Dynamic APACHE II Score to Predict the Outcome of Intensive Care Unit Patients

Abstract

ObjectiveThis study aims to evaluate the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE) II score on different days in predicting the mortality of critically ill patients to identify the best time point for the APACHE II score.MethodsThe demographic and clinical data are retrieved from the Medical Information Mart for Intensive Care (MIMIC)-IV dataset. APACHE II scores on days 1, 2, 3, 5, 7, 14, and 28 of hospitalization are calculated, and their performance is evaluated using the area under the receiver operating characteristic (AUROC) analysis. The cut-off for defining the high risk of mortality is determined using Youden's index. The APACHE II score on day 3 is the best time point to predict hospital mortality of ICU patients. The Hosmer-Lemeshow goodness-of-fit test is then applied to evaluate the calibration of the day 3 APACHE II score.ResultsWe recruited 6,374 eligible subjects from the MIMIC-IV database. Day 3 is the optimal time point for obtaining the APACHE II score to predict the hospital mortality of patients. The best cut-off for day 3 APACHE II score is 17. When APACHE II score ≥17, the sensitivity for the non-survivors and survivors is 92.8 and 82.2%, respectively, and the positive predictive value (PPV) is 23.1%. When APACHE II socre <17, the specificity for non-survivors and survivors is 90.1 and 80.2%, respectively, and the negative predictive value (NPV) is 87.8%. When day-3 APACHE II is used to predict the hospital mortality, the AUROC is 0.743 (P <0.001). In the ≥17 group, the sensitivity of non-survivors and survivors is 92.2 and 81.3%, respectively, and the PPV is 30.3%. In the <17 group, the specificity of non-survivors and survivors is 100.0 and 80.2%, respectively, and the NPV is 81.6%. The Hosmer-Lemeshow test indicated day-3 APACHE II has a high predicting the hospital mortality (X2 = 6.198, P = 0.625, consistency = 79.4%). However, the day-1 APACHE II has a poor calibration in predicting the hospital mortality rate (X2 = 294.898, P <0.001).ConclusionDay-3 APACHE II score is an optimal biomarker to predict the outcomes of ICU patients; 17 is the best cut-off for defining patients at high risk of mortality.

Association between the Predicted Value of APACHE IV Scores and Intensive Care Unit Mortality: A Secondary Analysis Based on EICU Dataset

“…Lee et al [ 2 ] used patients who had undergone living donor or deceased donor liver transplantation were admitted to the surgical ICU as the study population and obtained similar results. Besides, Tian et al [ 15 ] showed that the APACHE II score on day 3 of hospitalization was the best biomarker to predict prognosis in ICU patients. However, our results differ from the conclusions of existing studies.…”

Emergency General Surgery: Predicting Morbidity and Mortality in the Geriatric Population

“…However, out of 213 patients, only 41 were admitted to the ICU in our study. 24 This may be the reason why the AUC was low for this measure.…”

“…This is not surprising as the scoring system was initially created to predict the operative risk of adverse outcomes rather than short-term complications. 24 An intrinsic limitation of the ASA score is that it is a subjective tool. Grading may differ between anesthesiologists due to the subjective nature of the score.…”

SIRS tanılı hastalarda enflamasyon ve kemik döngüsü arasındaki ilişkinin sklerostin ve Dickkopf-1 (DKK-1) düzeyleri ile değerlendirilmesi

“…The presence of at least two of the findings was accepted as SIRS, and the presence of documented or suspected infection in this picture was accepted as sepsis. One of the scoring systems, the APACHE II (Acute Physiology and Chronic Health Evolution II) score, was used to evaluate the severity of the disease and predict the outcomes [18].…”