Prognostic utilization of models based on the APACHE II, APACHE IV, and SAPS II scores for predicting in-hospital mortality in emergency department

Rahmatinejad, Zahra; Tohidinezhad, Fariba; Reihani, Hamidreza; Rahmatinejad, Fatemeh; Pourmand, Ali; Abu‐Hanna, Ameen; Eslami, Saeid

doi:10.1016/j.ajem.2020.05.053

Cited by 38 publications

(25 citation statements)

References 27 publications

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“…For risk classification based on a single cut-off, redefining the score model to improve discrimination performance means to determine new cut-off values or combining different predictors. In this study, we confirmed the moderate prognostic value of the single SAPS II score as observed in previous studies performed in ED [ 24 , 25 ]. However, when we considered the performance of NEWS2 in low-risk patients combined with that of SAPS II in high-risk patients, we observed an increment in this prognostic value.…”

Section: Discussionsupporting

confidence: 92%

Prognostic scores and early management of septic patients in the emergency department of a secondary hospital: results of a retrospective study

et al. 2021

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Background Sequential Organ Failure Assessment (SOFA) and other illness prognostic scores predict adverse outcomes in critical patients. Their validation as a decision-making tool in the emergency department (ED) of secondary hospitals is not well established. The aim of this study was to compare SOFA, NEWS2, APACHE II, and SAPS II scores as predictors of adverse outcomes and decision-making tool in ED. Methods Data of 121 patients (age 73 ± 10 years, 58% males, Charlson Comorbidity Index 5.7 ± 2.1) with a confirmed sepsis were included in a retrospective study between January 2017 and February 2020. Scores were computed within the first 24 h after admission. Primary outcome was the occurrence of either in-hospital death or mechanical ventilation within 7 days. Secondary outcome was 30-day all-cause mortality. Results Patients older than 64 years (elderly) represent 82% of sample. Primary and secondary outcomes occurred in 40 and 44%, respectively. Median 30-day survival time of dead patients was 4 days (interquartile range 1–11). The best predictive score based on the area under the receiver operating curve (AUROC) was SAPS II (0.823, 95% confidence interval, CI, 0.744–0.902), followed by APACHE II (0.762, 95% CI 0.673–0.850), NEWS2 (0.708, 95% CI 0.616–0.800), and SOFA (0.650, 95% CI 0.548–0.751). SAPS II cut-off of 49 showed the lowest false-positive rate (12, 95% CI 5–20) and the highest positive predictive value (80, 95% CI 68–92), whereas NEWS2 cut-off of 7 showed the lowest false-negative rate (10, 95% CI 2–19) and the highest negative predictive value (86, 95% CI 74–97). By combining NEWS2 and SAPS II cut-offs, we accurately classified 64% of patients. In survival analysis, SAPS II cut-off showed the highest difference in 30-day mortality (Hazards Ratio, HR, 5.24, 95% CI 2.99–9.21, P < 0.001). Best independent negative predictors of 30-day mortality were body temperature, mean arterial pressure, arterial oxygen saturation, and hematocrit levels. Positive predictors were male sex, heart rate and serum sodium concentration. Conclusions SAPS II is a good prognostic tool for discriminating high-risk patient suitable for sub-intensive/intensive care units, whereas NEWS2 for discriminating low-risk patients for low-intensive units. Our results should be limited to cohorts with a high prevalence of elderly or comorbidities.

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Section: Discussionsupporting

confidence: 92%

Prognostic scores and early management of septic patients in the emergency department of a secondary hospital: results of a retrospective study

et al. 2021

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“…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 ]. Due to the complexity of the disease, mortality after admission to the EICU is usually related to age, prior chronic disease status, and the presence or absence of complicated organ failure [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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

Chao

Niu

2022

Computational and Mathematical Methods in Medicine

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Objective. The evidence regarding the relationship between Acute Physiological and Chronic Health Assessment (APACHE) IV scores and emergency intensive care unit (EICU) mortality in patients following organ transplantation remains controversial. The purpose of this study was to investigate the relationship between APACHE IV score and EICU mortality. Methods. Data from 391 American men and women admitted to the EICU after undergoing organ transplants including heart, bone marrow, liver, kidney, lung, and pancreas in the United States. We used this data to analyze the relationship between APACHE IV scores and in-hospital mortality in the postoperative EICU. The primary endpoint was ICU hospitalization mortality after organ transplantation. The entire study data was extracted from the EICU database and uploaded to the DataDryad website. Results. Interaction tests indicate age, respiratory failure, and hormone use can modify the association between APACHE IV and EICU mortality. A stronger association of APACHE and mortality can be observed at <60 years old, no respiratory failure, and no use of hormones. In contrast, there was no association between respiratory failure, hormone use, APACHE, and ICU mortality in patients over 60 years of age. Conclusion. When using the APACHE score for risk stratification of critically ill patients after transplantation, the patient’s age, respiratory failure, and use of hormones should be taken into account.

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“…Res. Public Health 2020, 17, 8367 2 of 11 order to assess the degree of organ dysfunction as accurately as possible and allow the prognoses of patients to be assessed throughout their hospitalization [1,2]. Among them, sequential organ failure assessment (SOFA) scores were initially developed to assess organ failure related to sepsis, with this being applied in recent years to a wide variety of clinical processes, especially in critical pathologies [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Role of qSOFA and SOFA Scoring Systems for Predicting In-Hospital Risk of Deterioration in the Emergency Department

López-Izquierdo

Brio-Ibañez

Martin-Rodríguez

et al. 2020

IJERPH

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The objective of this study was to analyze and compare the usefulness of quick sequential organ failure assessment score (qSOFA) and sequential organ failure assessment (SOFA) scores for the detection of early (two-day) mortality in patients transported by emergency medical services (EMSs) to the emergency department (ED) (infectious and non-infectious). We performed a multicentric, prospective and blinded end-point study in adults transported with high priority by ambulance from the scene to the ED with the participation of five hospitals. For each score, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was calculated. We included 870 patients in the final cohort. The median age was 70 years (IQR 54–81 years), and 338 (38.8%) of the participants were women. Two-day mortality was 8.3% (73 cases), and 20.9% of cases were of an infectious pathology. For two-day mortality, the qSOFA presented an AUC of 0.812 (95% CI: 0.75–0.87; p < 0.001) globally with a sensitivity of 84.9 (95% CI: 75.0–91.4) and a specificity of 69.4 (95% CI: 66.1–72.5), and a SOFA of 0.909 (95% CI: 0.86–0.95; p < 0.001) with sensitivity of 87.7 (95% CI: 78.2–93.4) and specificity of 80.7 (95% CI: 77.4–83.3). The qSOFA score can serve as a simple initial assessment to detect high-risk patients, and the SOFA score can be used as an advanced tool to confirm organ dysfunction.

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Prognostic utilization of models based on the APACHE II, APACHE IV, and SAPS II scores for predicting in-hospital mortality in emergency department

Cited by 38 publications

References 27 publications

Prognostic scores and early management of septic patients in the emergency department of a secondary hospital: results of a retrospective study

Prognostic scores and early management of septic patients in the emergency department of a secondary hospital: results of a retrospective study

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

Role of qSOFA and SOFA Scoring Systems for Predicting In-Hospital Risk of Deterioration in the Emergency Department

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