Comparison between acute physiology and chronic health evaluationIIand IV in mortality risk prediction of 192 servere acute pancreatitis patients

Abstract

Objective To compare the efficiency of acute physiology and chronic health evaluation (APACHE)Ⅱ and Ⅳ in mortality risk prediction of severe acute pancreatitis (SAP). Methods From January 2013 to December 2014, SAP patients admitted to intensive care units (ICU) were retrospectively analyzed in single center. The clinical data of the first 24 hours since the patients admitted into ICU were collected. The modified Marshall score, APACHE Ⅱ and APACHE Ⅳ score were calculated. The mortality risk predictive value of each patient was calculated by APACHE Ⅱ and APACHE Ⅳ. According to the final clinical outcome of patients, Hosmer-Lemeshow was performed to compare real mortality rate with predictive mortality rate, and calibration of APACHE Ⅱ and APACHE Ⅳ in the mortality risk of each patients was evaluated. The resoluation of the two scoring systems was compared by the area under the receiver operator characteristic curve (AUC). Results In the end, 192 patients (152(79.2%) survivors and 40(20.8%) dead) were enrolled. Modified Marshall score, APACHE Ⅱ score and APACHE Ⅳ score of patients in dead group was 6.30±0.36, 21.3±8.0 and 88.1±30.2, respectively; and those of survival group was 3.70±0.20, 12.3±5.6 and 53.4±19.0, respectively, and the differences between two groups were statistically significant (t=-6.436、-6.683、-6.913, all P 0.05). The AUC of APACHE Ⅱ score (cut-off ≥26) and APACHE Ⅳ score (cut-off≥91) was 0.81(95%CI 0.74 to 0.89) and 0.83(95%CI 0.75 to 0.90), respectively, and the difference was not statistically significant (χ2=0.21, P=0.644), which indicated that there was no statistically significant difference in calibration. Conclusions APACHE Ⅳ scoring system is not better than APACHE Ⅱ scoring system in prognosis prediction of SAP patients. The prognosis of SAP patients could be accurately evaluated by APACHE Ⅱ. Key words: APACHEⅡ; APACHE Ⅳ; Severe acute pancreatitis; Prognosis