predictor of patient survival. There is a significant trend with APACHE II score for outcome.

APACHE↗
PubMed1999

Interobserver variability in data collection of the APACHE II score in teaching and community hospitals.

OBJECTIVES: To examine interobserver reliability of the Acute Physiologic and Chronic Health Evaluation (APACHE) II score and identify major causes of variability in data collection. DESIGN: Descriptive, comparative analysis. SETTING: Nine intensive care units in two teaching and six community hospitals SUBJECTS: A random sample of 342 patient records selected from a network database. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Data were reabstracted and compared with the original records. Individual physiologic points derived from the APACHE II scoring system (instead of the actual physiologic values) were compared using the kappa statistic. Paired measurements of the continuous variables were compared using the interclass correlation coefficient and Bland-Altman plots. Excellent agreement was found in most demographic, admission, and discharge data. The system failure requiring intensive care unit admission was consistently identified by both data collectors in 88% of cases, but only 66% agreed on the exact admitting diagnosis. For APACHE II score components, the kappa statistic ranged from 0.315 for the Glasgow Coma Scale point to 0.976 for the age point. Significant disagreement regarding the probability of death derived from the APACHE II model was evident in some patient records. Overall agreement among groups of patients regarding the APACHE II score was good, however, with no significant difference in the mean score (20.2 vs. 20.1; p = .758). The predicted mortality from the reabstracted data was 30%, similar to the 27% predicted mortality from the original data (p = .380). CONCLUSION: Reliability of data collection varied widely in different components of the APACHE II probability-of-death model. Significant discrepancies in some components suggested a lack of explicit definitions and timing for consistent data collection between institutions or between data collectors. Nonetheless, variability resulting from data collection appears to be randomly distributed, so that comparisons of group means are valid.

APACHE↗
PubMedDate not supplied

Outcome prediction for critically ill cirrhotic patients: a comparison of APACHE II and Child-Pugh scoring systems.

Cirrhotic patients admitted to the medical intensive care unit (ICU) are associated with high mortality rates. The prognosis of critically ill cirrhotic patients is determined by the extent of hepatic and extrahepatic organ dysfunction. This study was conducted to assess and compare the accuracy of the Child-Pugh classification and APACHE II scores, obtained on the first day of ICU admission, in predicting hospital mortality in critically ill cirrhotic patients. One hundred thirty-five patients diagnosed with liver cirrhosis were admitted to the medical ICU between January 2002 and March 2003. Information considered necessary to compute the Child-Pugh and APACHE II scores on the first day of ICU admission was prospectively collected. The overall hospital mortality rate was 66.6%. Liver disease was most commonly attributed to hepatitis B viral infection. The APACHE II scores demonstrate a good fit using the Hosmer and Lemeshow goodness-of-fit test. Furthermore, by using the areas under receiver operating characteristic (AUROC) curve, the APACHE II scores demonstrated a better discriminative power (AUROC 0.833 +/- 0.039) than Child-Pugh scores (AUROC 0.75 +/- 0.05) (P=.024). This investigation confirms the grave prognosis for the cirrhotic patients admitted to the ICU. While both Child-Pugh and the APACHE II scores can satisfactorily predict the outcomes for critically ill cirrhotic patients, APACHE II is more powerful in discriminating the survivors from the nonsurvivors.

APACHE↗
PubMed2002

External validation of a modified model of Acute Physiology and Chronic Health Evaluation (APACHE) II for orthotopic liver transplant patients.

INTRODUCTION: The purpose of the study was to validate the newly derived postoperative orthotopic liver transplantation (OLTX)-specific diagnostic weight for the Acute Physiology and Chronic Health Evaluation (APACHE) II mortality prediction system in independent databases. METHODS: Medical records of 174 liver transplantation patients admitted postoperatively to the adult intensive care units at King Fahad National Guard Hospital and the University of Wisconsin were reviewed, and data on age, sex, the underlying liver disease, APACHE II scores and the hospital outcome were collected. Predicted mortality was calculated using: 1) the original APACHE II diagnostic weight of postoperative other gastrointestinal surgery and 2) the newly derived OLTX-specific diagnostic category weight. Standardized mortality ratio and 95% confidence intervals were calculated. Calibration was evaluated with the Hosmer-Lemeshow goodness-of-fit C-statistic. Discrimination was tested by 2 x 2 classification matrices and by computing the areas under the receiver operating characteristic curves. Patient characteristics and outcome data were compared between the two hospitals. RESULTS: APACHE II significantly overestimated mortality when the original diagnostic weight was used, but provided a closer estimate of mortality with the OTLX-specific diagnostic weight. The C-statistic analysis showed better calibration for the new approach; discrimination was also improved. The performances of the prediction systems were similar in the two hospitals. The new model provided more accurate estimates of hospital mortality in each hospital. DISCUSSION: APACHE II provided an accurate estimate of mortality in liver transplant patients when the OLTX-specific diagnostic weight was used. With the new model, APACHE II can be used as a valid mortality prediction system in this group of patients.

APACHE↗
PubMed2003

Evaluation of APACHE II system among intensive care patients at a teaching hospital.

CONTEXT: The high-complexity features of intensive care unit services and the clinical situation of patients themselves render correct prognosis fundamentally important not only for patients, their families and physicians, but also for hospital administrators, fund-providers and controllers. Prognostic indices have been developed for estimating hospital mortality rates for hospitalized patients, based on demographic, physiological and clinical data. OBJECTIVE: The APACHE II system was applied within an intensive care unit to evaluate its ability to predict patient outcome; to compare illness severity with outcomes for clinical and surgical patients; and to compare the recorded result with the predicted death rate. DESIGN: Diagnostic test. SETTING: Clinical and surgical intensive care unit in a tertiary-care teaching hospital. PARTICIPANTS: The study involved 521 consecutive patients admitted to the intensive care unit from July 1998 to June 1999. MAIN MEASUREMENTS: APACHE II score, in-hospital mortality, receiver operating characteristic curve, decision matrices and linear regression analysis. RESULTS: The patients' mean age was 50 +/- 19 years and the APACHE II score was 16.7 +/- 7.3. There were 166 clinical patients (32%), 173 (33%) post-elective surgery patients (33%), and 182 post-emergency surgery patients (35%), thus producing statistically similar proportions. The APACHE II scores for clinical patients (18.5 +/- 7.8) were similar to those for non-elective surgery patients (18.6 +/- 6.5) and both were greater than for elective surgery patients (13.0 +/- 6.3) (p < 0.05). The higher this score was, the higher the mortality rate was (p < 0.05). The predicted death rate was 25.6% and the recorded death rate was 35.5%. Through the use of receiver operating curve analysis, good discrimination was found (area under the curve = 0.80). From the 2 x 2 decision matrix, 72.2% of patients were correctly classified (sensitivity = 35.1%; specificity = 92.6%). Linear regression analysis was equivalent to r(2) = 0.92. CONCLUSIONS: APACHE II was useful for stratifying these patients. The illness severity and death rate among clinical patients were higher than those recorded for surgical patients. Despite the stratification ability of the APACHE II system, it lacked accuracy in predicting death rates. The recorded death rate was higher than the predicted rate.

APACHE↗
PubMed1995

Severity scores in respiratory intensive care: APACHE II predicted mortality better than SAPS II.

BACKGROUND: In recent years several scoring systems have been developed to describe the severity of illness, to establish the individual prognosis, and to group adult ICU patients by predicted risk of mortality. In addition, these scores can be used to measure and/or compare the quality of care in different ICUs. We compared the mortality predictions of the Acute Physiology and Chronic Health Evaluation (APACHE II) score and a new Simplified Acute Physiology Score (SAPS II) in patients with respiratory disease who require intensive care. PATIENTS & METHODS: We prospectively studied all 306 admissions from January 1, 1992 through December 31, 1994. McNemar and Hosmer-Lemeshow tests, and receiver operating characteristic (ROC) curves were used to describe and analyze our data. RESULTS: The average APACHE II score was 17.5 (SD 6.0), corresponding to a mean predicted death rate of 24.9% (SD 17.2%) as compared to an observed overall RICU mortality rate of 21.6%. The average SAPS II score was 39.1 (SD 11.1) corresponding to a mean predicted death rate of 26.0% (SD 18.4%). The ratio between the actual and predicted hospital mortality was 86% for APACHE II and 83% for SAPS II. Survivors had a significantly lower predicted risk of death than nonsurvivors (p < 0.0001) with both indices, and a higher Glasgow coma scale score (p < 0.0001). The ROC-curve analysis suggested the superior predictive ability of APACHE II in our patients. Area under the APACHE II ROC curve was 80.88% (standard error [SE] 2.89%), significantly larger (p < 0.01) than that found for SAPS II (73.52%, SE 3.61%). CONCLUSIONS: The APACHE II score was a good predictor of hospital outcome and better than SAPS II in our population.

APACHE↗
PubMed2004

[The value of Ranson and APACHE II scoring systems, and serum levels of interleukin-6 and C-reactive protein in the early diagnosis of the severity of acute pancreatitis].

BACKGROUND: We investigated the effectiveness of scoring systems, acute inflammation and acute phase responses in the early diagnosis of the severity of acute pancreatitis. METHODS: In a prospective design, we determined Ranson and APACHE II scores, and serum interleukin-6 (IL-6) and C-reactive protein (CRP) levels in 30 patients (21 females, 9 males; mean age 56 years; range 28 to 82 years) with acute pancreatitis. The patients were divided into two groups as mild and severe pancreatitis according to the clinical, biochemical, and computed tomography findings. Ranson and APACHE II scores were determined after 48 hours, IL-6 levels within 24 hours, and CRP levels after 24, 48, and 72 hours of admission. Ranson scores of 4 or above, APACHE II scores of 8 or above, baseline serum IL-6 and CRP levels of 50 pg/ml and 150 mg/L, respectively, were regarded as strong predictors of acute pancreatitis. RESULTS: Severe pancreatitis was diagnosed in six patients (20%), one of whom died due to multiple organ failure. Biliary symptoms were the most common presenting signs in both groups. The mean Ranson (p=0.004) and APACHE II (p=0.001) scores, serum IL-6 (p=0.001) and CRP levels at 24, 48, and 72 hours (p=0.02) were significantly high in patients with severe pancreatitis. The sensitivity was found as 66.6%, 83.3%, 100%, and 83.3%; the specificity as 87.5%, 91.7%, 87.5% and 71%; and the accuracy as 83.3%, 90%, 90%, and 73.3% for Ranson and APACHE II scores, IL-6 and CRP levels, respectively. CONCLUSION: Ranson and APACHE II scores, CRP and, in particular, serum IL-6 levels are strong predictors of severe pancreatitis.

APACHE↗
PubMed1998

[Mathematical model for the predictive value of a test in critically ill patients studies according to APACHE II score and pathology at admission].

OBJECTIVE: To find a predictive model for mortality at four different days from the admission for critically ill patients. DESIGN: Retrospective study on two consecutive series of critically ill patients admitted in ICU. SUBJECTS: 1254 critically ill patients, subdivided into two series of 813 (561 survivors and 252 non survivors) and 441 patients (291 survivors and 150 non survivors), respectively. INTERVENTIONS: None. MEASUREMENTS: All patients had APACHE II calculated within the first 24 hours from the admission in ICU and, if the patient was still in ICU, also at the 5th, 10th and 15th day from the admission. Casistics was subdivided into two unequal series, ratio 2:1, with a random selection made on each of the 6 considered years. On the 1st series, in 1st, 5th, 10th and 15th day, for mathematical predictive models were made, using stepwise logistic regression (BMDP, Los Angeles). In the 1st day the following independent variables were utilized: APACHE II score, the specific diagnosis at admission, fitted following Knaus' diagnostic criteria, united in 6 principal categories, while for the other 3 days the variation % of APACE II score as regards the previous day. RESULTS: For each of the considered day four mathematical models have been made. These models have been validated in both series in calibration from the Hosmer-Lemeshow Goodness-of-fit test and in discrimination from the ROC curves. For each day Y (Prob.% to die) = eLogit/1 + eLogit, where Logit = beta 0 (constant) + beta 1*APACHE II + beta 2*Variat.%APACE II (difference between actual APACHE II - APACHE II of the previous day/actual APACHE II) + beta k, (coefficient pertinent to pathology). CONCLUSIONS: The mathematical model, as other models do, stratifies enough the casistics according to the risk of death. Waiting for further studies to make more precise prognostic mathematical models, this one and others can help the clinical assessment in single patient evaluation.

APACHE↗
PubMed1990

Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical assessment and multiple factor scoring systems.

The APACHE II severity of disease classification system has been examined prospectively in 160 patients with acute pancreatitis. Using clinical and simple laboratory data APACHE II was able to provide useful discrimination between uncomplicated, complicated and fatal attacks within a few hours of admission. Peak APACHE II scores (recorded during the first 3 days) had a prognostic accuracy similar to the multiple factor scoring systems, but then incurred a similar delay. Patients could be graded according to their risk of death or of developing a major complication; no deaths occurred in patients with a peak APACHE II score less than 10. APACHE II can be repeated daily, uncomplicated attacks demonstrating falling scores in association with clinical improvement, in contrast to the rising scores associated with clinical deterioration in those dying early. APACHE II appears to reflect any continuing disease activity and may prove a useful means of monitoring the course of the illness and response to therapy.

Acute Disease↗
PubMed1988

APACHE II score and mortality in respiratory failure due to cardiogenic pulmonary edema.

We reviewed retrospectively 88 patients to assess whether the APACHE II severity of disease classification system can predict mortality in patients with respiratory failure due to cardiac pulmonary edema. Mean score for survivors was higher than for nonsurvivors (24.5 +/- 6.7 vs. 20.7 +/- 5.7, p less than .01), and increasing APACHE II scores were not associated with increasing mortality. Mortality was 54% for APACHE II scores less than or equal to 18, 43% for scores greater than 18 and less than or equal to 24, 22% for scores greater than 24 and less than or equal to 31, and 25% for scores between 32 and 40. The relationship of APACHE II scores to mortality did not improve when the 25 patients with ICU stays less than 48 h were analyzed; the mean score of survivors in this group was 24.3 +/- 5.2 vs. 18.8 +/- 4.6 for nonsurvivors, p less than .001. The presence of myocardial infarction (MI) was associated with a high mortality. Mortality in the 51 MI patients was 52.9% vs. 13.5% in the 37 patients without MI (p less than .001), but APACHE II scores were similar (22.6 +/- 6.6 and 23.7 +/- 6.4, respectively). The relationship between APACHE II scores and mortality did not improve if patients with and without MI are analyzed separately. For patients with MI, mortality was 78.6% for scores between 12 and 17, 56.2% for scores between 18 and 23, 33.3% for scores between 24 and 29, and 33.3% for scores greater than 29.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Comparison of APACHE II, TRISS, and a proposed 24-hour ICU point system for prediction of outcome in ICU trauma patients.

The APACHE II system for predicting outcomes in critically ill patients is now being used to evaluate quality of care for patients in surgical intensive care units, including trauma patients. The trauma data, however, on which the APACHE outcomes are based, were derived from only 364 ICU trauma patients. We compared the outcome predictions by APACHE II, TRISS, and a proposed 24-hour ICU point system in 1,000 ICU patients. [table: see text] p less than 0.025 by unpaired t test for predictive power of ICU point system versus APACHE II. Values of more than 15.5 represent poor agreement between the outcomes estimated from the model and the observed outcomes; a low value represents good agreement. The APACHE system significantly overestimated the risk of death in the lower ranges of predicted risk and underestimated the deaths in the higher ranges. Although TRISS was not developed for ICU trauma patients, it tended to perform better than APACHE II in our sample. The 24-hour ICU point system performed well, with accurate agreement between the outcomes estimated from the model and the observed outcomes.

False Positive Reactions↗
PubMed1992

Prospective comparison of clinical judgment and APACHE II score in predicting the outcome in critically ill surgical patients.

Prospective identification of patients who will not survive has been proposed as a means of limiting utilization of medical resources including critical care. This study prospectively compared prediction of outcome for surgical ICU patients by clinical assessment and the APACHE II score. Five hundred seventy-eight patients were assessed within 24 hours of admission by the ICU attending physician and predicted to live or die. An APACHE II score was calculated in that same time period. All data were stored in a data base and compared with actual SICU outcome. There were 40 deaths in 578 patients (6.9%). The clinical assessment had an overall accuracy of 95.2% vs. 90.9% for APACHE II. The Pearson correlation coefficients for the two methods of prediction were 0.59 for clinical assessment and 0.44 for APACHE II. Predictive power was not greatly improved by combining both prediction methods. Over 40% of patients predicted to die by both methods actually survived. This study demonstrates that clinical assessment is superior to APACHE II in predicting outcome in this group of surgical patients, although the difference is small. In addition, this study suggests that neither clinical assessment nor the APACHE II score, when obtained within 24 hours of admission, is very reliable at predicting which surgical ICU patients will die.

Adolescent↗
PubMed2004

Cardiac troponin I levels are a risk factor for mortality and multiple organ failure in noncardiac critically ill patients and have an additive effect to the APACHE II score in outcome prediction.

Cardiac troponin I (cTnI) is a specific marker of myocardial damage used in the diagnosis of acute coronary syndrome (ACS). Recent studies have shown that cTnI levels can also be elevated in patients without ACS, such as in sepsis and trauma patients, and that this is associated with an adverse prognosis. We have evaluated the clinical implications and prognostic significance of serum cTnI levels in noncardiac critically ill patients in a prospective observational study in a general medical intensive care unit at a tertiary-level hospital. A total of 108 consecutive patients without ACS or other cardiac disease was enrolled. Serum cTnI levels were measured on admission using enzyme-linked immunoabsorbant assay kits. Clinical laboratory parameters and outcome were compared between patients with elevated and normal cTnI levels. The prognostic significance of cTnI levels and the Acute Physiology And Chronic Health Evaluation (APACHE) II score was also analyzed. Forty-nine patients (45%) had elevated cTnI levels and 59 (55%) had normal levels. Compared with patients with normal cTnI levels, patients with elevated levels had a higher incidence of new failure of two or more organs, had a lower left ventricular ejection fraction during admission, were more likely to be associated with bacteremia, and had a higher intensive care unit mortality; they also had a significantly shorter survival over a 180-day follow up, before and after stratification by the APACHE II score. Multiple organ failure was the leading cause of mortality in patients with elevated cTnI levels. By multivariate analysis, elevated cTnI levels, a high APACHE II score, and underlying cancer were the three most important independent predictors for a shorter survival. Combination analysis showed a shorter survival in patients with a high APACHE II score plus elevated cTnI levels than in patients with a high APACHE II score or elevated cTnI levels alone. In conclusion, elevated serum cTnI levels is a risk factor for multiple organ failure and mortality in noncardiac critically ill patients, and the cTnI levels and APACHE II score have an additive effect in outcome prediction.

Aged↗