Tian Yao, Yao Yang, Zhou Jing, Diao Xin, Chen Hui, Cai Kaixia, Ma Xuan, Wang Shengyu
Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China.
Front Med (Lausanne). 2022 Jan 26;8:744907. doi: 10.3389/fmed.2021.744907. eCollection 2021.
This study aims to evaluate the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE) II score on different days in predicting the mortality of critically ill patients to identify the best time point for the APACHE II score.
The demographic and clinical data are retrieved from the Medical Information Mart for Intensive Care (MIMIC)-IV dataset. APACHE II scores on days 1, 2, 3, 5, 7, 14, and 28 of hospitalization are calculated, and their performance is evaluated using the area under the receiver operating characteristic (AUROC) analysis. The cut-off for defining the high risk of mortality is determined using Youden's index. The APACHE II score on day 3 is the best time point to predict hospital mortality of ICU patients. The Hosmer-Lemeshow goodness-of-fit test is then applied to evaluate the calibration of the day 3 APACHE II score.
We recruited 6,374 eligible subjects from the MIMIC-IV database. Day 3 is the optimal time point for obtaining the APACHE II score to predict the hospital mortality of patients. The best cut-off for day 3 APACHE II score is 17. When APACHE II score ≥17, the sensitivity for the non-survivors and survivors is 92.8 and 82.2%, respectively, and the positive predictive value (PPV) is 23.1%. When APACHE II socre <17, the specificity for non-survivors and survivors is 90.1 and 80.2%, respectively, and the negative predictive value (NPV) is 87.8%. When day-3 APACHE II is used to predict the hospital mortality, the AUROC is 0.743 ( <0.001). In the ≥17 group, the sensitivity of non-survivors and survivors is 92.2 and 81.3%, respectively, and the PPV is 30.3%. In the <17 group, the specificity of non-survivors and survivors is 100.0 and 80.2%, respectively, and the NPV is 81.6%. The Hosmer-Lemeshow test indicated day-3 APACHE II has a high predicting the hospital mortality ( = 6.198, = 0.625, consistency = 79.4%). However, the day-1 APACHE II has a poor calibration in predicting the hospital mortality rate ( = 294.898, <0.001).
Day-3 APACHE II score is an optimal biomarker to predict the outcomes of ICU patients; 17 is the best cut-off for defining patients at high risk of mortality.
本研究旨在评估急性生理学与慢性健康状况评估（APACHE）II评分在不同时间预测危重症患者死亡率的准确性，以确定APACHE II评分的最佳时间点。
从重症监护医学信息数据库（MIMIC）-IV数据集中检索人口统计学和临床数据。计算住院第1、2、3、5、7、14和28天的APACHE II评分，并使用受试者工作特征曲线下面积（AUROC）分析评估其性能。使用约登指数确定定义高死亡风险的临界值。第3天的APACHE II评分是预测ICU患者医院死亡率的最佳时间点。然后应用Hosmer-Lemeshow拟合优度检验评估第3天APACHE II评分的校准情况。
我们从MIMIC-IV数据库中招募了6374名符合条件的受试者。第3天是获得APACHE II评分以预测患者医院死亡率的最佳时间点。第3天APACHE II评分的最佳临界值为17。当APACHE II评分≥17时，非幸存者和幸存者的敏感性分别为92.8%和82.2%，阳性预测值（PPV）为23.1%。当APACHE II评分<17时，非幸存者和幸存者的特异性分别为90.1%和80.2%，阴性预测值（NPV）为87.8%。当使用第3天的APACHE II评分预测医院死亡率时，AUROC为0.743（P<0.001）。在≥17组中，非幸存者和幸存者的敏感性分别为92.2%和81.3%，PPV为30.3%。在<17组中，非幸存者和幸存者的特异性分别为100.0%和80.2%，NPV为81.6%。Hosmer-Lemeshow检验表明第3天的APACHE II评分对医院死亡率有较高的预测性（χ² = 6.198，P = 0.625，一致性 = 79.4%）。然而，第1天的APACHE II评分在预测医院死亡率方面校准较差（χ² = 294.898，P<0.001）。
第3天的APACHE II评分是预测ICU患者预后的最佳生物标志物；17是定义高死亡风险患者的最佳临界值。
