UNNECESSARY USE OF ANTIMICROBIALS – COMPARISON OF THE PREDICTIVE PERFORMANCE OF QSOFA AND APACHE SCORE FOR EVALUATION OF DISEASE PROGNOSIS PATTERNS IN CRITICAL ILLNESS

Abstract

In critical care, accurate prognosis assessment, including antimicrobial therapy, is vital for guiding treatment decisions. The Acute Physiology and Chronic Health Evaluation (APACHE) and quick Sequential Organ Failure Assessment (qSOFA) scores are widely used for predicting patient outcomes. Yet, their relative performance and potential implications for antimicrobial stewardship need further exploration. Objective: To evaluate the disease prognosis patterns in critically ill patients by comparing the predictive performance of APACHE and qSOFA scores and to explore their correlation with antimicrobial misuse. Methods: A comparative study was conducted at the National Hospital and Medical Center in Lahore from January to November 2023. The study included 138 critically ill patients. Demographic information, clinical parameters, and medical history were collected, explicitly focusing on APACHE and qSOFA scores recorded at admission and during follow-up. Statistical analysis, including Pearson's and Spearman's correlation coefficients and logistic regression models, was performed using RStudio to assess the predictive ability of these scores for disease progression and patient outcomes. Results: The analysis revealed a moderate positive correlation (r=0.51) between qSOFA and APACHE-II scores, suggesting that both scores align in assessing the severity of illness in critically ill patients. The predictive models indicated that combining qSOFA and APACHE-II scores enhanced the accuracy of predicting critical outcomes, such as shortness of breath (SOB), with a combined model AUC of 0.659 compared to 0.601 for the APACHE-II model alone. Conclusion: The findings underscore the value of integrating multiple clinical scoring systems in managing critically ill patients. Such integration can aid in more judicious use of antibiotics, potentially mitigating the risk of antimicrobial resistance. The study advocates incorporating these insights into clinical guidelines and decision-making processes in critical care settings.