APACHE IV Is Superior to MELD Scoring System in Predicting Prognosis in Patients after Orthotopic Liver Transplantation

Abstract

This study aims to compare the efficiency of APACHE IV with that of MELD scoring system for prediction of the risk of mortality risk after orthotopic liver transplantation (OLT). A retrospective cohort study was performed based on a total of 195 patients admitted to the ICU after orthotopic liver transplantation (OLT) between February 2006 and July 2009 in Guangzhou, China. APACHE IV and MELD scoring systems were used to predict the postoperative mortality after OLT. The area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow C statistic were used to assess the discrimination and calibration of APACHE IV and MELD, respectively. Twenty-seven patients died during hospitalization with a mortality rate of 13.8%. The mean scores of APACHE IV and MELD were 42.32 ± 21.95 and 18.09 ± 10.55, respectively, and APACHE IV showed better discrimination than MELD; the areas under the receiver operating characteristic curve for APACHE IV and MELD were 0.937 and 0.694 (P < 0.05 for both models), which indicated that the prognostic value of APACHE IV was relatively high. Both models were well-calibrated (The Hosmer-Lemeshow C statistics were 1.568 and 6.818 for APACHE IV and MELD, resp.; P > 0.05 for both). The respective Youden indexes of APACHE IV, MELD, and combination of APACHE IV with MELD were 0.763, 0.430, and 0.545. The prognostic value of APACHE IV is high but still underestimates the overall hospital mortality, while the prognostic value of MELD is poor. The function of the APACHE IV is, thus, better than that of the MELD.

Validation of APACHE IV score in postoperative liver transplantation in southern Brazil: a cohort study

“…Our results are consistent with the described by Hu et al, 6 a study in which APACHE IV presented excellent calibration and discrimination for prediction of in-hospital outcome in patients in the postoperative period of liver transplantation. The good performance of APACHE IV may be due to the weight of the physiological changes in the estimated mortality.…”

Association between the Predicted Value of APACHE IV Scores and Intensive Care Unit Mortality: A Secondary Analysis Based on EICU Dataset

“…In the past, we used APACHE II/III for the assessment, but this version proved to overestimate the mortality rate [ 1 , 5 ]. Most studies have suggested that APACHE IV has a good ability to discriminate and calibrate hospital mortality predictions, but there are few reports of significant differences among patients admitted to the emergency ICU (EICU) after organ transplantation [ 6 – 8 ]. Previous studies have shown that APACHE IV can better predict the severity of disease in EICU patients with acute trauma [ 3 ].…”

Comparison of APACHE IV with APACHE II, SAPS 3, MELD, MELD-Na, and CTP scores in predicting mortality after liver transplantation

“…A major advantage of the APACHE IV model is its accommodation of 116 detailed admitting diagnostic options, including postoperative liver transplantation, which promotes outcome analysis in specific subgroups 12 . A recent study of 195 orthotopic liver transplant patients showed that APACHE IV score (AUC 0.94) demonstrated better performance compared to MELD score (AUC 0.69) in predicting in-hospital mortality after deceased donor liver transplantation 19 . Despite the discrepancy between our study population and that from which liver transplant-specific diagnostic weighted equation of APACHE IV for mortality prediction was derived (70% living donor liver transplantation vs. 158 orthotopic liver transplantation only) 12 , our results were similar and showed that APACHE IV outperformed other scores.…”