Combination of APACHE Scoring Systems with Adductor Pollicis Muscle Thickness for the Prediction of Mortality in Patients Who Spend More Than One Day in the Intensive Care Unit.

BACKGROUND

The objective of the present study was to compare the ability of Acute Physiology and Chronic Health Evaluation (APACHE) scoring systems with the combination of an anthropometric variable score "adductor pollicis muscle (APM) thickness" to the APACHE systems in predicting mortality in the intensive care unit.

METHODS

A prospective observational study was conducted with the APM thickness in the dominant hand, and APACHE II and III scores were measured for each patient upon admission. Given scores for the APM thickness were added to APACHE score systems to make two composite scores of APACHE II-APM and APACHE III-APM. The accuracy of the two composite models and APACHE II and III systems in predicting mortality of patients was compared using the area under the ROC curve.

RESULTS

Three hundred and four patients with the mean age of 54.75 ± 18.28 years were studied, of which 96 (31.57%) patients died. Median (interquartile range) of APACHE II and III scores was 15 (12-20) and 47 (33-66), respectively. Median (interquartile range) of APM thickness was 15 (12-17) mm, respectively. The area under the ROC curves for the prediction of mortality was 0.771 (95% CI: 0.715-0.827), 0.802 (95% CI: 0.751-0.854), 0.851 (95% CI: 0.807-0.896), and 0.865 (95% CI: 0.822-0.908) for APACHE II, APACHE III, APACHE II-APM, and APACHE III-APM, respectively.

CONCLUSION

Although improvements in the area under ROC curves were not statistically significant when the APM thickness added to the APACHE systems, but the numerical value added to AUCs are considerable.