Predicting Mortality in Patients with Ventilator‐Associated Pneumonia: The APACHE II Score versus the New IBMP‐10 Score

Abstract

Ventilator-associated pneumonia (VAP) is the leading cause of mortality associated with nosocomial infection. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score at the time of diagnosis of VAP is considered the best scoring system to predict mortality in patients with VAP. The objective of this study was to develop a simple score to predict mortality in patients with VAP and to compare its results with those for the APACHE II scoring system. The new score was developed by performing a univariate analysis of data collected from 178 patients with VAP. The mortality prediction ability of the new score was compared with the APACHE II score on the basis of receiver operating characteristic curve analysis. The IBMP-10 score assigned 1 point to each of the following variables: (1) the presence of immunodeficiency; (2) blood pressure <90 mm Hg (systolic) or <60 mm Hg (diastolic); (3) multilobar infiltrates noted on a chest radiograph; (4) platelet count, <100,000/mm(3); and (5) duration of hospitalization before the onset of VAP of >10 days. The area under the curve was 0.743 for the APACHE II score and 0.824 for the IBMP-10 score (P < .001). This preliminary work indicates that a 5-point score, the IBMP-10, is comparable to the APACHE II score in its ability to predict mortality in patients with VAP. If future studies validate the IBMP-10 score, physicians may be have a simple tool to evaluate the disease severity and to predict outcomes in patients with VAP.