Validating the APACHE IV score in predicting length of stay in the intensive care unit among patients with sepsis

Abstract

The Acute Physiology and Chronic Health Evaluation (APACHE) IV model can predict the intensive care unit (ICU) length of stay (LOS) in critically ill patients. Thus, this study aimed to validate the performance of the APACHE IV score in predicting ICU LOS among patients with sepsis. This retrospective study was conducted in the medical ICU of a tertiary university between 2017 and 2020. A total of 1,039 sepsis patients were enrolled. Patients with an ICU stay of 1 and > 3 days accounted for 20.1% and 43.9%. The overall observed and APACHE IV predicted ICU LOS were 6.3 ± 6.5 and 6.8 ± 6.5, respectively. The APACHE IV slightly over-predicted ICU LOS with standardized length of stay ratio 0.95 (95% CI 0.89–1.02). The predicted ICU LOS based on the APACHE IV score was statistically longer than the observed ICU LOS (p < 0.001) and were poorly correlated (R2 = 0.02, p < 0.001), especially in patients with a lower severity of illness. In conclusions the APACHE IV model poorly predicted ICU LOS in patients with sepsis. The APACHE IV score needs to be modified or we need to make a new specific model to predict ICU stays in patients with sepsis.

Navigating the Complexity of Scoring Systems in Sepsis Management: A Comprehensive Review

“…APACHE III emerges as a significant determinant in forecasting patient outcomes within the framework of sepsis management [ 13 ]. The subsequent iteration, APACHE IV, has undergone validation for its ability to predict the length of stay (LOS) in the ICU for patients grappling with sepsis [ 14 ]. However, findings from a study indicate that APACHE IV tends to overpredict ICU LOS in septic patients, revealing suboptimal performance in this predictive aspect [ 14 ].…”

“…The subsequent iteration, APACHE IV, has undergone validation for its ability to predict the length of stay (LOS) in the ICU for patients grappling with sepsis [ 14 ]. However, findings from a study indicate that APACHE IV tends to overpredict ICU LOS in septic patients, revealing suboptimal performance in this predictive aspect [ 14 ]. While APACHE scores, especially APACHE III, have proven useful in sepsis management for prognostication and severity assessment, it is imperative to acknowledge the limitations inherent in these scoring systems.…”

Fluid balance versus weighing: A comparison in ICU patients: A single center observational study

“…Short-term variations in body weight are almost exclusively associated with changes in body fluids [10]. The Acute Physiology and Chronic Health Evaluation (APACHE) IV score serves as a prognostic indicator for assessing the severity of illness, consequently offering insight into the length of stay (LOS) among ICU patients [11]. Considering body weight measurements may provide a more accurate estimate of the fluid balance, further investigation in accuracy is needed [10,12].…”