Evaluation of illness severity scoring systems and risk prediction in vascular intensive care admissions

Vascular ◽  
2016 ◽  
Vol 24 (4) ◽  
pp. 390-403 ◽  
Author(s):  
M Dover ◽  
Wael Tawfick ◽  
Niamh Hynes ◽  
Sherif Sultan
Keyword(s):  
Intensive Care ◽  
Clinical Decision Making ◽  
Characteristic Curve ◽  
Scoring Systems ◽  
Apache Ii ◽  
Multiple Organ Dysfunction Score ◽  
Vascular Intervention ◽  
Saps Ii ◽  
Operative Severity Score ◽  
Apache Iv

IntroductionThis study examines the predictive value of intensive care unit (ICU) scoring systems in a vascular ICU population.MethodsFrom April 2005 to September 2011, we examined 363 consecutive ICU admissions. Simplified Acute Physiology Score II (SAPS II), Acute Physiology and Chronic Health Evaluation II (APACHE II), APACHE IV, Multiple Organ Dysfunction Score (MODS), organ dysfunctions and/or infection (ODIN), mortality prediction model (MPM) and physiologic and operative severity score for the enumeration of mortality and morbidity (POSSUM) were calculated. The Glasgow Aneurysm Score (GAS) was calculated for patients with aneurysm-related admissions.ResultsOverall mortality for complex vascular intervention was 11.6%. At admission, the areas under the receiver operating characteristic curve (AUCs) was 0.884 for SAPS II, 0.894 for APACHE II, 0.895 for APACHE IV, 0.902 for MODS, 0.891 for ODIN and 0.903 for MPM. At 24 h, model discrimination was best for POSSUM (AUC = 0.906) and MPM (AUC = 0.912).ConclusionThe good discrimination of these scoring systems indicates their value as an adjunct to clinical assessment but should not be used on an individual basis as a clinical decision-making tool.

scholarly journals Comparing APACHE II, APACHE IV, SAPS II, and SOFA Predictive Power in Poisoned Patients Admitted to the Intensive Care Unit

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Samaneh Silakhori ◽  
Bita Dadpour ◽  
Majid Khadem-Rezaiyan ◽  
Alireza Sedaghat ◽  
Farzad Mirzakhani
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Scoring Systems ◽  
Cross Sectional Study ◽  
Mortality Prediction ◽  
Apache Ii ◽  
Cross Sectional ◽  
Saps Ii ◽  
Hospitalization Period ◽  
Apache Iv

Background: This study aimed to assess the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE IV, Simplified Acute Physiologic Score (SAPS) II, and Sequential Organ Failure Assessment (SOFA) scores in predicting mortality rate in poisoning patients admitted to an intensive care unit (ICU).Methods: This cross-sectional study was performed on all admitted patients in the poisoning ICU of Imam Reza Hospital, Mashhad City, Iran. All patients were evaluated for three consecutive days since admission time and then every two days until discharge from ICU or death. The scoring systems mentioned above were calculated and analyzed by MedCalc statistical software version 18.9.1 and SPSS version 16.Results: Overall, 150 patients were studied, out of whom 67% (101) were male. Their mean±SD age was 41.6±18.9 years. In their whole hospitalization period, APACHE II (79.5%), SAPS II (78.7%), APACHE IV (78.4%), and SOFA (72.9%) were the most precise measures. On the first day of admission APACHE II (77.4%), on the second day, APACHE II (83.1%), on the third day, APACHE II (90.7%), and on the fifth day, SOFA (81.6%) were the most precise measures.Conclusion: All four systems have acceptable discriminatory power for poisoned patients. However, it seems that APACHE II can be used for mortality prediction, especially in the early days of admission. 

scholarly journals The Pros and Cons of the Prediction Game: The Never-ending Debate of Mortality in the Intensive Care Unit

2019 ◽  
Vol 16 (18) ◽  
pp. 3394 ◽  
Author(s):  
Piotr A. Fuchs ◽  
Iwona J. Czech ◽  
Łukasz J. Krzych
Keyword(s):  
Intensive Care ◽  
Scoring Systems ◽  
Roc Curves ◽  
Simplified Acute Physiology Score ◽  
Apache Ii ◽  
Icu Mortality ◽  
Saps Ii ◽  
Icu Discharge ◽  
Pros And Cons ◽  
Long Term Prognosis

Background: The Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scales are scoring systems used in intensive care units (ICUs) worldwide. We aimed to investigate their usefulness in predicting short- and long-term prognosis in the local ICU. Methods: This single-center observational study covered 905 patients admitted from 1 January 2015 to 31 December 2017 to a tertiary mixed ICU. SAPS II, APACHE II, and SOFA scores were calculated based on the worst values from the first 24 h post-admission. Patients were divided into surgical (SP) and nonsurgical (NSP) subjects. Unadjusted ICU and post-ICU discharge mortality rates were considered the outcomes. Results: Baseline SAPS II, APACHE II, and SOFA scores were 41.1 ± 20.34, 14.07 ± 8.73, and 6.33 ± 4.12 points, respectively. All scores were significantly lower among SP compared to NSP (p < 0.05). ICU mortality reached 35.4% and was significantly lower for SP (25.3%) than NSP (57.9%) (p < 0.001). The areas under the receiver-operating characteristic (ROC) curves were 0.826, 0.836, and 0.788 for SAPS II, APACHE II, and SOFA scales, respectively, for predicting ICU prognosis, and 0.708, 0.709, and 0.661 for SAPS II, APACHE II, and SOFA, respectively, for post-ICU prognosis. Conclusions: Although APACHE II and SAPS II are good predictors of ICU mortality, they failed to predict survival after discharge. Surgical patients had a better prognosis than medical ICU patients.

scholarly journals Performance of Prognostic Scoring Systems in Trauma Patients in the Intensive Care Unit of a Trauma Center

2020 ◽  
Vol 17 (19) ◽  
pp. 7226
Author(s):  
Shao-Chun Wu ◽  
Sheng-En Chou ◽  
Hang-Tsung Liu ◽  
Ting-Min Hsieh ◽  
Wei-Ti Su ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Organ Dysfunction ◽  
Scoring Systems ◽  
Predictive Performance ◽  
Apache Ii ◽  
Trauma Patients ◽  
Saps Ii ◽  
Significant Difference ◽  
Prognostic Scoring Systems

Background: Prediction of mortality outcomes in trauma patients in the intensive care unit (ICU) is important for patient care and quality improvement. We aimed to measure the performance of 11 prognostic scoring systems for predicting mortality outcomes in trauma patients in the ICU. Methods: Prospectively registered data in the Trauma Registry System from 1 January 2016 to 31 December 2018 were used to extract scores from prognostic scoring systems for 1554 trauma patients in the ICU. The following systems were used: the Trauma and Injury Severity Score (TRISS); the Acute Physiology and Chronic Health Evaluation (APACHE II); the Simplified Acute Physiology Score (SAPS II); mortality prediction models (MPM II) at admission, 24, 48, and 72 h; the Multiple Organ Dysfunction Score (MODS); the Sequential Organ Failure Assessment (SOFA); the Logistic Organ Dysfunction Score (LODS); and the Three Days Recalibrated ICU Outcome Score (TRIOS). Predictive performance was determined according to the area under the receiver operator characteristic curve (AUC). Results: MPM II at 24 h had the highest AUC (0.9213), followed by MPM II at 48 h (AUC: 0.9105). MPM II at 24, 48, and 72 h (0.8956) had a significantly higher AUC than the TRISS (AUC: 0.8814), APACHE II (AUC: 0.8923), SAPS II (AUC: 0.9044), MPM II at admission (AUC: 0.9063), MODS (AUC: 0.8179), SOFA (AUC: 0.7073), LODS (AUC: 0.9013), and TRIOS (AUC: 0.8701). There was no significant difference in the predictive performance of MPM II at 24 and 48 h (p = 0.37) or at 72 h (p = 0.10). Conclusions: We compared 11 prognostic scoring systems and demonstrated that MPM II at 24 h had the best predictive performance for 1554 trauma patients in the ICU.

Comparison of Sensitivity, Specificity and Accuracy of APACHE II, SAPS II and SOFA Scoring Systems as Predictors

2021 ◽  
Vol 15 (12) ◽  
pp. 3364-3366
Author(s):  
Aamir Furqan ◽  
Mehwish Naseer ◽  
Rafia Tabassum
Keyword(s):  
Intensive Care ◽  
Scoring System ◽  
Scoring Systems ◽  
Mortality Prediction ◽  
Apache Ii ◽  
Icu Patients ◽  
Saps Ii ◽  
Icu Stay ◽  
Study Results ◽  
Sensitivity Specificity

Aim: To compare the APACHE II, SAPS II and SOFA scoring systems as predictors of mortality in ICU patients in terms of sensitivity, specificity and accuracy. Methodology: A prospective observational study. Intensive care unit from May 13, 2018 to September 15, 2021. For 1368 patients included in study, results for APACHE II, SAPS II and SOFA were calculated with the worst values recorded. At the end of ICU stay, patient outcome was labelled as survivors and non-survivors. The cut off value for APACHE II, SAPS II and SOFA was taken as 50% of the highest possible score, with <50% expected to survive and with ≥50% expected to die during their ICU stay. Cross tables were made against real outcome of the patients, and sensitivity, specificity and accuracy for APACHE II, SAPS II and SOFA were calculated. Results: Sensitivity, specificity and accuracy were 77.53%, 94.28% and 85.45% for APACHE II scoring system; 47.29%, 87.32%, and 66.23% for SAPS II scoring system; and 73.37%, 60.28%, and 67.18% for SOFA scoring system, respectively. Conclusion: Apache Ii scoring system has highest sensitivity, specificity and accuracy in mortality prediction in ICU patients as compared to SAPS II and SOFA scoring systems, with SAPS II being least sensitive and accurate. Keywords: Sensitivity, specificity, accuracy, Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II), Sequential Organ Failure Assessment (SOFA), Intensive care units (ICU), Mortality.

scholarly journals Comparative study of scoring systems in ICU and emergency department in predicting mortality of critically ill

2017 ◽  
Vol 5 (4) ◽  
pp. 1352 ◽  
Author(s):  
Sasi Sekhar T. V. D. ◽  
Anjani Kumar C. ◽  
Bhavya Ch. ◽  
Sameera B. ◽  
Rama Devi Ch.
Keyword(s):  
Emergency Department ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Decision Making ◽  
Predictive Accuracy ◽  
Laboratory Data ◽  
Scoring Systems ◽  
Apache Ii ◽  
Early Warning Score ◽  
Saps Ii

Background: Scoring systems can be used to define critically ill patients, estimate their prognosis, help in clinical decision making, and guide the allocation of resources and to estimate the quality of care.  It remains unclear whether the additional data needed to compute ICU scores improves mortality prediction for critically ill patients compared to the simpler ED scores.Methods: We have done a prospective observational study of consecutively admitted 400 critically ill patients to ICU directly from Emergency Department in Dr PSIMS and RF over a period of 2 years. Clinical and laboratory data conforming to the modified early warning score (MEWS), rapid emergency medicine score (REMS), acute physiology and chronic health evaluation (APACHE II), and simplified acute physiology score (SAPS II) were recorded for all patients. A comparison was made between ED scoring systems MEWS, REMS and ICU scoring systems APACHE II, SAPSII. The outcome was recorded in two categories: survived and non-survived with a primary end point of 30-day mortality. Discrimination was evaluated using receiver operating characteristic (ROC) curves.Results: The ICU scores outperformed the ED scores with more area under curve values. The predicted mortality percentage of ICU based scoring systems is high compared to emergency scores (predicted mortality % of SAPS II-63%, APACHE II-33.3%, MEWS-18.5%, REMS-14.8%).Conclusions: ICU scores showed more predictive accuracy than ED scores in prognosticating the outcomes in critically ill patients. This difference is seemed more due to complexity of ICU scores.

A PROSPECTIVE COMPARITIVE STUDY OF APACHE II AND APACHE IV IN MORTALITY PREDICTION IN ICU

2021 ◽  
pp. 38-39
Author(s):  
R Kavitha ◽  
Kiran Mayi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prospective Study ◽  
Scoring Systems ◽  
Mortality Prediction ◽  
Apache Ii ◽  
Age Group ◽  
Mortality And Morbidity ◽  
The Mean ◽  
Apache Iv

Various scoring systems have been developed to predict mortality and morbidity in intensive care unit, but different data has been reported so far. To compare the predicted mortality of APACHE II and AP Aims: ACHE IV. This Methodology : prospective study was conducted in 12 bed ICU center in our hospital. 57 patients were taken with age group of above 15years irrespective of diagnosis, managed in ICU for >24hrs . APACHE II and APACHE IV scores were calculated based on the worst values of the rst 24 h of admission. All enrolled patients were followed during their ICU stay Or till death and outcome was recorded as survivors or non survivors. Results : There were 40 survivors .In APACHE II the mean score for survivors was 16.39 ± 6.82, which was less compared to mean the score of 22.08 ± 7.18 for non survivors. (P = 0.001).In APACHE IV the mean score for the survivors was 83.96 ± 17.93, which was less compared with mean the score of 107.44 ± 21.53 for non survivors.(P < .001) Conclusion: Discrimination, was fair for both models, but APACHE IV was superior to APACHE II. Calibration, was better for APACHE II than APACHE IV in our ICU. There was good correlation observed between the models.

scholarly journals Chronic heart failure in intensive care unit: can we accurately predict the risk?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Maltes ◽  
S Maltes ◽  
B.M.L Rocha ◽  
G.J.L Cunha ◽  
P Lopes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care ◽  
Kidney Injury ◽  
Scoring Systems ◽  
Roc Curves ◽  
Simplified Acute Physiology Score ◽  
Apache Ii ◽  
Risk Scores ◽  
Risk Of Death ◽  
Saps Ii

Abstract Background Severity of disease scoring systems, namely the Simplified Acute Physiology Score (SAPS) and Acute Physiology and Chronic Health Evaluation (APACHE), are widely used to predict mortality in Intensive Care Units (ICU). Yet, neither score includes chronic HF in their model. We aimed to evaluate whether these scores perform well in risk prediction of death of patients previously diagnosed with heart failure (HF). Methodology This is a single-center retrospective cohort of patients admitted to an ICU in 2019. Those whose admission lasted &lt;24 hours were excluded from analysis. The SAPS II and APACHE II scores were calculated using data from the first 24 hours of ICU admission, imputing the worst variable obtained within this timeframe. HF was defined according to the ESC recommendations. In order to assess the performance of the scores, Receiver Operating Characteristic (ROC) Curves were used to predict the risk of death in ICU in HF compared to the non-HF population. Results A total of 267 patients were hospitalized in ICU for a period over 24 hours in 2019 (mean age 67±16 years; 58.8% males; 21.7% with chronic HF; 33.7% admitted for sepsis). Compared to patients without HF, those with chronic HF were older (74±13 vs. 65±16 years; p&lt;0.001) and had higher risk scores (mean SAPS II: 43.2±21.7 vs. 56.5±20.7; p&lt;0.001; mean APACHE II: 19.8±10.0 vs. 25.1±10.0; p&lt;0.001). Moreover, these patients were at higher risk of meaningful events during hospitalization (e.g. acute kidney injury: 38.0 vs. 66.1%; p&lt;0.001; shock at any time: 52.4 vs. 67.8%; p=0.036). Furthermore, patients with HF had a trend towards higher mortality rates in ICU (17.3 vs. 28.8%; p=0.051) and a significantly higher death in overall hospitalization (30.8 vs. 45.8%; p=0.032). ROC curves performed well in predicting the risk of ICU death regardless of HF (SAPS II – AUC 0.78 vs. 0.81; p=0.36; APACHE II – AUC 0.75 vs. 0.78; p=0.37). Conclusion Approximately 1 in every 4 patients admitted to the ICU had chronic HF. Traditional risk scoring systems (SAPS II and APACHE II) performed well regardless of HF. While these results are reassuring as far as risk stratification accuracy is concerned, HF patients remained at a higher risk for worse outcomes. Therefore, prognostic tools with a therapeutic clinical applicability are urgently needed to improve the outcome of this population. FUNDunding Acknowledgement Type of funding sources: None.

Sign in / Sign up

Export Citation Format

Share Document