Comparison of Acute Physiology and Chronic Health Evaluations II and III and Simplified Acute Physiology Score II: A prospective cohort study evaluating these methods to predict outcome in a German interdisciplinary intensive care unit

Markgraf, R.; Deutschinoff, G.; Pientka, Ludger; Scholten, T

doi:10.1097/00003246-200001000-00005

Cited by 104 publications

(86 citation statements)

References 35 publications

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“…6,[7][8][9][10][11] There was a higher frequency of trauma (15%) in relation to American and European studies, but this was similar to what has already been found in Brazil, 7,10,12 The patient distribution in the APACHE II score intervals showed highest concentrations in the intermediate ranges, coinciding with what was found by other authors. 8,10,13 However, the percentage of patients with APACHE II scores of less than 10 (22.4%), and thus with less severe illness conditions, was much lower than for the US study, 56%.…”

Section: Discussionsupporting

confidence: 80%

“…Although APACHE II was one of the first systems described, it is still the most widely used of them, insofar as the data required for its calculation are simple, well defined, reproducible, and collected on a routine basis during intensive care service provision.In Brazil, it is used by the Ministry of Health as a criterion for classifying intensive care units. 5 Markgraf et al 6 compared the predictive capabilities of APACHE II, APACHE III and SAPS II and concluded that the three indices have good discriminating power and that APACHE II has the best calibration. For this reason, it scored the most accurate mortality prediction.…”

Section: Introductionmentioning

confidence: 99%

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

Chiavone

Sens

2003

Sao Paulo Med. J.

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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 r² = 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.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

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

Chiavone

Sens

2003

Sao Paulo Med. J.

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“…Jubran et al confirmed that the comorbidity score might increase mortality by 24% [18]. Finally, APACHE II was found to be a better predictor of mortality compared to SAPS II in patients with respiratory disease in ICUs (AUCOC = 0.81) [19], as well as having a higher diagnostic accuracy compared to APACHE III and SAPS II in German interdisciplinary ICUs [20].…”

Section: Discussionmentioning

confidence: 99%

APACHE II score predicts mortality in patients requiring prolonged ventilation in a weaning center

Rojek-Jarmuła

Hombach²,

Krzych

2016

Anaesthesiol Intensive Ther

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Background: Little is known about the diagnostic accuracy of the APACHE II scoring system in prolonged mechanical ventilation. The aim of this study was to assess the utility of APACHE II in order to predict in-hospital mortality, length of stay (LOS) and discharge destination of patients in a weaning centre. Methods: The study group included 130 consecutive patients (median age 71 years; IQR 62−77). APACHE II was assessed based on the worst values taken during the first 24 hours post admission. The primary outcome was in-hospital mortality. LOS and discharge destination were considered secondary outcomes. Results: The APACHE II median score was 11 points (IQR 9−14) while 15 patients (11.5%) died. Mortality was lower in men (10.3%) than in women (14%) (P = 0.04). APACHE II was higher in non-survivors (15; IQR 10.25−19.5) compared to survivors (11; 8.25−14) (P < 0.001). In a bivariate analysis, APACHE II predicted mortality with good diagnostic accuracy (AUROC = 0.714; P = 0.007). In a multivariate analysis APACHE II (OR = 1.22; 95% CI: 1.06−1.40 per 1 point) and mode of ventilation (OR = 0.28; 95% CI: 0.08−0.99; CPAP vs. BIPAP) only predicted mortality. The median length of stay (LOS) was 28 days (IQR 20−39). There was weak correlation between APACHE II and LOS (R = 0.23; P = 0.01). Most patients were transferred to a rehabilitation center (53.9%) or a geriatric ward (13.9%). APACHE II did not differ between patients discharged to different healthcare facilities (P = 0.14). Conclusion:The APACHE II score is a powerful tool for predicting mortality of patients undergoing weaning from prolonged mechanical ventilation.

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“…Studies from developing countries also reported good calibration of PIM2 score, such as a study from Trinidad (X2=5.61, df=8, p=0.69) done by Hariharan [4]., and a study from Barbados (X2=5.64, df=7, p=0.58) done by Hariharan [38], and in Al Fayoum University a study done by Bekhit [37] found (H-L X2= 1.410, df= 8, p=0.9) well calibration, while in Italy by Atti [29] Calibration was less satisfactory (114.7 vs. 53; p < 0.001). Difference in results of discrimination, calibration and SMR among different studies has been attributed to various factors like poor performance of medical system in developing countries where resources are more limited [12], different case mix [42], disease pattern [43] and failure of the scoring system equation to model the actual situation accurately [44]. In our study, PIM2 score on day of admission showed significant positive correlation with risk of mortality with acceptable discrimination ability (area under ROC curve 0.73), and good calibration (p=0.88).…”

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confidence: 99%

Usefulness of the Pediatric Index of Mortality 2 in Predicting Mortality Rate in Benha University Pediatric Intensive Care Unit.

Elghaiaty¹,

Sobeih²,

Bayoumy³

2018

IJAR

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Background: little is known about the exact causes of death, and the impact of general risk factors that may complicate the course of critically ill patients. Scoring systems for use in ICUS allow an assessment. Aim of the study: To evaluate the usefulness of PIM2 score in predicting the outcome (mortality rate) in PICU in Benha university hospitals. Methods: This prospective study was conducted on 113 patients admitted to PICU in Benha University Hospitals in pediatric department over a period of six months. All patients aged more than one month up to less than sixteen years old. Pediatric index of mortality 2 was scored for all patients within an hour of admission to PICU using a structured data collection form and then compared with outcome which recorded as death or discharge. Results: Data were collected prospectively as a cohort study upon 11 children admitted to PICU in Benha University hospitals during a six months period. The outcome of the 113 patients included in the study was 77 survivors and 36 non-survivors. Observed death rate was (31.9%) and the predicted mortality rate by PIM2 score was 38.1%. So, the standardized mortality ratio was 0.84 signifying overestimation of mortality rate and/or good performance of our unit. PIM2 discriminated between death and survival well with area under the ROC curve was 0.73 and cutoff value at (-2.99) which is a good discrimination and calibrated well (p = 0.88 in non survivors and 0.83 in survivors). Conclusion: PIM2 applied in our PICU was significantly correlated to mortalities as PICU outcome and showed adequate discriminatory function and well calibrated for the case mix of patients in PICU of Benha University hospitals. So, it can be used as a good predictor of mortality in PICUS.

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Comparison of Acute Physiology and Chronic Health Evaluations II and III and Simplified Acute Physiology Score II: A prospective cohort study evaluating these methods to predict outcome in a German interdisciplinary intensive care unit

Cited by 104 publications

References 35 publications

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

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

APACHE II score predicts mortality in patients requiring prolonged ventilation in a weaning center

Usefulness of the Pediatric Index of Mortality 2 in Predicting Mortality Rate in Benha University Pediatric Intensive Care Unit.

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