External validation of a modified model of Acute Physiology and Chronic Health Evaluation (APACHE) II for orthotopic liver transplant patients

Arabi, Yaseen M.; Abbasi, Adnan; Goraj, Radosław; Al-Abdulkareem, Abdulmajeed; Shimemeri, Abudullah Al; Kalayoğlu, Münci; Wood, Kenneth E.

doi:10.1186/cc1497

Cited by 21 publications

(10 citation statements)

References 19 publications

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“…An attempt to calibrate APACHE II for postoperative liver transplant patients (25-28) resulted in the overestimation of mortality, although to a lesser degree when compared with the original model. Arabi et al (27) used the recalibration of APACHE II proposed by Angus et al (26), and the results were the same as those obtained in the study by the latter group.…”

Section: Discussionsupporting

confidence: 57%

“…We recommend using different scores that consider each transplant's peculiar characteristics that contribute to post-transplantation mortality, such as MELD score variables for liver transplant patients (27-30), which account for creatinine, prothrombin time (INR) and bilirubin. For example, SAPS3 does not consider prothrombin time, a liver function marker that is an important variable.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Is SAPS 3 better than APACHE II at predicting mortality in critically ill transplant patients?

Oliveira¹,

Brauner²,

Filho³

et al. 2013

Clinics

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OBJECTIVES:This study compared the accuracy of the Simplified Acute Physiology Score 3 with that of Acute Physiology and Chronic Health Evaluation II at predicting hospital mortality in patients from a transplant intensive care unit.METHOD:A total of 501 patients were enrolled in the study (152 liver transplants, 271 kidney transplants, 54 lung transplants, 24 kidney-pancreas transplants) between May 2006 and January 2007. The Simplified Acute Physiology Score 3 was calculated using the global equation (customized for South America) and the Acute Physiology and Chronic Health Evaluation II score; the scores were calculated within 24 hours of admission. A receiver-operating characteristic curve was generated, and the area under the receiver-operating characteristic curve was calculated to identify the patients at the greatest risk of death according to Simplified Acute Physiology Score 3 and Acute Physiology and Chronic Health Evaluation II scores. The Hosmer-Lemeshow goodness-of-fit test was used for statistically significant results and indicated a difference in performance over deciles. The standardized mortality ratio was used to estimate the overall model performance.RESULTS:The ability of both scores to predict hospital mortality was poor in the liver and renal transplant groups and average in the lung transplant group (area under the receiver-operating characteristic curve = 0.696 for Simplified Acute Physiology Score 3 and 0.670 for Acute Physiology and Chronic Health Evaluation II). The calibration of both scores was poor, even after customizing the Simplified Acute Physiology Score 3 score for South America.CONCLUSIONS:The low predictive accuracy of the Simplified Acute Physiology Score 3 and Acute Physiology and Chronic Health Evaluation II scores does not warrant the use of these scores in critically ill transplant patients.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Is SAPS 3 better than APACHE II at predicting mortality in critically ill transplant patients?

Oliveira¹,

Brauner²,

Filho³

et al. 2013

Clinics

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“…Although liver transplantation is widely conducted, the mortality remains significantly high as much as 5%~8% [2]. …”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Liu

et al. 2013

Clinical and Developmental Immunology

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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.

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“…The APACHE II score 8 , introduced in 1985, is an old version of the APACHE system but still widely used because of its simplicity and capability of classifying severity of illness and predicting hospital mortality 14 . The APACHE II score did not have liver transplantation in the diagnostic category and was shown to overestimate in-hospital mortality in postoperative liver transplantation patients unless orthotopic liver transplantation specific diagnostic weight was applied 15 . The liver transplant-specific coefficients using original APACHE II score was reported to be a good predictor of hospital and 1 year mortality after liver transplantation 16 and in our study, the performance of liver transplant-specific coefficient of APACHE II score was similar to the performance of the APACHE II score.…”

Section: Discussionmentioning

confidence: 96%

“…In addition, unique perioperative aspects of hepatic dysfunction and liver transplantation such as hypotension, lactic acidosis, and coagulopathy followed by subsequent rapid recovery after transplantation may be reflected in APACHE scores and SAPS 27 , 28 . Liver transplant patients are unique in that the wide variety of abnormalities quickly recover after transplantation, which may explain the inaccuracy of APACHE II when the diagnostic category weight of ‘postoperative gastrointestinal surgery’ is used 15 .…”

Section: Discussionmentioning

confidence: 99%

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

Lee

Yoon

et al. 2017

Sci Rep

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The Acute Physiology and Chronic Health Evaluation (APACHE) IV score and Simplified Acute Physiology Score (SAPS) 3 include liver transplantation as a diagnostic category. The performance of APACHE IV-liver transplantation (LT) specific predicted mortality, SAPS 3, APACHE II, Model for End-stage Liver Disease (MELD)-Na, MELD, and CTP scores in predicting in-hospital and 1 year mortality in liver transplant patients was compared using 590 liver transplantations in a single university hospital. In-hospital mortality and 1 year mortality were 2.9% and 4.2%, respectively. The APACHE IV-LT specific predicted mortality showed better performance in predicting in-hospital mortality (AUC 0.91, 95% CI [0.86–0.96]) compared to SAPS 3 (AUC 0.78, 95% CI [0.66–0.90], p = 0.01), MELD-Na (AUC 0.74, 95% CI [0.57–0.86], p = 0.01), and CTP (AUC 0.68, 95% CI [0.54–0.81], p = 0.01). The APACHE IV-LT specific predicted mortality showed better performance in predicting 1 year mortality (AUC 0.83, 95% CI [0.76–0.9]) compared to MELD-Na (AUC 0.67, 95% CI [0.55–0.79], p = 0.04) and CTP (AUC 0.64, 95% CI [0.53–0.75], p = 0.03), and also in all MELD groups and in both living and deceased donor transplantation. The APACHE IV-LT specific predicted mortality showed better performance in predicting in-hospital and 1 year mortality after liver transplantation.

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External validation of a modified model of Acute Physiology and Chronic Health Evaluation (APACHE) II for orthotopic liver transplant patients

Cited by 21 publications

References 19 publications

Is SAPS 3 better than APACHE II at predicting mortality in critically ill transplant patients?

Is SAPS 3 better than APACHE II at predicting mortality in critically ill transplant patients?

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

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

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