A comparative study of four intensive care outcome prediction models in cardiac surgery patients
Fabian DoerrAkmal M.A. BadreldinMatthias HeldweinTorsten BossertMarkus RichterThomas LehmannO BayerKhosro Hekmat
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Abstract Background Outcome prediction scoring systems are increasingly used in intensive care medicine, but most were not developed for use in cardiac surgery patients. We compared the performance of four intensive care outcome prediction scoring systems (Acute Physiology and Chronic Health Evaluation II [APACHE II], Simplified Acute Physiology Score II [SAPS II], Sequential Organ Failure Assessment [SOFA], and Cardiac Surgery Score [CASUS]) in patients after open heart surgery. Methods We prospectively included all consecutive adult patients who underwent open heart surgery and were admitted to the intensive care unit (ICU) between January 1 st 2007 and December 31 st 2008. Scores were calculated daily from ICU admission until discharge. The outcome measure was ICU mortality. The performance of the four scores was assessed by calibration and discrimination statistics. Derived variables (Mean- and Max- scores) were also evaluated. Results During the study period, 2801 patients (29.6% female) were included. Mean age was 66.9 ± 10.7 years and the ICU mortality rate was 5.2%. Calibration tests for SOFA and CASUS were reliable throughout (p-value not < 0.05), but there were significant differences between predicted and observed outcome for SAPS II (days 1, 2, 3 and 5) and APACHE II (days 2 and 3). CASUS, and its mean- and maximum-derivatives, discriminated better between survivors and non-survivors than the other scores throughout the study (area under curve ≥ 0.90). In order of best discrimination, CASUS was followed by SOFA, then SAPS II, and finally APACHE II. SAPS II and APACHE II derivatives had discrimination results that were superior to those of the SOFA derivatives. Conclusions CASUS and SOFA are reliable ICU mortality risk stratification models for cardiac surgery patients. SAPS II and APACHE II did not perform well in terms of calibration and discrimination statistics.Keywords:
SAPS II
Cardiothoracic surgery
SOFA score
Aim: To compare the APACHE II, SAPS II and SOFA scoring systems as predictors of mortality in ICU patients in terms of sensitivity, specificity and accuracy. Methodology: A prospective observational study. Intensive care unit from May 13, 2018 to September 15, 2021. For 1368 patients included in study, results for APACHE II, SAPS II and SOFA were calculated with the worst values recorded. At the end of ICU stay, patient outcome was labelled as survivors and non-survivors. The cut off value for APACHE II, SAPS II and SOFA was taken as 50% of the highest possible score, with <50% expected to survive and with ≥50% expected to die during their ICU stay. Cross tables were made against real outcome of the patients, and sensitivity, specificity and accuracy for APACHE II, SAPS II and SOFA were calculated. Results: Sensitivity, specificity and accuracy were 77.53%, 94.28% and 85.45% for APACHE II scoring system; 47.29%, 87.32%, and 66.23% for SAPS II scoring system; and 73.37%, 60.28%, and 67.18% for SOFA scoring system, respectively. Conclusion: Apache Ii scoring system has highest sensitivity, specificity and accuracy in mortality prediction in ICU patients as compared to SAPS II and SOFA scoring systems, with SAPS II being least sensitive and accurate. Keywords: Sensitivity, specificity, accuracy, Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II), Sequential Organ Failure Assessment (SOFA), Intensive care units (ICU), Mortality.
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This study assessed the ability of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology, Chronic Health Evaluation (APACHE) II scoring systems, as well as the Simplified Acute Physiology Score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with organophosphate. The medical records of 149 organophosphate poisoned patients admitted to the ICU from September 2006 to December 2012 were retrospectively examined. The SOFA, APACHE II, and SAPS II were calculated based on initial laboratory data in the Emergency Department, and during the first 24 hr of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II equations. The ability to predict group mortality by the SOFA score, APACHE II score, and SAPS II method was assessed using two by two decision matrices and receiver operating characteristic (ROC) curve analysis. A total of 131 patients (mean age, 61 yr) were enrolled. The sensitivities, specificities, and accuracies were 86.2%, 82.4%, and 83.2% for the SOFA score, respectively; 65.5%, 68.6%, and 67.9% for the APACHE II scoring system, respectively; and 86.2%, 77.5%, and 79.4% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.896, 0.716, and 0.852, respectively. In conclusion, the SOFA, APACHE II, and SAPS II have different capability to discriminate and estimate early in-hospital mortality of organophosphate poisoned patients. The SOFA score is more useful in predicting mortality, and easier and simpler than the APACHE II and SAPS II.
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We investigated the prognostic performance of scoring systems by the intensive care unit (ICU) type. This was a retrospective observational study using data from the Marketplace for Medical Information in the Intensive Care IV database. The primary outcome was in-hospital mortality. We obtained Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) III, and Simplified Acute Physiology Score (SAPS) II scores in each ICU type. Prognostic performance was evaluated with the area under the receiver operating characteristic curve (AUROC) and was compared among ICU types. A total of 29,618 patients were analyzed, and the in-hospital mortality was 12.4%. The overall prognostic performance of APACHE III was significantly higher than those of SOFA and SAPS II (0.807, [95% confidence interval, 0.799-0.814], 0.785 [0.773-0.797], and 0.795 [0.787-0.811], respectively). The prognostic performance of SOFA, APACHE III, and SAPS II scores was significantly different between ICU types. The AUROC ranges of SOFA, APACHE III, and SAPS II were 0.723-0.826, 0.728-0.860, and 0.759-0.819, respectively. The neurosurgical and surgical ICUs had lower prognostic performance than other ICU types. The prognostic performance of scoring systems in patients with suspected infection is significantly different according to ICU type. APACHE III systems have the highest prediction performance. ICU type may be a significant factor in the prognostication.
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Background: The Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scales are scoring systems used in intensive care units (ICUs) worldwide. We aimed to investigate their usefulness in predicting short- and long-term prognosis in the local ICU. Methods: This single-center observational study covered 905 patients admitted from 1 January 2015 to 31 December 2017 to a tertiary mixed ICU. SAPS II, APACHE II, and SOFA scores were calculated based on the worst values from the first 24 h post-admission. Patients were divided into surgical (SP) and nonsurgical (NSP) subjects. Unadjusted ICU and post-ICU discharge mortality rates were considered the outcomes. Results: Baseline SAPS II, APACHE II, and SOFA scores were 41.1 ± 20.34, 14.07 ± 8.73, and 6.33 ± 4.12 points, respectively. All scores were significantly lower among SP compared to NSP (p < 0.05). ICU mortality reached 35.4% and was significantly lower for SP (25.3%) than NSP (57.9%) (p < 0.001). The areas under the receiver-operating characteristic (ROC) curves were 0.826, 0.836, and 0.788 for SAPS II, APACHE II, and SOFA scales, respectively, for predicting ICU prognosis, and 0.708, 0.709, and 0.661 for SAPS II, APACHE II, and SOFA, respectively, for post-ICU prognosis. Conclusions: Although APACHE II and SAPS II are good predictors of ICU mortality, they failed to predict survival after discharge. Surgical patients had a better prognosis than medical ICU patients.
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ICU prognostic scores were developed to measure the severity of the disease and the patients' prognosis. The objective of this study was to assess the validity of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score II (SAPS II) scores in patients with septic shock.The APACHE II, SOFA and SAPS II scores were determined prospectively, in the first 24 hours after admission, for all 56 patients with septic shock who were included in this study. Data were statistically evaluated; the discriminating power regarding survivors vs deceased patients was calculated based on the receiver operating characteristic curves (ROC).The overall mortality of the 56 patients with septic shock was 60.71% (34 deaths). The average APACHE II score was 25.36 ± 7.477. The average SOFA score was 7.679 ± 3.197. The average SAPS II score was 44.45 ± 16.97. For the APACHE II and SOFA scores the differences when deceased and survivors were compared were not statistically significant (APACHE II: 26.76 ± 6.742 vs 23.18 ± 8.175 respectively for SOFA: 8.029 ± 3.099 vs 7.136 ± 3.342). For the SAPS II score the values are: 49.12 ± 16.61 in deceased vs 37.23 ± 15.20 in survivors, the difference being statistically significant (p = 0.0092). The areas under ROC for the three scores are 0.622 for APACHE II, 0.575 for SAPS II and 0.705 for SOFA.In our study the SAPS II score was superior to the other scores for predicting survival in patients with septic shock.Scorurile de prognostic utilizate în Terapie Intensivă au fost dezvoltate cu scopul de a cuantifica severitatea boli şi prognosticul pacientului. Obiectivul acestui studiu a fost de a aprecia validitatea scorurile utilizate în prezent (APACHE II, SOFA şi SAPS II) în cazul pacienţilor cu şoc septic.Au fost calculate în primele 24 de ore de la internare, scorurile APACHE II, SOFA şi SAPS II pentru toţi cei 56 de pacienţi, cu şoc septic, care au fost înrolaţi prospectiv în studiu. Datele obţinute au fost evaluate statistic iar puterea de diferenţiere dintre supravieţuitori vs decedaţi a fost calculată conform curbelor ROC (receiver operating characteristic).Mortalitatea generală a celor 56 de pacienţi cu şoc septic a fost de 60,71% (34 decese). Scorul mediu APACHE II a fost de 25,36 ± 7,477, scorul mediu SOFA a fost de 7,679 ± 3,197 iar scorul mediu SAPS II de 44,45 ± 16,97. Pentru scorurile APACHE II şi SOFA diferenţele dintre supravieţuitori şi decedaţi nu au fost semnificative statistic (APACHE II: 26,76 ± 6,742 vs 23,18 ± 8,175 respectiv pentru SOFA: 8,029 ± 3,099 vs 7,136 ± 3,342). Scorurile SAPS II medii au fost în cazul decedaţilor de 49,12 ± 16,61 vs 37, 23 ± 15,20 în cazul supravieţuitorilor, cu o diferenţă semnificativă statistic între grupuri (p = 0,0092). Ariile de sub curbele ROC pentru cele trei scoruri au fost 0,622 pentru APACHE II, 0,575 pentru SAPS II şi 0,705 pentru SOFA.În studiul nostru scorul SAPS II a fost superior celorlalte scoruri în ce priveşte capacitatea de predicţie a supravieţuirii la pacientul cu şoc septic.
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Acute organophosphate (OP) poisoning accounts for a large number of intoxication cases treated in the Intensive Care Unit (ICU). The aim of this study is to evaluate the performance of APACHE II, SAPS II, and SOFA scoring systems for predicting mortality of OP poisoned patients admitted to the ICU. Subjects and methods: Seventy three OP intoxicated patients admitted to the ICU of the PCC-ASUH during the period from June 2013 to June 2015 were prospectively evaluated through a cross sectional hospital based study. Results: An APACHE II score of 10.5 or more was predictive of mortality, with 53.57 % sensitivity and 97.78% specificity. A SAPS II score of 25 or more was predictive of mortality, with 75.00 % sensitivity and 84.44% specificity. A SOFA score of 2.5 or more was predictive of mortality, with 75.00 % sensitivity and 91.11 % specificity. Conclusion:The three scoring systems, APACHE II, SAPS II, and SOFA, were more precise in differentiating the survivors from the non survivors than plasma butyrylcholinesterase.
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Sepsis is a life-threatening organ dysfunction with high mortality and morbidity. Various mortality prediction scores are currently in use for prediction of mortality. Although combination of various scores have not been used before. The aim of the study was to compare SOFA, APACHE II, SAPS II, as a predictor of mortality and to assess the usefulness of combination of different scores.A one-year hospital based prospective study conducted from 1st January 2020 to 31st December 2020 in medical ICU, where 100 patients of sepsis admitted in ICU with evidence of organ dysfunction were included in the study and various scores like SOFA, APACHE II, and SAPS II were calculated at 24 and 48 hours of admission, using laboratory results and clinical examination. and an attempt to access for predictive accuracy of combination of scores was undertaken.Majority of the patients (37%) were in the age group of 60-79 years with maximum mortality in this age group of (39.22 %). Mortality rate was 51%, with higher mortality in the female group being 68.63%. Diabetes was most common comorbid in our study (41%). No significant difference was observed in physiological variable over 24 and 48 hours, however decrease in WBC and platelet count was noted at the end of 48 hours; Mean SOFA, APACHE II, SAPS II were significantly higher in the mortality group than the recovery group; All three scores had good diagnostic performance, with max sensitivity at 24 and 48 hours with APACHE II being 64.10% and 78.79% respectively, max specificity at 24 and 48 hours was noticed with SAPS II being 96.97% and 87.88% respectively. On further combination of scores, maximum sensitivity was seen with SOFA plus APACHE II at 48 hours of 74.36%, maximum specificity was seen at 24 hours with SOFA plus SAPS II of 93.94%. Upon application of Youden's index to the combination of scores, best diagnostic performance was seen with SOFA plus SAPS II at 48 hours.All the three scores showed good mortality prediction rate but among the scores higher sensitivity was seen with APACHE II score at 24 and 48 hours and higher specificity was seen with SAPS II at 24 and 48 hours. Combination of scores did show a slightly better predictability with combination of SAPS II and SOFA showing maximum Youden's index at 48 hours. Mortality was comparatively higher among the females and elderly group with most common risk factor being diabetes.
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Scoring systems in critical care patients are essential for predicting of the patient outcome and evaluating the therapy. In this study, we determined the value of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA) and Glasgow Coma Scale (GCS) scoring systems in the prediction of mortality in adult patients admitted to the intensive care unit (ICU) with severe purulent bacterial meningitis.We retrospectively analysed data from 98 adult patients with severe purulent bacterial meningitis who were admitted to the single ICU between March 2006 and September 2015.Univariate logistic regression identified the following risk factors of death in patients with severe purulent bacterial meningitis: APACHE II, SAPS II, SOFA, and GCS scores, and the lengths of ICU stay and hospital stay. The independent risk factors of patient death in multivariate analysis were the SAPS II score, the length of ICU stay and the length of hospital stay. In the prediction of mortality according to the area under the curve, the SAPS II score had the highest accuracy followed by the APACHE II, GCS and SOFA scores.For the prediction of mortality in a patient with severe purulent bacterial meningitis, SAPS II had the highest accuracy.
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ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Kądziołka I, Świstek R, Borowska K, Tyszecki P, Serednicki W. Validation of APACHE II and SAPS II scales at the intensive care unit along with assessment of SOFA scale at the admission as an isolated risk of death predictor. Anaesthesiology Intensive Therapy. 2019;51(2):107-111. doi:10.5114/ait.2019.86275. APA Kądziołka, I., Świstek, R., Borowska, K., Tyszecki, P., & Serednicki, W. (2019). Validation of APACHE II and SAPS II scales at the intensive care unit along with assessment of SOFA scale at the admission as an isolated risk of death predictor. Anaesthesiology Intensive Therapy, 51(2), 107-111. https://doi.org/10.5114/ait.2019.86275 Chicago Kądziołka, Izabela, Rafał Świstek, Karolina Borowska, Paweł Tyszecki, and Wojciech Serednicki. 2019. "Validation of APACHE II and SAPS II scales at the intensive care unit along with assessment of SOFA scale at the admission as an isolated risk of death predictor". Anaesthesiology Intensive Therapy 51 (2): 107-111. doi:10.5114/ait.2019.86275. Harvard Kądziołka, I., Świstek, R., Borowska, K., Tyszecki, P., and Serednicki, W. (2019). Validation of APACHE II and SAPS II scales at the intensive care unit along with assessment of SOFA scale at the admission as an isolated risk of death predictor. Anaesthesiology Intensive Therapy, 51(2), pp.107-111. https://doi.org/10.5114/ait.2019.86275 MLA Kądziołka, Izabela et al. "Validation of APACHE II and SAPS II scales at the intensive care unit along with assessment of SOFA scale at the admission as an isolated risk of death predictor." Anaesthesiology Intensive Therapy, vol. 51, no. 2, 2019, pp. 107-111. doi:10.5114/ait.2019.86275. Vancouver Kądziołka I, Świstek R, Borowska K, Tyszecki P, Serednicki W. Validation of APACHE II and SAPS II scales at the intensive care unit along with assessment of SOFA scale at the admission as an isolated risk of death predictor. Anaesthesiology Intensive Therapy. 2019;51(2):107-111. doi:10.5114/ait.2019.86275.
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The modified Nutrition Risk in the Critically Ill (mNUTRIC) score is a helpful tool to evaluate nutritional risk in critically ill patients. However, there is a lack of data on the relationship between mNUTRIC score and septic patients' outcomes. So, this study aims to validate the prognostic role of the mNUTRIC score and to compare the performances of mNUTRIC, APACHE II, SOFA, and SAPS 2 scores for mortality prediction in patients with sepsis.This prospective observational study was performed on 194 septic patients admitted to the Intensive Care Unit (ICU) of 108 Military Central Hospital. Sepsis was defined based on the sepsis-3 definition. The mNUTRIC score was used to evaluate the nutritional status within 24 h of ICU admission. Baseline characteristics and clinical information were collected to calculate the mNUTRIC, APACHE II, SOFA, and SAPS 2 scores. The outcome was in-hospital mortality from all causes.Nonsurvivors patients had a significantly higher median mNUTRIC score (6 vs. 4, P < 0.001). The mortality rate in the group with a NUTRIC score ≥5 was significantly higher than in the group with a NUTRIC score <5 (56.0% vs 10.2%; P < 0.001). The area under the ROC curves (AUC) for predicting the mortality of mNUTRIC was 0.79 (sensitivity 67.1% and specificity 81.0% (P < 0.001)). Compared with other severity scores in mortality prediction, AUC was 0.78 for APACHE II (sensitivity 84.9% and specificity 67.7%), 0.77 for SOFA score (sensitivity 76.7% and specificity 65.3%), and 0.73 for SAPS 2 (sensitivity 66.1%, specificity 77.7%). In the multivariate analysis, mNUTRIC score was associated with in-hospital mortality (HR, 2.00; 95% CI, 1.54 to 2.58; P < 0.001).Our study showed that the mNUTRIC score was similar to severity scores (APACHE II, SOFA, SAPS 2) in mortality prediction and was the independent mortality predictor in patients with sepsis.
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