Predicting outcome in acute cardiotoxicity based on Glasgow coma scale (GCS) and modified APACHE II score (MAS)

Abstract

Introduction: Acute cardiotoxicity patients can have adverse effects that may lead to intensive care unit (ICU) admission. Because of limited ICU beds, triage and stratification of cases into different groups according to survival is a must nowadays. Many scoring systems have been as a tool for triage and improve ICU quality management. This study aims to evaluate the role of GCS (Glasgow coma scale) and MAS (Modified Acute Physiology And Chronic Health Evaluation) as effective scoring system in predicting mortality in acute cardiotoxicity Methods: A prospective study was carried on 100 patients with acute cardiotoxicity by drugs and toxins known to cause cardiac injury admitted to Sohag Hospitals. Results 94% of patients had survived 4 of which discharged with complication. By ROC curve analysis to assess the predictor of outcome of acute cardiovascular toxicity, it was found that MAS score at cut off value > 11.5 had sensitivity 100% and specificity 74.5%, GCS at cut off < 9.5 had sensitivity 100% and specificity 72.3%.The accuracy rate of GCS was (92.4%) while that of MAS was (90.8%). Conclusion: GCS and MAS can be used as simple predictor tools of mortality in acute cardiotoxicity. Recommendation: GCS and MAS may be used as simple triage tools in acute cardiotoxicity patients in ICU to improve quality management and utilizing hospital resources.

Validity of Vital Signs, Coma Scales and Modified APACHE Score in Prediction of Prognosis and Outcome of Acutely Poisoned Patients

“…Also, Assaf et al (28) in their study of outcome of acutely intoxicated patients in PCC-ASUH found that there were statistically significant difference between respiratory rate, blood pressure and pulse between survivors and non-survivors group. As regard GCS and MAS coma scales, our results are in accordance with Shokry et al (10) study of acute poisoning with cardio-toxic effects in Sohag University Hospitals who revealed that GCS and MAS had excellent discrimination of death in the studied patients. The cut off values of GCS less than 9 and MAS more than 11 predicted mortality with 100% sensitivity for both scales and 72.3% and 74.5% specificity respectively.…”

“…C. GCS (3-15 points) was calculated from assessment of motor, verbal and eye components. D. Modified APACHE II Score (MAS) according to Shokry et al(10) was calculated from 5 physiological parameters: mean arterial pressure, temperature, respiratory rate, heart rate and each component was marked from 0 being normal and 4 the most abnormal then the 5th parameter GCS score (15-GCS) was added.…”