A Prospective Study of Comparison of APACHE- I V &amp; SAPS- I I Scoring Systems and Calculation of Standardised Mortality Rate in Severe Sepsis and Septic Shock Patients

Dabhi, Ajay Somabhai; Khedekar, Suhas S; Mehalingam, Vadivelan

doi:10.7860/jcdr/2014/9925.5052

Cited by 13 publications

(16 citation statements)

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“…These reasons probably lead to a higher mortality rate in hospital that is not related to the performance of ICU. [16] Comparing our study's actual death rate of 52% in sepsis and septic shock patient we found that it is nearly similar to those of the other studies in India (60.71%) [17] and abroad (Saudi Arabia 46% [5] , Italy 46.7% [18] , France 42% [19] , UK 50% [20] ). In the present study, APACHE IV and SAPS II showed good calibration in Hosmer-Lemeshow goodness of fit Statistic (p value >0.05).…”

Section: Resultssupporting

confidence: 84%

EVALUATION OF APACHE- IV & SAPS- II SCORING SYSTEMS AND CALCULATION OF STANDARDISED MORTALITY RATE IN SEVERE SEPSIS AND SEPTIC SHOCK PATIENTS- A PROSPECTIVE OBSERVATIONAL STUDY

Chakraborty¹,

Swaika²,

Choudhuri³

et al. 2019

jemds

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BACKGROUND Sepsis and septic shock are major causes of mortality in the intensive care units worldwide. The scoring systems are very useful to predict risk of mortality and evaluating outcome in critically ill patients. In this study, we aimed to research the effectiveness of SAPS II and APACHE IV scoring systems in the evaluation of prognosis in severe sepsis and septic shock patients hospitalized in ICU. MATERIALS AND METHODS A prospective observational study was conducted on 50 consecutive patients of severe sepsis and septic shock admitted to ICU between April 2016 to April 2017. Predicted mortality was calculated using online calculator. Standardised mortality rate (SMR) was calculated with 95% confidence intervals. Calibration was assessed using Hosmer-Lemeshow test, statistic and Cohen's kappa statistic. Discrimination was assessed using receiver operating characteristic curves. RESULTS The actual mortality rate in this study was 52%. Predicted mortality rate of APACHE IV and SAPS II were 39.21% (SMR 1.32) and 45.85% (SMR 1.13) respectively. The Cohen's kappa for APACHE IV and SAPS II were 0.369 and 0.426 respectively. Hosmer-Lemeshow goodness of fit statistic indicates good logistic regression model fit for both APACHE IV and SAPS II scoring system (p value > 0.05). AUROC of APACHE IV and SAPS II were 0.748 and 0.760 respectively. CONCLUSION SAPS II had a closer prediction and better discriminative ability than APACHE IV.

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Section: Resultssupporting

confidence: 84%

EVALUATION OF APACHE- IV & SAPS- II SCORING SYSTEMS AND CALCULATION OF STANDARDISED MORTALITY RATE IN SEVERE SEPSIS AND SEPTIC SHOCK PATIENTS- A PROSPECTIVE OBSERVATIONAL STUDY

Chakraborty¹,

Swaika²,

Choudhuri³

et al. 2019

jemds

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“…Majority of the study patients had respiratory illness followed by neurological emergencies, renal disease requiring intensive care, obstetric emergencies and sepsis. Present study population was similar to the study population of Dabhi AS et al, and Varghese YE et al 14,15 The Present study observed a very good correlation between APACHE II and APACHE IV scoring systems with a Spearman's rho correlation coefficient of 0.776 (P<0.001), which was similar to Varghese YE et al, and Parajuli BD et al, who also reported good correlation between APACHE II and APACHE IV, with Spearman's correlation coefficient of 0.708 and 0.808 respectively. 15,17 The mean predicted length of ICU stay by APACHE IV model was 5.79±2.1 and observed ICU length of stay was 5.27±3.1.…”

Section: Discussionsupporting

confidence: 89%

The comparison of apache II and apache IV score to predict mortality in intensive care unit in a tertiary care hospital

et al. 2019

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Background: The prognostication of critically ill patients, in a systematic way, based on definite objective data is an integral part of the quality of care in Intensive Care Unit (ICU). Acute physiology and chronic health evaluation (APACHE) scoring systems provide an objective means of mortality prediction in Intensive Care Unit (ICU). The aims of this study were to compare the performance of APACHE II and APACHE IV in predicting mortality in our intensive care unit (ICU).Methods: A prospective observational study was conducted in a 13 bedded intensive care unit (ICU) of a tertiary level teaching hospital. All the patients above the age of 12 years, irrespective of diagnosis managed in ICU for >24hours were enrolled. APACHE II and APACHE IV scores were calculated based on the worst values in the first 24hours of admission. All enrolled patients were followed up, and outcome was recorded as survivors or non survivors. Observed mortality rates were compared with predicted mortality rates for both the APACHE II and APACHE IV. Receiver operator characteristic curves (ROC) were used to compare accuracy of the two scores.Results: APACHE II score of the patients ranged from 1 to 32 and APACHE IV score of the patients ranged from 25 to 142. There was good correlation between APACHE II and APACHE IV scores with the spearman’s rho value of 0.776 (P<0.01). Discrimination for APACHE II and APACHE IV models were good with area under ROC curve of 0.805 and 0.832 respectively. APACHE IV was more accurate than APACHE II in this regard. The cut-off point with best Youden index for APACHE II was 17 and for APACHE IV were 72 respectively for predicting mortality.Conclusions: Discrimination was better for APACHE IV than APACHE II model however Calibration was better for APACHE II than APACHE IV model in present study. There was good correlation between the two models observed in present study.

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“…In critically ill patients hospitalized in intensive care units, serial and comprehensive evaluation of end‐organ function/damage is an element of standard care, being commonly applied to the models (e.g. APACHE, SOFA) to stratify the risk of complications and to optimize management . Importantly, we included entirely different patient populations — at lower risk, i.e.…”

Section: Discussionmentioning

confidence: 99%

Multi‐organ dysfunction/injury on admission identifies acute heart failure patients at high risk of poor outcome

Zymliński

Sokolski

Biegus

et al. 2018

European J of Heart Fail

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Background Clinical consequences of an interplay between dysfunction/injury of different end‐organs in acute heart failure (AHF) remain unknown. Methods and results In 284 consecutive AHF patients, end‐organ dysfunction/injury was defined as cardiac [troponin I level above the upper reference limit (URL, > 0.056 ng/mL)], kidney (estimated glomerular filtration rate < 60 mL/min/1.73 m2), and liver [at least one of the following: aspartate transaminase (AST)/alanine transaminase (ALT) > 3 times the URL (> 114 IU/L and > 105 IU/L for AST and ALT, respectively), bilirubin above the URL (> 1.3 mg/mL), albumin below the lower reference limit (< 3.5 mg/dL)]. The primary endpoints were early (within first 48 h) in‐hospital worsening of heart failure and 1‐year all‐cause mortality. On admission, cardiac, kidney, liver dysfunction/injury were present in 38%, 50%, and 54% of patients, respectively. Patients were classified as having 0, 1, 2, or 3 organ injury/dysfunction (17%, 36%, 35%, and 12% of patients, respectively). Baseline clinical characteristics and co‐morbidity profile were similar across groups. Patients with three organ dysfunction/injury had the worst 1‐year survival rate [46%; hazard ratio (HR) with 95% confidence interval (CI) vs. patients without organ dysfunction: 6.75 (2.52–18.13), those with two (67%; HR 3.54, 95% CI 1.38–9.08), one (84%; HR 1.58, 95% CI 0.58–4.30), or no organ dysfunction/injury (90%); P < 0.01]. Worsening of heart failure was more frequent in patients with three and two vs. those with one or no organ dysfunction/injury (37% vs. 38% vs. 23% vs. 21%, P < 0.05). Conclusions In patients with AHF, dysfunction/injury of > 1 end‐organ dysfunction/injury identifies patients at the highest risk of poor outcomes.

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A Prospective Study of Comparison of APACHE- I V & SAPS- I I Scoring Systems and Calculation of Standardised Mortality Rate in Severe Sepsis and Septic Shock Patients

Cited by 13 publications

References 14 publications

EVALUATION OF APACHE- IV & SAPS- II SCORING SYSTEMS AND CALCULATION OF STANDARDISED MORTALITY RATE IN SEVERE SEPSIS AND SEPTIC SHOCK PATIENTS- A PROSPECTIVE OBSERVATIONAL STUDY

EVALUATION OF APACHE- IV & SAPS- II SCORING SYSTEMS AND CALCULATION OF STANDARDISED MORTALITY RATE IN SEVERE SEPSIS AND SEPTIC SHOCK PATIENTS- A PROSPECTIVE OBSERVATIONAL STUDY

The comparison of apache II and apache IV score to predict mortality in intensive care unit in a tertiary care hospital

Multi‐organ dysfunction/injury on admission identifies acute heart failure patients at high risk of poor outcome

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