Mortality Predictions Using Current Physiologic Scoring Systems in Patients Meeting Criteria for Early Goal-Directed Therapy and the Severe Sepsis Resuscitation Bundle

Abstract

Physiologic scoring systems are often used to prognosticate mortality in critically ill patients. This study examined the performance of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, Mortality in Emergency Department Sepsis (MEDS), and Mortality Probability Models (MPM) II0 in predicting in-hospital mortality of patients in the emergency department meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle. The discrimination and calibration characteristics of APACHE II, SAPS II, MEDS, and MPM II0 were evaluated. Data are presented as median and quartiles (25th, 75th). Two-hundred forty-six patients aged 68 (52, 81) years were analyzed from a prospectively maintained sepsis registry, with 76.0% of patients in septic shock, 45.5% blood culture positive, and 35.0% in-hospital mortality. Acute Physiology and Chronic Health Evaluation II, SAPS II, and MEDS scores were 29 (21, 37), 54 (40, 70), and 13 (11, 16), with predicted mortalities of 64% (40%, 85%), 58% (25%, 84%), and 16% (9%, 39%), respectively. Mortality Probability Models II0 showed a predicted mortality of 60% (27%, 80%). The area under the receiver operating characteristic curves was 0.73 for APACHE II, 0.71 for SAPS II, 0.60 for MEDS, and 0.72 for MPM II0. The standardized mortality ratios were 0.59, 0.63, 1.68, and 0.64, respectively. Thus, APACHE II, SAPS II, MEDS, and MPM II0 have variable abilities to discriminate early and estimate in-hospital mortality of patients presenting to the emergency department requiring the severe sepsis resuscitation bundle. Adoption of these prognostication tools in this setting may influence therapy and resource use for these patients.

The impact of prior long-term versus short-term statin use on the mortality of bacteraemic patients

“…Several scoring systems for assessing the severity of clinical conditions, such as the Acute Physiology and Chronic Health Evaluation (APACHE II and APACHE III) [30], the Simplified Acute Physiology Score (SAPS), the Sepsis-related Organ Failure Assessment (SOFA), the Mortality Probability Model (MPM) [28], and Charlson comorbidity index, have been developed for use in intensive care units [16,[31][32][33][34]. In our study, we used the MEDS, SOFA, and Charlson comorbidity index for assessing the severity, comorbidity index, and the outcome of our patients.…”

Comparison of Predisposition, Insult/Infection, Response, and Organ dysfunction, Acute Physiology And Chronic Health Evaluation II, and Mortality in Emergency Department Sepsis in patients meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle

“…Specifically, the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system is currently used in the United States to determine patient severity and therapeutic indication for recombinant human activated protein C (rhAPC) as part of the severe sepsis bundle [13]. For the ED setting, the Mortality in Emergency Department Sepsis (MEDS) score has been evaluated in patients with suspected infection, but its accuracy in predicting mortality in the very high-R patients with severe sepsis and septic shock is limited [14,15]. Furthermore, the MEDS score requires the clinician to subjectively determine if the patient is to succumb from illness within the next 30 days [16].…”

The Mortality in Emergency Department Sepsis Score as a Predictor of 1-Month Mortality among Adult Patients with Sepsis: Weighing the Evidence

“…However, the discriminatory power of the MEDS score in predicting mortality does not seem to be consistent across different risk groups, being more accurate for low-risk patients and less for those in the high-risk group [13,14]. This is thought to be attributable to the low mortality rate among the MEDS score's derivation cohort, thereby inherently underestimating the risk when it is applied to populations with higher baseline mortality rates like those with severe sepsis and septic shock [13,15].…”

“…The performance of the MEDS score has been validated in various populations and appears to compare favourably in some reports with other clinical scores like the Acute Physiology and Chronic Health Evaluation (APACHE) II, the Confusion, Urea, Respiratory Rate, Blood Pressure, 65 Years or Older (CURB-65), and the modified Rapid Emergency Medicine Score (mREMS) [10][11][12]. However, the discriminatory power of the MEDS score in predicting mortality does not seem to be consistent across different risk groups, being more accurate for low-risk patients and less for those in the high-risk group [13,14]. This is thought to be attributable to the low mortality rate among the MEDS score's derivation cohort, thereby inherently underestimating the risk when it is applied to populations with higher baseline mortality rates like those with severe sepsis and septic shock [13,15].…”