Abstract
Background The objective of the present study was to compare the ability of Acute Physiology and Chronic Health Evaluation (APACHE) scoring systems with the combination of an anthropometric variable score “adductor pollicis muscle (APM) thickness” to the APACHE systems in predicting mortality in the intensive care unit. Methods A prospective observational study was conducted with the APM thickness in the dominant hand, and APACHE II and III scores were measured for each patient upon admission. Given scores for the APM thickness were added to APACHE score systems to make two composite scores of APACHE II-APM and APACHE III-APM. The accuracy of the two composite models and APACHE II and III systems in predicting mortality of patients was compared using the area under the ROC curve. Results Three hundred and four patients with the mean age of 54.75 ± 18.28 years were studied, of which 96 (31.57%) patients died. Median (interquartile range) of APACHE II and III scores was 15 (12–20) and 47 (33–66), respectively. Median (interquartile range) of APM thickness was 15 (12–17) mm, respectively. The area under the ROC curves for the prediction of mortality was 0.771 (95% CI: 0.715–0.827), 0.802 (95% CI: 0.751–0.854), 0.851 (95% CI: 0.807–0.896), and 0.865 (95% CI: 0.822–0.908) for APACHE II, APACHE III, APACHE II-APM, and APACHE III-APM, respectively. Conclusion Although improvements in the area under ROC curves were not statistically significant when the APM thickness added to the APACHE systems, but the numerical value added to AUCs are considerable.
Highlights
Predictive scoring systems have been developed to measure the severity of the disease and the prognosis of patients in the intensive care unit (ICU)
Such measurements are helpful for clinical decision-making, standardizing research, and comparing the quality of patient care in the ICUs. e Acute Physiologic and Chronic Health Evaluation (APACHE) scoring system is one of the predictive scoring systems widely used in the world. e most frequently cited APACHE models are APACHE II and III; APACHE IV has been validated. e APACHE II severity score is based upon the worst variables during the initial 24 hours in the ICU [1]
If adductor pollicis muscle (APM) thickness at the time of ICU admission is sensitive to predicting outcomes, incorporating it directly into the predictive scoring models like APACHE II and III may increase the predictive value of these models. e purpose of this study was to determine whether a nutrition score on admission measured by APM thickness combined with APACHE II and APACHE III scores could increase prediction of mortality in the ICU
Summary
Predictive scoring systems have been developed to measure the severity of the disease and the prognosis of patients in the intensive care unit (ICU). Two studies have reported that the APM thickness on the day of admission predicts morbidity and mortality in critically ill patients [10, 11]. If APM thickness at the time of ICU admission is sensitive to predicting outcomes, incorporating it directly into the predictive scoring models like APACHE II and III may increase the predictive value of these models. E purpose of this study was to determine whether a nutrition score on admission measured by APM thickness combined with APACHE II and APACHE III scores could increase prediction of mortality in the ICU. To estimate weight for the APM thickness, multivariate logistic regression analysis was used to determine the relation between mortality and the APM thickness while controlling for other physiologic variables (12 physiologic variables for APACHE II and 18 physiologic variables for APACHE III). e area under the receiver-operating curves (ROC curve) to predict mortality was used to compare APACHE II, APACHE III, APACHE II-APM, and APACHE III-APM systems
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