APACHE II Predicts long-term survival in COPD patients admitted to a general medical ward

Abstract

OBJECTIVE:The Acute Physiology and Chronic Health Evaluation II (APACHE II) was developed to predict intensive-care unit (ICU) resource utilization. This study tested APACHE II's ability to predict long-term survival of patients with chronic obstructive pulmonary disease (COPD) admitted to general medical floors. DESIGN:We performed a retrospective cohort study of patients admitted for COPD exacerbation outside the ICU. APACHE II scores were calculated by chart review. Mortality was determined by the Social Security Death Index. We tested the association between APACHE II scores and long-term mortality with Cox regression and logistic regression. PATIENTS:The analysis included 92 patients admitted for COPD exacerbation in two Burlington, Vermont hospitals between January 1995 and June 1996. In addition to ICU resource utilization, the APACHE II has been used to predict long-term survival. The APACHE II score is strongly associated with long-term survival in general cohorts of ICU patients. 5,6 It is less predictive of long-term survival with selected cohorts of ICU patients such as in-hospital survivors of cardiopulmonary arrest and patients with Pneumocystis carinii infection. MEASUREMENTS AND MAIN RESULTS: 7,8The APACHE II has rarely been studied outside the ICU. Rubin et al. found a monotonic inverse relationship between APACHE II score and 30-day survival in patients receiving a transjugular intrahepatic portosystemic shunt. El-Shahawy et al. found that APACHE II score was correlated with mortality in 222 patients with acute tubular necrosis.10 Extending the APACHE II outside the ICU may be useful in predicting long-term survival. Patients with chronic obstructive pulmonary disease (COPD) exacerbation represent a spectrum of disease with a wide range of acuity. We suspect the pathophysiology of COPD exacerbation in patients admitted to the general medical floor is similar to the disease process in patients admitted to the ICU. Many of the components of APACHE II (i.e., age, oxygenation, anemia, renal insufficiency, and immunosuppression) appear to be related to mortality. This makes COPD exacerbation a good candidate disease for extending the APACHE II outside the ICU.The APACHE II has been used to predict inpatient and long-term survival in COPD patients admitted to the ICU. 11,12 Afessa et al. studied 180 patients admitted to an ICU for COPD exacerbation requiring intubation.11 APACHE II score was independently associated with hospital outcome. Breen et al. studied 74 patients admitted to the ICU for COPD exacerbation and found the partial presence of carbon dioxide (pCO 2 ) and APACHE II scores were independently associated with inpatient mortality. 12 They found no significant predictors of long-term survival.

Comparison of Death Rate in Hospitalized and Non Hospitalized Intensive Care Patients of Masih Daneshvari Hospital

“…The average APACHE score in patients who died and those who survived outside the ICU had a significant statistical difference (P < 0.05), which shows that APACHE is considerable out of the ICU from the pre-awareness point of view. This finding is compatible with the study of Goel, who showed APACHE results were a predictive tool for death in COPD patients' death treated in hospital units other that the ICU (15).…”

Predictors of Mortality in Patients with Stable COPD

“…Our results are congruent with recently published studies. 7,24,27,28 Whether co-morbidities are predictors of mortality among patients with COPD remains controversial. We did not observe an association between number of comorbidities, much as Domingo-Salvany et al found.…”

Data Reduction and Regression Using Principal Component Analysis in Qualitative Spatial Reasoning and Health Informatics

“…The liver disease model is a composition of these two functions as shown below. The mapping from linear to logistic function is described as follows [23].…”