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. 2017 Apr-Jun;33(2):248-253.
doi: 10.4103/0970-9185.209741.

Comparison of acute physiology and chronic health evaluation II (APACHE II) and acute physiology and chronic health evaluation IV (APACHE IV) severity of illness scoring systems, in a multidisciplinary ICU

Yeldho Eason Varghese  1 , M S Kalaiselvan  1 , M K Renuka  2 , A S Arunkumar  1
Affiliations

Comparison of acute physiology and chronic health evaluation II (APACHE II) and acute physiology and chronic health evaluation IV (APACHE IV) severity of illness scoring systems, in a multidisciplinary ICU

Yeldho Eason Varghese et al. J Anaesthesiol Clin Pharmacol. 2017 Apr-Jun.

Abstract

Background and aims: Outcome prediction of critically ill patients is an integral part of care in an Intensive Care Unit (ICU). Acute Physiology and Chronic Health Evaluation (APACHE) scoring systems provide an objective means of mortality prediction in ICU. The aim of this study was to compare the performance of APACHE II and IV scoring system in our ICU.

Material and methods: All patients admitted to the ICU between January and June 2014 and who met the inclusion criteria were evaluated. APACHE II and IV score were calculated during the first 24 h of ICU stay based on the worst values. All patients were followed up till discharge from the hospital or death. Statistical analysis was performed using SPSS version 19.0. Discrimination of the model for mortality was assessed using receiver operating characteristic curve and calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test.

Results: Of a total 1268, 1003 patients were included in this study. The mean (±standard deviation) admission APACHE II score was 19.4 ± 8.9, and APACHE IV score was 59.1 ± 27.2. The APACHE scores were significantly higher among nonsurvivors than survivors (P < 0.001). The overall crude hospital mortality rate was 17.6%. APACHE IV had better discriminative power area under the ROC curve ([AUC] -0.82) than APACHE II (AUC-0.75). Both APACHE II and APACHE IV had poor calibration.

Conclusions: APACHE IV showed better discrimination compared to APACHE II in our ICU population. Both APACHE II and APACHE IV had poor calibration. However, APACHE II calibrated better compared to APACHE IV.

Keywords: Acute Physiology and Chronic Health Evaluation; Intensive Care Unit; Intensive Care Unit scoring system; validation.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Case distribution as per Acute Physiology and Chronic Health Evaluation II scores
Figure 2
Figure 2
Case distribution according to Acute Physiology and Chronic Health Evaluation IV scores
Figure 3
Figure 3
Correlation between Acute Physiology and Chronic Health Evaluation II and Acute Physiology and Chronic Health Evaluation IV scores
Figure 4
Figure 4
Receiver operating characteristic curves: Acute Physiology and Chronic Health Evaluation II and Acute Physiology and Chronic Health Evaluation IV scores
Figure 5
Figure 5
Calibration plot for Acute Physiology and Chronic Health Evaluation II (H-statistics - 151.2, P-0.031)
Figure 6
Figure 6
Calibration plot for Acute Physiology and Chronic Health Evaluation IV (H-statistics - 283.6, P-0.001)
See this image and copyright information in PMC

References

    1. Sinuff T, Adhikari NK, Cook DJ, Schünemann HJ, Griffith LE, Rocker G, et al. Mortality predictions in the intensive care unit: Comparing physicians with scoring systems. Crit Care Med. 2006;34:878–85. - PubMed
    1. Becker RB, Zimmerman JE. ICU scoring systems allow prediction of patient outcomes and comparison of ICU performance. Crit Care Clin. 1996;12:503–14. - PubMed
    1. Zimmerman JE, Kramer A, McNair DS, Malila FM. Acute physiology and chronic health evaluation (APACHE) IV: Hospital mortality assessment for today's critically ill patients. Crit Care Med. 2006;34:1297–308. - PubMed
    1. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med. 1985;13:818–29. - PubMed
    1. Parajuli BD, Shrestha GS, Pradhan B, Amatya R. Comparison of acute physiology and chronic health evaluation II and acute physiology and chronic health evaluation IV to predict intensive care unit mortality. Indian J Crit Care Med. 2015;19:87–91. - PMC - PubMed