APACHE IV Versus PPI for Predicting Community Hospital ICU Mortality

Abstract

Both the Acute Physiology and Chronic Health Evaluation (APACHE) IV and Palliative Performance Index (PPI) are scales used to estimate intensive care unit (ICU) prognosis and mortality. To Compare the diagnostic utility of the PPI and APACHE IV and their subsequent implications in predicting ICU mortality at a community hospital. This was a Prospective Cohort Study. The study was conducted at the Community hospital ICU. Participants were 211 patients admitted from December 24, 2008 to June 11, 2009. An observer gathered appropriate data and performed the APACHE IV and PPI scales within 24 hours of admission. Results were then analyzed using standard formulae. The study included 211 participants in total with 211 participants in the PPI group (n = 211) and 162 in the APACHE IV group (n = 162). The APACHE score and PPI were found to be significant for predicting ICU mortality (P value of P < .002 and 99% CI of 13.74 to 20.32, P value of P < .001and 99% CI of 3.70 to 4.61, respectively). APACHE IV demonstrated a sensitivity of 84.6%, specificity of 96.0%, PPV of 64.7%, and NPV of 98.6%. In contrast, the PPI possessed a sensitivity of 69.2%, specificity of 96.0%, PPV of 64.7%, and NPV of 97.8%. Limitations may have occurred with the subjective nature of the PPI and Glasgow Coma Scale (GCS), along with meeting criterion for the APACHE IV. This prospective cohort study in the ICU of a community hospital demonstrated that both the APACHE IV and PPI were significant tools for predicting ICU mortality. When contrasting the 2 scales, the APACHE IV could more accurately rule in mortality when mortality occurred and rule out mortality when survival occurred.