Validation of the APACHE IV scoring system in patients with severe sepsis and comparison with the APACHE II system

Dahhan, Talal; Jamil, Mouhamad G.; Al-Tarifi, Ashraf; Abouchala, Nabil; Kherallah, Mazen

doi:10.1186/cc7675

Cited by 13 publications

(10 citation statements)

References 1 publication

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“…Despite the increasing elderly population, the median age and severity of illness of critically ill patients admitted to ICU has remained relatively unchanged, while the hospital mortality of ICU patients has decreased by 32% between April 1 2008 and March 31 2019. When compared with international data, severity of illness adjusted mortality as assessed by APACHE IV SMR is relatively low, as is the predicted LOS ratio, suggesting that admitted cases receive efficient and high-quality care [8,[24][25][26][27][28][29]. Although the APACHE IV score had good discrimination, it overestimated the hospital mortality for ICU patients in Hong Kong.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018

Ling

et al. 2021

j intensive care

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Background Globally, mortality rates of patients admitted to the intensive care unit (ICU) have decreased over the last two decades. However, evaluations of the temporal trends in the characteristics and outcomes of ICU patients in Asia are limited. The objective of this study was to describe the characteristics and risk adjusted outcomes of all patients admitted to publicly funded ICUs in Hong Kong over a 11-year period. The secondary objective was to validate the predictive performance of Acute Physiology And Chronic Health Evaluation (APACHE) IV for ICU patients in Hong Kong. Methods This was an 11-year population-based retrospective study of all patients admitted to adult general (mixed medical-surgical) intensive care units in Hong Kong public hospitals. ICU patients were identified from a population electronic health record database. Prospectively collected APACHE IV data and clinical outcomes were analysed. Results From 1 April 2008 to 31 March 2019, there were a total of 133,858 adult ICU admissions in Hong Kong public hospitals. During this time, annual ICU admissions increased from 11,267 to 14,068, whilst hospital mortality decreased from 19.7 to 14.3%. The APACHE IV standard mortality ratio (SMR) decreased from 0.81 to 0.65 during the same period. Linear regression demonstrated that APACHE IV SMR changed by − 0.15 (95% CI − 0.18 to − 0.11) per year (Pearson’s R = − 0.951, p < 0.001). Observed median ICU length of stay was shorter than that predicted by APACHE IV (1.98 vs. 4.77, p < 0.001). C-statistic for APACHE IV to predict hospital mortality was 0.889 (95% CI 0.887 to 0.891) whilst calibration was limited (Hosmer–Lemeshow test p < 0.001). Conclusions Despite relatively modest per capita health expenditure, and a small number of ICU beds per population, Hong Kong consistently provides a high-quality and efficient ICU service. Number of adult ICU admissions has increased, whilst adjusted mortality has decreased over the last decade. Although APACHE IV had good discrimination for hospital mortality, it overestimated hospital mortality of critically ill patients in Hong Kong.

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Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018

Ling

et al. 2021

j intensive care

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“…Baseline data (including age, sex, medical vs surgical admission, planned vs emergency admission, and highest Acute Physiology and Chronic Health Evaluation IV [APACHE-IV] and Sequential Organ Failure Assessment [SOFA] score) were collected. [7][8] In case of readmission, the highest score overall was collected. Data on the clinical parameters at the time of death or within 12 hours prior to death were retrospectively collected from the medical charts.…”

Section: Data Collectionmentioning

confidence: 99%

Causes of Mortality in ICU-Acquired Weakness

Wagenberg

Witteveen

Horn

2017

J Intensive Care Med

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“…The APACHE IV determines the severity of illness by including a number of physiological, biochemical and demographic (e.g. age, blood pressure and chronic health status) variables to calculate a numerical score to assess the predicted risk of death 18 . Hospital LOS was defined as the total number of days that a patient stayed in hospital, including ICU stay, from the time of admission.…”

Section: Methodsmentioning

confidence: 99%

Transfer Time from the Intensive Care Unit and Patient Outcome: A Retrospective Analysis from a Tertiary Care Hospital in India

Chatterjee

Sinha

Todi

2019

Indian Journal of Critical Care Medicine

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Background and aims Patients' outcome after ICU transfer reflect hospital's post-ICU care status. This study assessed association of after-hour ICU transfer on patient outcome. Subjects and methods Single-centre, retrospective analysis of data between March 2016 and April 2017 was performed at a tertiary-care hospital in India. Patient data were collected on all consecutive ICU admissions during study period. Patients were categorized according to ICU transfer time into daytime (08:00-19:59 hours) and after-hour (20:00-07:59 hours). Patients transferred to other ICUs/hospitals, died in ICU, or discharged home from ICU were excluded. Only ?rst ICU admission was considered for outcome analysis. Primary outcome-hospital mortality; secondary outcomes-ICU readmission and hospital length of stay (LOS). All analysis were adjusted for illness severity. Results Of 1857 patients admitted during study period,1356 were eligible for study; out of which 53.9% were males and 383(28%) patients transferred during after-hour. Mean age of two groups (daytime vs. after-hour 65.7±15.2 vs. 66.3±16.2 years) was similar ( p = 0.7). Mean APACHE IV score was comparable between daytime vs. after-hour transfers (45.6±20.4 vs 46.8±22; p = 0.05). Unadjusted hospital mortality rate of after-hour-transfers was significantly higher compared to daytime-transfers (7.1% vs. 4.1%; p = 0.02). After adjustment with illness severity, after-hour-transfers were associated with significantly higher hospital mortality compared to daytime-transfers(aOR1.7, 95%CI 1.1,2.8; p = 0.04). Median duration of hospital LOS and ICU readmission though higher for after-hour-transfers, was not statistically significant in adjusted analysis (aOR hospitalLOS 1.1, 95% CI 0.8, 1.4, p = 0.5; aOR readmission 1.6, 95% CI 0.9,2.7; p = 0.06, respectively). Conclusion After-hour-transfers from ICU is associated with significantly higher hospital mortality. Hospital LOS and readmission rates are similar for daytime and after-hour -transfers. How to cite this article Chatterjee S, Sinha S et al ., Transfer Time from the Intensive Care Unit and Patient Outcome: A Retrospective Analysis from a Tertiary Care Hospital in India. Indian J Crit Care Med 2019;23(3):115-121.

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Validation of the APACHE IV scoring system in patients with severe sepsis and comparison with the APACHE II system

Cited by 13 publications

References 1 publication

Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018

Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018

Causes of Mortality in ICU-Acquired Weakness

Transfer Time from the Intensive Care Unit and Patient Outcome: A Retrospective Analysis from a Tertiary Care Hospital in India

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