Department of Anesthesiology, Jigme Dorji Wangchuk National Referral Hospital, 11001, Thimphu, Bhutan.
Division of Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Songkhla, Thailand.
Sci Rep. 2023 Apr 11;13(1):5899. doi: 10.1038/s41598-023-33173-4.
The Acute Physiology and Chronic Health Evaluation (APACHE) IV model can predict the intensive care unit (ICU) length of stay (LOS) in critically ill patients. Thus, this study aimed to validate the performance of the APACHE IV score in predicting ICU LOS among patients with sepsis. This retrospective study was conducted in the medical ICU of a tertiary university between 2017 and 2020. A total of 1,039 sepsis patients were enrolled. Patients with an ICU stay of 1 and > 3 days accounted for 20.1% and 43.9%. The overall observed and APACHE IV predicted ICU LOS were 6.3 ± 6.5 and 6.8 ± 6.5, respectively. The APACHE IV slightly over-predicted ICU LOS with standardized length of stay ratio 0.95 (95% CI 0.89-1.02). The predicted ICU LOS based on the APACHE IV score was statistically longer than the observed ICU LOS (p < 0.001) and were poorly correlated (R = 0.02, p < 0.001), especially in patients with a lower severity of illness. In conclusions the APACHE IV model poorly predicted ICU LOS in patients with sepsis. The APACHE IV score needs to be modified or we need to make a new specific model to predict ICU stays in patients with sepsis.
急性生理学与慢性健康状况评分系统第四版（APACHE IV）模型可预测危重症患者的重症监护病房（ICU）入住时间（LOS）。因此，本研究旨在验证 APACHE IV 评分在预测脓毒症患者 ICU LOS 中的性能。这是一项回顾性研究，于 2017 年至 2020 年在一所三级大学的内科 ICU 进行。共纳入 1039 例脓毒症患者。入住 ICU 1 天和>3 天的患者分别占 20.1%和 43.9%。总体观察和 APACHE IV 预测的 ICU LOS 分别为 6.3±6.5 和 6.8±6.5。APACHE IV 评分略微高估了 ICU LOS，标准化 LOS 比为 0.95（95%CI 0.89-1.02）。基于 APACHE IV 评分预测的 ICU LOS 明显长于观察到的 ICU LOS（p<0.001），且相关性较差（R=0.02，p<0.001），尤其是在疾病严重程度较低的患者中。总之，APACHE IV 模型对脓毒症患者的 ICU LOS 预测效果不佳。APACHE IV 评分需要进行修改，或者我们需要建立一个新的特定模型来预测脓毒症患者的 ICU 入住时间。
