scholarly journals Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV Score in COVID-19 Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Jeroen Vandenbrande ◽  
Laurens Verbrugge ◽  
Liesbeth Bruckers ◽  
Laurien Geebelen ◽  
Ester Geerts ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Scoring Systems ◽  
Chronic Health Evaluation ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Goodness Of Fit Test ◽  
Discriminative Performance ◽  
Chronic Health ◽  
Apache Iv

Background. Severity scoring systems are inherent to ICU practice for multiple purposes. Acute Physiology and Chronic Health Evaluation (APACHE) scoring systems are designed for ICU mortality prediction. This study aims to validate APACHE IV in COVID-19 patients admitted to the ICU. Methods. All COVID-19 patients admitted to the ICU between March 13, 2020, and October 17, 2020, were retrospectively analyzed. APACHE II and APACHE IV scores as well as SOFA scores were calculated within 24 hours after admission. Discrimination for mortality of all three scoring systems was assessed by receiver operating characteristic curves. Youden index was determined for the scoring system with the best discriminative performance. The Hosmer–Lemeshow goodness-of-fit test was used to assess calibration. All analyses were performed for both the overall population as in a subgroup treated with anti-Xa adjusted dosages of LMWHs. Results. 116 patients were admitted to our ICU during the study period. 13 were excluded for various reasons, leaving 103 patients in the statistical analysis of the overall population. 57 patients were treated with anti-Xa adjusted prophylactic dosages of LMWH and were supplementary analyzed in a subgroup analysis. APACHE IV had the best discriminative power of the three scoring systems, both in the overall population (APACHE IV ROC AUC 0.67 vs. APACHE II ROC AUC 0.63) as in the subgroup (APACHE IV ROC AUC 0.82 vs. APACHE II ROC AUC 0.7). This model exhibits good calibration. Hosmer–Lemeshow p values for APACHE IV were 0.9234 for the overall population and 0.8017 for the subgroup. Calibration p values of the APACHE II score were 0.1394 and 0.6475 for the overall versus subgroup, respectively. Conclusions. APACHE IV provided the best discrimination and calibration of the considered scoring systems in critically ill COVID-19 patients, both in the overall group and in the subgroup with anti-Xa adjusted LMWH doses. Only in the subgroup analysis, discriminative abilities of APACHE IV were very good. This trial is registered with NCT04713852.

scholarly journals A Study on the Effects of Hypomagnesaemia among Critically Ill Patients at a Tertiary Care Hospital of Southern Bihar

2020 ◽  
Vol 7 (43) ◽  
pp. 2458-2462
Author(s):  
Harjot Singh ◽  
Amit Kumar Ranjan ◽  
Ranjan Kumar
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Serum Magnesium ◽  
Chronic Health Evaluation ◽  
Apache Ii ◽  
Electrolyte Imbalance ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Ventilator Support ◽  
Chronic Health

BACKGROUND Hypomagnesaemia is associated with other electrolyte abnormalities like hypokalaemia, hyponatremia, and hypophosphatemia. We wanted to study the serum magnesium levels in critically ill patients, and correlate the serum magnesium levels with patient outcome and other parameters like duration of stay in ICU, ventilator support and APACHE-II (Acute Physiology and Chronic Health Evaluation-II) score. METHODS The study included all the cases admitted in the ICU of Narayan Medical College & Hospital, with variable medical conditions within 6 months fulfilling the inclusion criteria. Demographic data (age and sex), medical history, surgical history, medications administrated and length of ICU stay were recorded for each patient. The severity scoring system used was Acute Physiology and Chronic Health Evaluation-II (APACHE-II). RESULTS Prevalence of Hypomagnesaemia in the present study was 60.2 %. Mortality and mechanical ventilator support (2.7 % and 28.4 %) in normomagnesemia subjects were significantly lesser than hypomagnesaemia subjects (33.9 % and 54.5 % respectively). CONCLUSIONS Hypomagnesaemia is a common electrolyte imbalance in critically ill patients. It is associated with higher mortality and morbidity in critically ill patients and is also associated with more frequent and more prolonged ventilatory support. KEYWORDS Critically Ill, Hypomagnesaemia, APACHE-II Score, Mortality, Ventilator Support

Does Acute Physiology and Chronic Health Evaluation II Provide a Valid Metric to Directly Compare Disease Severity in Trauma versus Surgical Intensive Care Unit Patients?

2012 ◽  
Vol 78 (11) ◽  
pp. 1261-1269
Author(s):  
Robert D. Becher ◽  
Michael C. Chang ◽  
J. Jason Hoth ◽  
Jennifer L. Kendall ◽  
H. Randall Beard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Disease Severity ◽  
Chronic Health Evaluation ◽  
Apache Ii ◽  
Surgical Intensive Care Unit ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Chronic Health ◽  
Risk Of Death

The Acute Physiology and Chronic Health Evaluation II (APACHE II) score has never been validated to risk-adjust between critically ill trauma (TICU) and general surgical (SICU) intensive care unit patients, yet it is commonly used for such a purpose. To study this, we evaluated risk of death in TICU and SICU patients with pneumonia. We hypothesized that mortality for a given APACHE II would be significantly different and that using APACHE II to directly compare TICU and SICU patients would not be appropriate. We conducted a retrospective review of patients admitted to the TICU or SICU at a tertiary medical center over an 18-month period with pneumonia. Admission APACHE II scores, in-hospital mortality, demographics, and illness characteristics were recorded. One hundred eighty patients met inclusion criteria, 116 in the TICU and 64 in the SICU. Average APACHE II scores were not significantly different in the TICU versus SICU (25 vs 24; P = 0.4607), indicating similar disease severity; overall mortality rates, however, were significantly different (24 vs 50%; P = 0.0004). Components of APACHE II, which contributed to this mortality differential, were Glasgow Coma Score, age, presence of chronic health problems, and operative intervention. APACHE II fails to provide a valid metric to directly compare the severity of disease between TICU and SICU patients with pneumonia. These groups represent distinct populations and should be separated when benchmarking outcomes or creating performance metrics in ICU patients. Improved severity scoring systems are needed to conduct clinically relevant and methodologically valid comparisons between these unique groups.

scholarly journals Performance of the Acute Physiology and Chronic Health Evaluation II (APACHE II) in the prediction of hospital mortality in a mixed ICU in Singapore

2018 ◽  
Vol 28 (3) ◽  
pp. 147-152 ◽  
Author(s):  
Charles Chin Han Lew ◽  
Gabriel Jun Yung Wong ◽  
Chee Keat Tan ◽  
Michelle Miller
Keyword(s):  
Hospital Mortality ◽  
Tertiary Care ◽  
Chronic Health Evaluation ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Chronic Health ◽  
Icu Admission ◽  
Local Setting ◽  
Calibration Accuracy

Background: The Acute Physiology and Chronic Health Evaluation II (APACHE II) is used to quantify disease severity and hospital mortality risk in critically ill patients. It is widely used in intensive care units (ICUs) in Singapore, but its prognostic validity remains questionable as it has not been thoroughly assessed by established statistical methods. Objectives: This study aimed to: (a) evaluate the discrimination and calibration accuracy of the APACHE II in the prediction of hospital mortality in a mixed ICU, and (b) customise the APACHE II in an effort to maximise its prognostic performance. Methods: A prospective cohort study was conducted and all adult patients with >24 h of ICU admission in a tertiary care institution in Singapore were included. The outcome measure was hospital mortality, and all patients were followed-up until hospital discharge or death for up to one year after ICU admission. Results: There were 503 patients, and their mean (SD) age and APACHE II score were 61.2 (15.8) years and 24.5 (8.2), respectively. Hospital mortality was 31%, and no patients were lost to follow-up. The APACHE II has good discrimination (receiver operating characteristic: 0.76) but poor calibration (Hosmer–Lemeshow C test: <0.001). Customisation did not significantly improve calibration accuracy. Conclusions: The APACHE II and its customised version should not be used in the local setting as they both have poor calibration. There is an urgent need for larger studies to perform second-level customisation or to develop a new prognostic model tailored to the Singapore critical care setting.

scholarly journals Role of acute physiology and chronic health evaluation II scoring system in risk stratification and management of small bowel perforations

2020 ◽  
Vol 7 (6) ◽  
pp. 1776
Author(s):  
Sanjana Kumar ◽  
Jainendra K. Arora ◽  
Sunil Kumar Jain
Keyword(s):  
Small Bowel ◽  
Mortality Rate ◽  
Scoring System ◽  
Chronic Health Evaluation ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Double Blind ◽  
Chronic Health ◽  
Significant Difference

Background: Despite the surgical treatment, sophisticated intensive care units, latest generation antibiotics and a better understanding of pathophysiology, the morbidity and mortality rate of perforation peritonitis are still high. Patients are usually managed by subjective decision of surgeon based on which mortality is very high.Methods: This was a double-blind observational study conducted over a period of 18 months on 50 patients with small bowel perforations. Based on the acute physiology and chronic health evaluation (APACHE) II score at presentation, patients were triaged into 3 groups: group 1 (score ≤10), group 2 (score 11 to 20) and group 3 (score >20). Study population was managed by the subjective decision of the operating surgeon who was blinded off the APACHE II score of patients. Hence removing the possibility of bias and observing a correlation between surgical outcome and APACHE II score of the patient.Results: Patients with higher APACHE II score (>10) were more likely to undergo exteriorization of bowel. Length of hospital stay was also found to be increased with an increase in score. APACHE II score of 10 was found to predict mortality with significant difference between 2 groups. Below this score the mortality was 0% and above this score the mortality rate rose to 31.25%.Conclusions: APACHE II can be used as a reliable and uniform scoring system as its assessment at presentation in patients of small bowel perforations provides an insight to their surgical management as well as predicting overall outcome. 

Acute Physiology and Chronic Health Evaluation (APACHE II) score and outcome in the surgical intensive care unit

1991 ◽  
Vol 19 (8) ◽  
pp. 1048-1053 ◽  
Author(s):  
ROBERT RUTLEDGE ◽  
SAMIR M. FAKHRY ◽  
EDMUND J. RUTHERFORD ◽  
FARID MUAKKASSA ◽  
CHRISTOPHER C. BAKER ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Chronic Health Evaluation ◽  
Apache Ii ◽  
Surgical Intensive Care Unit ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Surgical Intensive Care ◽  
Chronic Health
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