Comparative Study of Sofa, Apache Ii, Saps Ii, as a Predictor of Mortality in Patients of Sepsis Admitted in Medical ICU.

UNLABELLED

Sepsis is a life-threatening organ dysfunction with high mortality and morbidity. Various mortality prediction scores are currently in use for prediction of mortality. Although combination of various scores have not been used before. The aim of the study was to compare SOFA, APACHE II, SAPS II, as a predictor of mortality and to assess the usefulness of combination of different scores.

MATERIAL

A one-year hospital based prospective study conducted from 1st January 2020 to 31st December 2020 in medical ICU, where 100 patients of sepsis admitted in ICU with evidence of organ dysfunction were included in the study and various scores like SOFA, APACHE II, and SAPS II were calculated at 24 and 48 hours of admission, using laboratory results and clinical examination. and an attempt to access for predictive accuracy of combination of scores was undertaken.

OBSERVATION

Majority of the patients (37%) were in the age group of 60-79 years with maximum mortality in this age group of (39.22 %). Mortality rate was 51%, with higher mortality in the female group being 68.63%. Diabetes was most common comorbid in our study (41%). No significant difference was observed in physiological variable over 24 and 48 hours, however decrease in WBC and platelet count was noted at the end of 48 hours; Mean SOFA, APACHE II, SAPS II were significantly higher in the mortality group than the recovery group; All three scores had good diagnostic performance, with max sensitivity at 24 and 48 hours with APACHE II being 64.10% and 78.79% respectively, max specificity at 24 and 48 hours was noticed with SAPS II being 96.97% and 87.88% respectively. On further combination of scores, maximum sensitivity was seen with SOFA plus APACHE II at 48 hours of 74.36%, maximum specificity was seen at 24 hours with SOFA plus SAPS II of 93.94%. Upon application of Youden's index to the combination of scores, best diagnostic performance was seen with SOFA plus SAPS II at 48 hours.

CONCLUSION

All the three scores showed good mortality prediction rate but among the scores higher sensitivity was seen with APACHE II score at 24 and 48 hours and higher specificity was seen with SAPS II at 24 and 48 hours. Combination of scores did show a slightly better predictability with combination of SAPS II and SOFA showing maximum Youden's index at 48 hours. Mortality was comparatively higher among the females and elderly group with most common risk factor being diabetes.