Asian Journal of Nursing Education and Research

Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

Comparison of Apache IV vs Apache II Scoring System in Predicting the Clinical Outcomes of Patients in Intensive Care Unit


Affiliations
1 Reader, Apollo College of Nursing, India
     

   Subscribe/Renew Journal


Background: Prognostication of critically ill patients is an integral part of the quality of care in ICU. The use of scoring system such as Acute Physiology and Chronic Health Evaluation (APACHE) to predict risk of mortality and evaluating outcome in critically ill patients is important in modern evidence-based medicine. the aim of the study was to compare the APACHE II and APACHE IV in predicting the mortality of patients intensive care unit. Methods: A prospective descriptive was among 100 adult patients admitted irrespective of diagnosis and managed for >24hours in the 25 bedded multidisciplinary ICU of a tertiary care hospital. The APACHE II and APACHE IV scores were calculated using the online calculators, based on the worst values in the first 24 hours of admission. All the study participants were followed up, to determine the observed mortality rates and length of stay of ICU which were compared with predicted mortality rates obtained from both the APACHE II and APACHE IV scoring systems. The receiver operator characteristic curves (ROC) were used to compare accuracy of the two scores using SPSS 20 version. Results: There was no statistically significant difference in the estimated mortality rate of patients in ICU based on APACHE II and APACHE IV scoring system (t = 1.674) at p < 0.05 level. There was a significant weak correlation between actual length of stay and estimated length of stay based on APACHE IV score (r = 0.469) at p < 0.01 level. Discrimination for APACHE II and APACHE IV models were good with area under the curve of 0.965 and 0.760 respectively. APACHE II was more accurate than APACEIV in this regard. Conclusion: Discrimination was more-better for APACHE II than APACHE IV model. there was a moderate correlation observed between the two models in this study.

Keywords

APACHE II and APACHE IV, ICU Patients.
Subscription Login to verify subscription
User
Notifications
Font Size


  • Relman, AS. Assessment of Medical practices, (editorial). N Engl J Med. 1980: 303:153-154.

  • Knaus WA, Draper EA, Wagner. APACHE II: a severity of disease classification system. Critical Care Medicine. 1985: 13(10) 818-29).

  • Nagar V S, Sajjan B, Chatterjee R & Para NM. The comparison of apache II and apache IV score to predict mortality in intensive care unit in a tertiary care hospital. Int J Res Med Sci. May 2019; 7(5):1598-1603 DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20191643

  • Wagner, D.P, Knaus, W.A & Draper. Statistical validation of a severity of illness measure. 1983: 73:878-884.

  • Dabhi AS, Khedekar SS, Mehalingam V. A prospective study of comparison of APACHE-IV and amp; SAPS-II scoring systems and calculation of standardised mortality rate in severe sepsis and septic shock patients. J Clin Diagn Res. 2014; 8(10):09-13.

  • Varghese YE, Kalaiselvan MS, Renuka MK, Arunkumar AS. Comparison of acute physiology and chronic health evaluation II (APACHE II) and acute physiology and chronic health evaluation IV (APACHE IV) severity of illness scoring systems, in a multidisciplinary ICU. J Anaesthesiol Clin Pharmacol. 2018; 33(2):248-53.

  • Lee H, Shon YJ, Kim H, Paik H, Park HP. Validation of the APACHE IV model and its comparison with the APACHE II, SAPS 3, and Korean SAPS 3 models for the prediction of hospital mortality in a Korean surgical intensive care unit. Korean J Anesthesiol. 2014; 67(2):115.

  • Ayazoglu TA. A comparison of APACHE II and APACHE IV scoring systems in predicting outcome in patients admitted with stroke to an intensive care unit. Anaesth Pain Intens Care. 2011; 15(1):7-12.

  • Zhu BP, Lemeshow S, Hosmer DW, Klar J, Avrunin J, Teres D. Factors affecting the performance of the models in the mortality probability model II system and strategies of customization: a simulation study. Crit Care Med. 1996; 24(1):57-63.


Abstract Views: 180

PDF Views: 0




  • Comparison of Apache IV vs Apache II Scoring System in Predicting the Clinical Outcomes of Patients in Intensive Care Unit

Abstract Views: 180  |  PDF Views: 0

Authors

Sasikala Dhakshinamoorthy
Reader, Apollo College of Nursing, India

Abstract


Background: Prognostication of critically ill patients is an integral part of the quality of care in ICU. The use of scoring system such as Acute Physiology and Chronic Health Evaluation (APACHE) to predict risk of mortality and evaluating outcome in critically ill patients is important in modern evidence-based medicine. the aim of the study was to compare the APACHE II and APACHE IV in predicting the mortality of patients intensive care unit. Methods: A prospective descriptive was among 100 adult patients admitted irrespective of diagnosis and managed for >24hours in the 25 bedded multidisciplinary ICU of a tertiary care hospital. The APACHE II and APACHE IV scores were calculated using the online calculators, based on the worst values in the first 24 hours of admission. All the study participants were followed up, to determine the observed mortality rates and length of stay of ICU which were compared with predicted mortality rates obtained from both the APACHE II and APACHE IV scoring systems. The receiver operator characteristic curves (ROC) were used to compare accuracy of the two scores using SPSS 20 version. Results: There was no statistically significant difference in the estimated mortality rate of patients in ICU based on APACHE II and APACHE IV scoring system (t = 1.674) at p < 0.05 level. There was a significant weak correlation between actual length of stay and estimated length of stay based on APACHE IV score (r = 0.469) at p < 0.01 level. Discrimination for APACHE II and APACHE IV models were good with area under the curve of 0.965 and 0.760 respectively. APACHE II was more accurate than APACEIV in this regard. Conclusion: Discrimination was more-better for APACHE II than APACHE IV model. there was a moderate correlation observed between the two models in this study.

Keywords


APACHE II and APACHE IV, ICU Patients.

References