Combination of APACHE Scoring Systems with Adductor Pollicis Muscle Thickness for the Prediction of Mortality in Patients Who Spend More Than One Day in the Intensive Care Unit

Abstract

Background The objective of the present study was to compare the ability of Acute Physiology and Chronic Health Evaluation (APACHE) scoring systems with the combination of an anthropometric variable score “adductor pollicis muscle (APM) thickness” to the APACHE systems in predicting mortality in the intensive care unit. Methods A prospective observational study was conducted with the APM thickness in the dominant hand, and APACHE II and III scores were measured for each patient upon admission. Given scores for the APM thickness were added to APACHE score systems to make two composite scores of APACHE II-APM and APACHE III-APM. The accuracy of the two composite models and APACHE II and III systems in predicting mortality of patients was compared using the area under the ROC curve. Results Three hundred and four patients with the mean age of 54.75 ± 18.28 years were studied, of which 96 (31.57%) patients died. Median (interquartile range) of APACHE II and III scores was 15 (12–20) and 47 (33–66), respectively. Median (interquartile range) of APM thickness was 15 (12–17) mm, respectively. The area under the ROC curves for the prediction of mortality was 0.771 (95% CI: 0.715–0.827), 0.802 (95% CI: 0.751–0.854), 0.851 (95% CI: 0.807–0.896), and 0.865 (95% CI: 0.822–0.908) for APACHE II, APACHE III, APACHE II-APM, and APACHE III-APM, respectively. Conclusion Although improvements in the area under ROC curves were not statistically significant when the APM thickness added to the APACHE systems, but the numerical value added to AUCs are considerable.

Mortality prediction models in the adult critically ill: A scoping review

“…Characteristics of the mortality prediction models and underlying derivation cohorts are presented in Table 1. In all, 19 mortality prediction models (44%) were developed using prospectively collected data specifically gathered for the development of the prediction model, 6,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] whereas 24 (56%) were developed using either retrospective data [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] or prospective data previously collected for other purposes. [45][46][47][48][49] The start of data collection for the development cohorts spanned 36 years (1979-2015), and the duration of the cohort studies varying from 2 months up to 10 years for each cohort.…”

“…Two mortality prediction models (4.7%) did not report the timespan during which their development cohort was assembled. 22,33 In all, 31 mortality prediction models (74%) were developed in a single country, 14,[18][19][20][21][22][23][24][25][26][27]29,31,[33][34][35][36][37][38][39][40][41][42][43][44][45]47,49 six (14%) in neighbouring countries (two or more) 6,13,28,30,32,46 and five (12%) were developed in multiple countries worldwide. [15][16][17]48 The number of patients included in the development databases ranged from 232 to 731 611 patients with a median of 4,895 (IQR 528-35 878).…”

“…Hospital mortality was the most frequently used primary outcome in 29 (67%) mortality prediction models. 6,[13][14][15][16][17][18][19]21,22,24,27,28,[30][31][32][33]35,36,38,[41][42][43]45,46 Other primary outcome variables were ICU mortality (7%), 23,26,34 28-day mortality (4.7%), 39,44 90-day mortality (4.7%), 48,49 3-to 28-day mortality (4.7%), 40 30-day mortality (2.3%), 47 180-day mortality (2.3%), 20 6-month mortality (2.3%), 25 15-year mortality (2.3%), 37 and 6-and 12-month mortality (2.3%). 29 Secondary outcomes were 1-month mortality after ICU admission (4.7%), 24,31 hospital mortality (4.7%), 29,34 ICU mortality (2.3%), 45 3-month mortality after ICU admission (2.3%), 31 6-month mortality after ICU admission (2.3%), 31 9-month mortality (2.3%), 47 1-year mortality (2.3%)…”

“…24 Of the 43, 37 mortality prediction models (86%) did not prognosticate any secondary outcome. 6,[13][14][15][16][17][18][19][20][21][22][23][25][26][27][28]30,32,33,[35][36][37][38][39][40][41][42][43][44]46,48,49 Hospital mortality rates of the development cohorts varied from 6.9% to 48% and were not reported for nine mortality prediction models (21%). 6,15,18,29,33,40,42 For 21 mortality prediction models (49% of 43), data were collected within the first 24 hours after patient admission to the ICU.…”

“…6,15,18,29,33,40,42 For 21 mortality prediction models (49% of 43), data were collected within the first 24 hours after patient admission to the ICU. 6,13,14,[17][18][19]24,26,27,30,31,34,38,39,42,44,[47][48][49] For 11 prediction models (26%), data on ICU admission were collected, 16,23,25,28,32,35,36,41,43,45,46 whereas for the remaining prediction models data timing varied from 24 days before admission up to 5 days after patient admission to the ICU.…”