Evaluation and comparison of the three scoring systems at 24 and 48 h of admission for prediction of mortality in an Indian ICU: a prospective cohort study

Khan, Mohd Saif; Pandey, Maitree; Agarwala, Radhika

doi:10.4103/1687-7934.159003

Cited by 6 publications

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“…Pvalue was significant for all the three scores <0.001.Author observed that the mortality rate in this study was 35% which is lesser than Khan MS et al, and Mohan A et al, which are done in India, whereas it's higher than Alejandria et al, which was done in Philippines. Average mortality reported in previous studies in India is 40.3% 2,[8][9][10]. A study by Bota PD et al, showed APACHE II to have better discriminative power than SOFA score and MODS, which is in accordance with this study for predicting the mortality 11.…”

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confidence: 90%

“…On ROC analysis, in the study done by Khan MS et al, highest sensitivity was for APACHE II (94.1%) scoring system which is concordant with this study but the highest specificity was for SOFA scoring (82.4%) which differs from this study in which SAPS II had the highest specificity. 8 According to analysis done by Mohan A et al, on comparison between…”

Section: Discussionmentioning

confidence: 99%

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Study of spectrum of sepsis and prediction of its outcome in patients admitted to ICU using different scoring systems

2019

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INTRODUCTIONSepsis is one of the leading causes of in-hospital mortality and morbidity among medical and surgical patients. Spectrum of sepsis includes sepsis, severe sepsis and septic shock. Severe sepsis accounts for one in five admissions to ICUs and is the leading cause of death in the non-coronary ICU. 1 In spite of this information regarding early predictive factors is limited.Data from western countries puts the overall incidence of sepsis ranging from 10% to 30% with mortality ranging from 10% to 56%. 2,3 Data from India suggest that the overall mortality of all sepsis patients is approximately 14% and that of severe sepsis alone is higher than 50%. 4 The early identification of sepsis and implementation of early evidence-based therapies have been documented to improve outcomes and decrease sepsis-related mortality. 5 Reducing the time to diagnosis of severe sepsis is thought to be a critical component of reducing mortality from sepsis-related multiple organ dysfunction. 6 Lack of early recognition is a major obstacle to sepsis bundle initiation. Sepsis screening tools have been developed to monitor ICU patients and their implementation has been associated with decreased sepsis-related mortality. 5,7 This study is intended to determine the spectrum of sepsis and to identify early and reliable prognostic variables for ABSTRACT Background: Although sepsis is one of the leading causes of mortality in hospitalized patients, information regarding early predictive factors for mortality and morbidity is limited. The aim was to identify reliable and early prognostic variables predicting mortality in patients admitted to ICU with sepsis. Methods: Patients fulfilling the Surviving Sepsis Campaign 2012 guidelines criteria for sepsis within the ICU were included over two years. Apart from baseline haematological, biochemical and metabolic parameters, APACHE II, SAPS II and SOFA scores were calculated on day 1 of admission. Patients were followed till death or discharge from the ICU. Chi-square test, student t-test, receiver operating curve analyses were done. Results: 100 patients were enrolled during the study period. The overall mortality was 35% (68.6% in males and 31.4% in females). Mortality was 88.6% and 11.4% in patients with septic shock and severe sepsis and none in the sepsis group, respectively. On multivariate analysis, significant predictors of mortality were APACHE II score greater than 27, SAPS II score greater than 43 and SOFA score greater than 11 on day the of admission. On ROC analysis APACHE II had the highest sensitivity (92.3%) and SAPS II had the highest specificity (82.9%). Conclusions: All three scores performed well in predicting the mortality. Overall, APACHE II had highest sensitivity, hence was the best predictor of mortality in critically ill patients. SAPS II had the highest specificity, hence it predicted improvement better than death. SOFA had intermediate sensitivity and specificity.

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confidence: 90%

Section: Discussionmentioning

confidence: 99%

Study of spectrum of sepsis and prediction of its outcome in patients admitted to ICU using different scoring systems

2019

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“…Prognostic scoring systems (PSS) like SAPS-3 and SOFA are utilized for this purpose in critical care medicine by disease severity assessment, comparing ICU performance and optimizing resource allocation. These systems use particular medical data to prognosticate an outcome's possibility of occurrence (10,12,13 ).…”

Section: Discussionmentioning

confidence: 99%

“…Calibration and the discrimination are the two objective measures that evaluate the performance of prognostic models. Calibration -the relation of the estimated mortality with the observed mortality -is claimed to be as important as the discrimination -differentiation between survivors and nonsurvivors-in the means of the ICU eligibility of the patients and comparison of care between ICUs (7,10). Nonetheless, the calibration and discrimination power of the PSS can vary in time with the improvement in healthcare and it can vary across centers (11).…”

Section: Introductionmentioning

confidence: 99%

The predictive power of SAPS-3 and SOFA scores and their relations with patient outcomes in the Surgical Intensive Care Unit

et al. 2019

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Objective: Individual risk of surgical patients is more often underestimated and there is not an absolute criterion demonstrating which patient deserves intensive care. Since a nominative assessment of these patients to quantify the intensity of critical illness is not appropriate, prognostic scores are used to assess the mortality rate and prognosis for critical patients including surgical ones. This study aimed to test the calibration power of SAPS-3 score and SOFA score of surgical patients undergoing gastrointestinal surgery, and identify any relation with patient outcomes in the department of surgical ICU. Material and Methods: This retrospective observational study was conducted during the period between August 2017 and December 2017. It was performed at a Gastroenterological Surgical ICU, a tertiary care hospital in Ankara, Türkiye. To calculate SAPS-3 and SOFA score, physiological data and laboratory analysis on the day of ICU admission were used. Records were reviewed from hospitalization to medical discharge or hospital mortality. Statistical analysis included Mann Whitney U-test and ROC-curves to predict 30-day mortality. Results: A total of 233 patients admitted to the Gastroenterological Surgical ICU were included into the study and the main reason for ICU admission was surgical problems. Mortality rate was 2.6 % (6 patients). Average SAPS-3 score was 32.5 and SOFA score was 30.1. A significant correlation was observed with the SAPS-3 score, but not with the SOFA score statistically in mortality as a dependent factor. The discriminative power, assessed using the AUC and the probability of death estimation, was satisfactory with the SAPS-3 scores (AUC 0.754) while it was lower with the SOFA score (AUC 0.631) Conclusion: We found that SAPS-3 score was significantly correlated not only with mortality rate, but also with LOS in the ICU. Nonetheless, SOFA score was not related to mortality, but related to LOS in the ICU. Prognostic score systems are used to estimate mortality but they may be used to identify LOS in the ICU and postoperative complications. It can be concluded that SAPS-3 and SOFA scores may be used to prognosticate postoperative ICU requirement.

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“…These scores also have been used as a surrogate measure of ICU performance and helpful in resource management. [4,5,6] Most of these scoring systems were developed for general ICU patients, using large population databases in European and American ICUs. The predictive accuracy of these scores in Indian ICUs may not fit well because of differences in case mix.…”

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EVALUATION OF APACHE- IV & SAPS- II SCORING SYSTEMS AND CALCULATION OF STANDARDISED MORTALITY RATE IN SEVERE SEPSIS AND SEPTIC SHOCK PATIENTS- A PROSPECTIVE OBSERVATIONAL STUDY

Chakraborty¹,

Swaika²,

Choudhuri³

et al. 2019

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BACKGROUND Sepsis and septic shock are major causes of mortality in the intensive care units worldwide. The scoring systems are very useful to predict risk of mortality and evaluating outcome in critically ill patients. In this study, we aimed to research the effectiveness of SAPS II and APACHE IV scoring systems in the evaluation of prognosis in severe sepsis and septic shock patients hospitalized in ICU. MATERIALS AND METHODS A prospective observational study was conducted on 50 consecutive patients of severe sepsis and septic shock admitted to ICU between April 2016 to April 2017. Predicted mortality was calculated using online calculator. Standardised mortality rate (SMR) was calculated with 95% confidence intervals. Calibration was assessed using Hosmer-Lemeshow test, statistic and Cohen's kappa statistic. Discrimination was assessed using receiver operating characteristic curves. RESULTS The actual mortality rate in this study was 52%. Predicted mortality rate of APACHE IV and SAPS II were 39.21% (SMR 1.32) and 45.85% (SMR 1.13) respectively. The Cohen's kappa for APACHE IV and SAPS II were 0.369 and 0.426 respectively. Hosmer-Lemeshow goodness of fit statistic indicates good logistic regression model fit for both APACHE IV and SAPS II scoring system (p value > 0.05). AUROC of APACHE IV and SAPS II were 0.748 and 0.760 respectively. CONCLUSION SAPS II had a closer prediction and better discriminative ability than APACHE IV.

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Evaluation and comparison of the three scoring systems at 24 and 48 h of admission for prediction of mortality in an Indian ICU: a prospective cohort study

Cited by 6 publications

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Study of spectrum of sepsis and prediction of its outcome in patients admitted to ICU using different scoring systems

Study of spectrum of sepsis and prediction of its outcome in patients admitted to ICU using different scoring systems

The predictive power of SAPS-3 and SOFA scores and their relations with patient outcomes in the Surgical Intensive Care Unit

EVALUATION OF APACHE- IV & SAPS- II SCORING SYSTEMS AND CALCULATION OF STANDARDISED MORTALITY RATE IN SEVERE SEPSIS AND SEPTIC SHOCK PATIENTS- A PROSPECTIVE OBSERVATIONAL STUDY

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