Background: Scoring systems can be used to define critically ill patients, estimate their prognosis, help in clinical decision making, guide the allocation of resources and estimate the quality of care in the ICU.Purpose: This study compared the predictive accuracy of four predictive scoring systems in the ICU.Methods: A prospective cohort study including consecutively admitted 110 adult ICU patients (88 males) with ARDS from Saudi German Hospital, Madinah, was performed from June 2013 to January 2015. The median age of the patients was 38 years, the median duration of illness before ICU admission was 6 days, and the median duration of ICU admission was 27 days. The APACHE II, APACHE III, SAPS II, and SOFA scores were calculated based on the worst values during the first 24 h of admission.Results: The actual mortality rate (27.3%) was higher than the estimated mortality rates, with the highest predicted rate of 11.3% obtained using the APACHE II. All four severity scores were significantly associated with mortality (F = 62.772, p = 0.000) and explained 83% of its variability (R 2 = 0.834). However, after adjustment, only the APACHE III scoring system was a significant predictor (Beta = À0.753, p = 0.000). Three scoring systems were significantly associated with mortality (F = 42.055, p = 0.000) and explained almost 70% of its variability (R 2 = 0.712), but after adjustment, only the APACHE II was a significant predictor (Beta = À0.631, p = 0.041).

PURPOSE: Scoring systems can be used to define critically ill patients, estimate their prognosis, help in clinical decision making, guide the allocation of resources and estimate the quality of care in the ICU. Aim of this study was to compare the predictive accuracy among four predictive scoring systems in the ICU in ARDS patients. METHODS:A prospective cohort study including consecutively admitted 110 adult ICU patients (88 males) with ARDS from Saudi German Hospital, Madinah, was performed from June 2013 to January 2015. The median age of the patients was 38 years, the median duration of illness before ICU admission was 6 days, and the median duration of ICU admission was 27 days. The APACHE II, APACHE III, SAPS II, and SOFA scores were calculated based on the worst values during the first 24 h of admission. RESULTS:The actual mortality rate (27.3%) was higher than the estimated mortality rates, with the highest predicted rate of 11.3% obtained using the APACHE II. All four severity scores were significantly associated with mortality (F¼ 62.772, p ¼ 0.000) and explained 83% of its variability (R2 ¼ 0.834). However, after adjustment, only the APACHE III scoring system was a significant predictor (Beta ¼ À0.753, p¼0.000). Three scoring systems were significantly associated with mortality (F ¼ 42.055, p ¼ 0.000) and explained almost 70% of its variability (R2¼0.712), but after adjustment, only the APACHE II was a significant predictor (Beta ¼ À0.631, p¼0.041). The combination of the severity score and mortality prediction were significant predictors of mortality (Beta ¼ À1.397, p ¼ 0.000 and Beta ¼ 0.517, p ¼ 0.036, respectively). CONCLUSIONS:The accuracy of the studied scoring systems for predicting ICU mortality in ARDS patients is limited. The performance of the APACHE II/III scorning systems was superior to that of other systems in terms of predicting the severity and mortality, and the combination of scores improved the performance. There is a need to develop ARDS-specific scoring systems. Until a new system is developed, it is better to use the updated versions of the APACHE scorning system or a combination of all ICU scoring systems.CLINICAL IMPLICATIONS: Acute respiratory distress syndrome (ARDS) is one of the leading causes of mortality in critically ill patients therefor, in the era of H1N1 and MERS-CoV, it is essentcial to to fined simple physiologic scoring system to evaluate the prognosis of ARDS patients from the first day of admission.

Diabetes mellitus is a chronic disease of two types: type I diabetes mellitus (T1DM) which results from insulin deficiency and type II diabetes mellitus (T2DM) which results from insulin resistance leading to hyperglycemia (Rosen et al., 2001). Diabetes mellitus is mostly called 'The silent killer' as it causes major complications without major symptoms and can affect many important organs in the body (Rang et al., 1991).

Hepatopulmonary syndrome (HPS) is a serious vascular complication of liver disease reported to be present in 4-32% of cirrhotic adults and 9-20% of children. HPS diagnosis depends on the presence of a triad of liver disease with intrapulmonary vascular dilation that causes abnormal arterial oxygenation. Pulmonary microvascular dilation and angiogenesis are two central mechanisms in pathogenesis of HPS. No effective medical therapies are currently available and liver transplantation is the only established treatment option.