Sobre la reproducibilidad y la efectividad del APACHE II, el APACHE III adaptado para España y el SAPS II en 9 unidades de cuidados intensivos en España

Abstract Background. There are several scores used for in-hospital mortality prediction in critical illness. Their application in a local scenario requires validation to ensure appropriate diagnostic accuracy. Moreover, their use in assessing post-discharge mortality in intensive care unit (ICU) survivors has not been extensively studied. We aimed to validate APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed adult ICU in Poland. APACHE II, APACHE III and SAPS II scores, with corresponding predicted mortality ratios, were calculated for 303 consecutive patients admitted to a 10-bed ICU in 2016. Short-term (in-hospital) and long-term (12-month post-discharge) mortality was assessed. Results. Median APACHE II, APACHE III and SAPS II scores were 19 (IQR 12-24), 67 (36.5-88) and 44 (27-56) points, with corresponding in-hospital mortality ratios of 25.8% (IQR 12.1-46.0), 18.5% (IQR 3.8-41.8) and 34.8% (IQR 7.9-59.8). Observed in-hospital mortality was 35.6%. Moreover, 12-month post-discharge mortality reached 17.4%. All the scores predicted in-hospital mortality (p<0.05): APACHE II (AUC=0.78; 95%CI 0.73-0.83), APACHE III (AUC=0.79; 95%CI 0.74-0.84) and SAPS II (AUC=0.79; 95%CI 0.74-0.84); as well as mortality after hospital discharge (p<0.05): APACHE II (AUC=0.71; 95%CI 0.64-0.78), APACHE III (AUC=0.72; 95%CI 0.65-0.78) and SAPS II (AUC=0.69; 95%CI 0.62-0.76), with no statistically significant difference between the scores (p>0.05). The calibration of the scores was good. Conclusions. All the scores are acceptable predictors of in-hospital mortality. In the case of post-discharge mortality, their diagnostic accuracy is lower and of borderline clinical relevance. Further studies are needed to create scores estimating the long-term prognosis of subjects successfully discharged from the ICU.

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Evaluación de la reproducibilidad de la recogida de datos para el APACHE II, APACHE III adaptado para España y SAPS II en 9 Unidades de Cuidados Intensivos en España

Medicina Intensiva ◽

10.1016/s0210-5691(08)70898-2 ◽

2008 ◽

Vol 32 (1) ◽

pp. 15-22 ◽

Cited By ~ 4

Author(s):

L. Domínguez ◽

P. Enríquez ◽

P. Álvarez ◽

M. De Frutos ◽

V. Sagredo ◽

...

Keyword(s):

Apache Ii ◽

Saps Ii ◽

Apache Iii

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The impact of low-risk intensive care unit admissions on mortality probabilities by SAPS II, APACHE II and APACHE III

Anaesthesia ◽

10.1046/j.1365-2044.2002.02362.x ◽

2002 ◽

Vol 57 (1) ◽

pp. 21-26 ◽

Cited By ~ 17

Author(s):

D. H. Beck ◽

G. B. Smith ◽

B. L. Taylor

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Low Risk ◽

Apache Ii ◽

Saps Ii ◽

Apache Iii ◽

The Impact

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Validation of APACHE II, APACHE III and SAPS II scores in in-hospital and one year mortality prediction in a mixed intensive care unit in Poland: a cohort study

BMC Anesthesiology ◽

10.1186/s12871-020-01203-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Szymon Czajka ◽

Katarzyna Ziębińska ◽

Konstanty Marczenko ◽

Barbara Posmyk ◽

Anna J. Szczepańska ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Diagnostic Accuracy ◽

Mortality Prediction ◽

Apache Ii ◽

Post Discharge ◽

Saps Ii ◽

Apache Iii

Abstract Background There are several scores used for in-hospital mortality prediction in critical illness. Their application in a local scenario requires validation to ensure appropriate diagnostic accuracy. Moreover, their use in assessing post-discharge mortality in intensive care unit (ICU) survivors has not been extensively studied. We aimed to validate APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed adult ICU in Poland. APACHE II, APACHE III and SAPS II scores, with corresponding predicted mortality ratios, were calculated for 303 consecutive patients admitted to a 10-bed ICU in 2016. Short-term (in-hospital) and long-term (12-month post-discharge) mortality was assessed. Results Median APACHE II, APACHE III and SAPS II scores were 19 (IQR 12–24), 67 (36.5–88) and 44 (27–56) points, with corresponding in-hospital mortality ratios of 25.8% (IQR 12.1–46.0), 18.5% (IQR 3.8–41.8) and 34.8% (IQR 7.9–59.8). Observed in-hospital mortality was 35.6%. Moreover, 12-month post-discharge mortality reached 17.4%. All the scores predicted in-hospital mortality (p < 0.05): APACHE II (AUC = 0.78; 95%CI 0.73–0.83), APACHE III (AUC = 0.79; 95%CI 0.74–0.84) and SAPS II (AUC = 0.79; 95%CI 0.74–0.84); as well as mortality after hospital discharge (p < 0.05): APACHE II (AUC = 0.71; 95%CI 0.64–0.78), APACHE III (AUC = 0.72; 95%CI 0.65–0.78) and SAPS II (AUC = 0.69; 95%CI 0.62–0.76), with no statistically significant difference between the scores (p > 0.05). The calibration of the scores was good. Conclusions All the scores are acceptable predictors of in-hospital mortality. In the case of post-discharge mortality, their diagnostic accuracy is lower and of borderline clinical relevance. Further studies are needed to create scores estimating the long-term prognosis of subjects successfully discharged from the ICU.

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The Applicability of Commonly Used Severity of Illness Scores to Tropical Infections in Australia

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0615 ◽

2021 ◽

Author(s):

Kris Salaveria ◽

Simon Smith ◽

Yu-Hsuan Liu ◽

Richard Bagshaw ◽

Markus Ott ◽

...

Keyword(s):

Case Fatality Rate ◽

Case Fatality ◽

Severity Of Illness ◽

Apache Ii ◽

Fatality Rate ◽

Rickettsial Disease ◽

Saps Ii ◽

Apache Iii ◽

Tropical Australia ◽

Tropical Infections

Many patients with leptospirosis, melioidosis, and rickettsial infection require intensive care unit (ICU) admission in tropical Australia every year. The multi-organ dysfunction associated with these infections results in significantly elevated severity of illness (SOI) scores. However, the accuracy of these SOI scores in predicting death from these tropical infections is incompletely defined. This retrospective study was performed at Cairns Hospital, a tertiary-referral hospital in tropical Australia. All patients admitted to ICU with laboratory-confirmed leptospirosis, melioidosis, and rickettsial disease between January 1, 1999 and June 30, 2020, were eligible for the study. The ability of Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, Simplified Acute Physiology Scores (SAPS) II, and Sequential Organ Failure Assessment (SOFA) scores to predict death before ICU discharge was evaluated. Overall, 18 (12.1%) of the 149 included patients died: 15/74 (20.3%) with melioidosis, 2/54 (3.7%) with leptospirosis and 1/21 (4.8%) with rickettsial disease. However, the APACHE II, APACHE III, SAPS II, and SOFA scores significantly overestimated the case-fatality rate of all the infections; the disparity between the predicted and observed mortality was most marked in the cases of leptospirosis and rickettsial disease. Commonly used SOI scores significantly overestimate the case-fatality rate of melioidosis, leptospirosis, and rickettsial infections in Australian ICU patients. This may be at least partly explained by the unique pathophysiology of these infections, particularly leptospirosis and rickettsial disease. However, SOI scores may still be useful in facilitating the comparison of disease severity in clinical trials that examine patients with these pathogens.

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Validation of APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed intensive care unit in Poland: a cohort study

10.21203/rs.3.rs-24209/v2 ◽

2020 ◽

Author(s):

Szymon Czajka ◽

Katarzyna Ziębińska ◽

Konstanty Marczenko ◽

Barbara Posmyk ◽

Anna Szczepańska ◽

...

Keyword(s):

Intensive Care Unit ◽

Hospital Mortality ◽

Mortality Prediction ◽

Apache Ii ◽

Post Discharge ◽

Saps Ii ◽

Apache Iii ◽

Short And Long Term ◽

Long Term Mortality

Abstract Background. There are several scores used for in-hospital mortality prediction in critical illness. Their application in a local scenario requires validation to ensure appropriate diagnostic accuracy. Moreover, their use in assessing post-discharge mortality in intensive care unit (ICU) survivors has not been extensively studied. We aimed to validate APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed adult ICU in Poland. APACHE II, APACHE III and SAPS II scores, with corresponding predicted mortality ratios, were calculated for 303 consecutive patients admitted to a 10-bed ICU in 2016. Short-term (in-hospital) and long-term (12-month post-discharge) mortality was assessed.Results. Median APACHE II, APACHE III and SAPS II scores were 19 (IQR 12-24), 67 (36.5-88) and 44 (27-56) points, with corresponding in-hospital mortality ratios of 25.8% (IQR 12.1-46.0), 18.5% (IQR 3.8-41.8) and 34.8% (IQR 7.9-59.8). Observed in-hospital mortality was 35.6%. Moreover, 12-month post-discharge mortality reached 17.4%. All the scores predicted in-hospital mortality (p<0.05): APACHE II (AUC=0.78; 95%CI 0.73-0.83), APACHE III (AUC=0.79; 95%CI 0.74-0.84) and SAPS II (AUC=0.79; 95%CI 0.74-0.84); as well as mortality after hospital discharge (p<0.05): APACHE II (AUC=0.71; 95%CI 0.64-0.78), APACHE III (AUC=0.72; 95%CI 0.65-0.78) and SAPS II (AUC=0.69; 95%CI 0.62-0.76), with no statistically significant difference between the scores (p>0.05). The calibration of the scores was good.Conclusions. All the scores are acceptable predictors of in-hospital mortality. In the case of post-discharge mortality, their diagnostic accuracy is lower and of borderline clinical relevance. Further studies are needed to create scores estimating the long-term prognosis of subjects successfully discharged from the ICU.

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Short- and long-term mortality prediction in critically ill subjects: a cohort study

10.21203/rs.3.rs-24209/v1 ◽

2020 ◽

Author(s):

Szymon Czajka ◽

Katarzyna Ziębińska ◽

Konstanty Marczenko ◽

Barbara Posmyk ◽

Anna Szczepańska ◽

...

Keyword(s):

Hospital Mortality ◽

Diagnostic Accuracy ◽

Mortality Prediction ◽

Apache Ii ◽

Post Discharge ◽

Saps Ii ◽

Apache Iii ◽

Icu Discharge ◽

Long Term Mortality

Abstract Background. There are several scoring systems used for in-hospital mortality prediction in critical illness. Their application in a local scenario requires validation to ensure appropriate diagnostic accuracy. Also, their use in assessing post-discharge mortality in the ICU survivors has not been extensively studied.Aim. To evaluate the ability of APACHE II, III and SAPS II to predict in-hospital and post-discharge mortality in adult ICU patients.Material and methods. APACHE II, APACHE III and SAPS II, with corresponding predicted mortality ratios, were calculated for 303 consecutive patients admitted to the 10-bed ICU in 2016. Long-term mortality was calculated based on information taken from PESEL database.Results. Median APACHE II, APACHE III and SAPS II scores were 19, 67 and 44 points, with corresponding in-hospital mortality ratios of 28.1, 18.5 and 34.8%. Observed in-hospital mortality was 35.6%. 12-month post-discharge mortality reached 17.4%. All systems predicted in-hospital mortality (p<0.05): APACHE II (AUC=0.783; 95%CI 0.732-0.828), APACHE III (AUC=0.793; 95%CI 0.743-0.838) and SAPS II (AUC=0.792; 95%CI 0.742-0.836), as well as mortality after ICU discharge (p<0.05): APACHE II (AUC=0.712; 95%CI 0.643-0.775), APACHE III (AUC=0.721; 95%CI 0.653-0.783) and SAPS II (AUC=0.695; 95%CI 0.625-0.759), with no statistically significant difference between them (p>0.05).Conclusions. Although the predictive values were the highest for APACHE III and SAPS II, no differences were noticed between the scores. In case of post-discharge mortality, diagnostic accuracy was much lower. Further studies are needed to create scores estimating the long-term prognosis of subjects successfully discharged from the ICU.

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Prognostic Analysis of Elderly Patients with Multiple Organ Dysfunction Syndrome Undergoing Invasive Mechanical Ventilation

Journal of Healthcare Engineering ◽

10.1155/2020/6432048 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Kun Xiao ◽

Bin Liu ◽

Wei Guan ◽

Peng Yan ◽

Licheng Song ◽

...

Keyword(s):

Mechanical Ventilation ◽

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Invasive Mechanical Ventilation ◽

The Elderly ◽

Multiple Organ ◽

Apache Ii ◽

Multiple Organ Dysfunction ◽

Saps Ii ◽

Apache Iii

Objective. To prospectively investigate early prognostic assessments of patients with Multiple Organ Dysfunction Syndrome in the Elderly (MODSE) who were receiving invasive mechanical ventilation (IMV). Methods. The clinical data of 351 patients were enrolled prospectively between January 2013 and January 2018. The Acute Physiology and Chronic Health Evaluation II (APACHE II), APACHE III, Simplified Acute Physiology Score (SAPS II), and Multiple Organ Dysfunction Score (MODS) were calculated. According to the outcome of 28-day, the patients were divided into survivors and nonsurvivors. Additionally, based on whether weaning could be implemented, all patients were divided into a successful-weaning group and a failure-to-wean group. Results. According to the prognosis, the areas under the receiver operating characteristic curve of the APACHE II, APACHE III, SAPS II, and MODS scoring systems were 0.837, 0.833, 0.784, and 0.860, respectively. MODS exhibited the highest sensitivity, whereas APACHE II showed the highest specificity, and successful weaning was conducive to ameliorating patients’ prognosis. Multivariate logistic regression analyses revealed that underlying lung disease, plasma albumin, serum creatinine level, number of failing organs, and IMV duration were related to prognosis of weaning, with odds ratios (ORs) of 1.447, 0.820, 1.603, 2.374, and 3.105, respectively. Conclusions. The APACHE II, APACHE III, SAPS II, and MODS systems could perform excellent prognostic assessment for patients with Multiple Organ Dysfunction Syndrome in the elderly. Underlying lung disease, plasma albumin, serum creatinine, number of failing organs, and IMV duration were independent prognostic factors of weaning in MODSE patients with invasive mechanical ventilation.

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Outcome Prediction in Patients with Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation—A Retrospective International Multicenter Study

Membranes ◽

10.3390/membranes11030170 ◽

2021 ◽

Vol 11 (3) ◽

pp. 170

Author(s):

Alexander Supady ◽

Jeff DellaVolpe ◽

Fabio Silvio Taccone ◽

Dominik Scharpf ◽

Matthias Ulmer ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

The United States ◽

Apache Ii ◽

Apache Ii Score ◽

Survival Prediction ◽

Study Cohort ◽

Additional Tool ◽

Saps Ii ◽

Membrane Oxygenation ◽

International Multicenter

The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19 acute respiratory distress syndrome (ARDS) is still under debate and conclusive data from large cohorts are scarce. Furthermore, criteria for the selection of patients that benefit most from this highly invasive and resource-demanding therapy are yet to be defined. In this study, we assess survival in an international multicenter cohort of COVID-19 patients treated with V-V ECMO and evaluate the performance of several clinical scores to predict 30-day survival. Methods: This is an investigator-initiated retrospective non-interventional international multicenter registry study (NCT04405973, first registered 28 May 2020). In 127 patients treated with V-V ECMO at 15 centers in Germany, Switzerland, Italy, Belgium, and the United States, we calculated the Sequential Organ Failure Assessment (SOFA) Score, Simplified Acute Physiology Score II (SAPS II), Acute Physiology And Chronic Health Evaluation II (APACHE II) Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score, Predicting Death for Severe ARDS on V‑V ECMO (PRESERVE) Score, and 30-day survival. Results: In our study cohort which enrolled 127 patients, overall 30-day survival was 54%. Median SOFA, SAPS II, APACHE II, RESP, and PRESERVE were 9, 36, 17, 1, and 4, respectively. The prognostic accuracy for all these scores (area under the receiver operating characteristic—AUROC) ranged between 0.548 and 0.605. Conclusions: The use of scores for the prediction of mortality cannot be recommended for treatment decisions in severe COVID-19 ARDS undergoing V-V ECMO; nevertheless, scoring results below or above a specific cut-off value may be considered as an additional tool in the evaluation of prognosis. Survival rates in this cohort of COVID-19 patients treated with V‑V ECMO were slightly lower than those reported in non-COVID-19 ARDS patients treated with V-V ECMO.

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