Abstract
Objective: The comparison of the APACHE II, SAPS II and SOFA scoring systems as predictors of mortality in ICU patients. Study Design: A prospective observational study. Place and Duration of Study: Intensive care unit of Ch. Pervaiz Ellahi Institute of Cardiology and Nishtar Medical University and Hospital, Multan, from May 13, 2018 to September 24, 2018. Methodology: For 36 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. Data was analyzed with SPSS v.23. Descriptive data was stated as median (minimum-maximum) or percentages. Pearson Chi square test and non-parametric statistics were applied accordingly. Linear regression analysis was also performed. Cut off value for statistical significance was taken as ≤0.05. Results: Of 36 patients, 22 survived and 14 died after being observed for 12 (2-17) days. On linear regression analysis, all the scoring systems were significantly associated with the mortality rates (p<0.05). However, after adjustment, only the APACHE II was a significant predictor of mortality (p<0.001). APACHE II scoring system calculated highest estimated mortality rates i.e. 19.3%, while SAPS II and SOFA scoring systems estimated 8.6% and 13.5% mortality, respectively. Conclusion: APACHE II scoring system was much superior to SAPS II and SOFA scoring systems as a significant predictor of the mortality among the ICU patients. Keywords: Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II), Sequential Organ Failure Assessment (SOFA), Intensive care units (ICU), Mortality. DOI : 10.7176/JMPB/53-03 Publication date :March 31 st 2019
Highlights
Assessment of the extent of disease plays a vital role in the medical management and prediction of morbidity and mortality in the acutely ill patients admitted in the ICU 1
Acute Physiology and Chronic Health Evaluation (APACHE) III is a further modification of APACHE II which focuses on the prior treatment location and diagnosis 3 but we are not including this in our study to avoid confusion
In a prior systemic review, APACHE II, APACHE III, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) scoring systems were analyzed and the APACHE systems were observed to be superior to the SAPS II and SOFA systems in predicting ICU mortality 7
Summary
Assessment of the extent of disease plays a vital role in the medical management and prediction of morbidity and mortality in the acutely ill patients admitted in the ICU 1. The worst values recorded for the comprised variables, within 24 hours of admission, are included in this modified version. The studies comparing APACHE II, SAPS II and SOFA scoring systems have not been performed in the South-East Asian population. We are conducting this prospective study to assess which system is better to predict the mortality in the critically ill patients admitted in the ICU regardless of the disease. APACHE II score was calculated by evaluating all the physiological components with the worst values observed within first 24 hours. The results for APACHE II, SAPS II and SOFA were calculated by using the worst values recorded for the included factors. Significance was two tailed and the cut off value for statistical significance was taken as ≤0.05
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