Mishra Subhendu, Swain Alok K, Tharwani Santosh, Kumar Devendra, Meshram Shilpa, Shukla Ankit
Anaesthesiology and Critical Care Medicine, Balco Medical Centre, Raipur, IND.
Oncoanesthesiology, Balco Medical Centre, Raipur, IND.
Cureus. 2024 Aug 6;16(8):e66268. doi: 10.7759/cureus.66268. eCollection 2024 Aug.
Background and aim A variety of scoring systems are employed in intensive care units (ICUs) with the objective of predicting patient morbidity and mortality. The present study aimed to compare four different severity assessment scoring systems, namely, Acute Physiology and Chronic Health Evaluation II (APACHE II), Rapid Emergency Medicine Score (REMS), Sequential Organ Failure Assessment (SOFA), and Simplified Acute Physiologic Score II (SAPS II) to predict prognosis of all patients admitted to a mixed medical ICU of a tertiary care teaching hospital in central India. Methods The prospective observational study included 1136 patients aged 18 years or more, admitted to the mixed medical ICU. All patients underwent severity assessment using the four scoring systems, namely APACHE II, SOFA, REMS, and SAPS II, after admission. Predicted mortality was calculated from each of the scores and actual patient outcomes were noted. Receiver operating curve analysis was undertaken to identify the cut-off value of individual scoring systems for predicting mortality with optimum sensitivity and specificity. Calibration and discrimination were employed to ascertain the validity of each scoring model. Bivariate and multivariable logistic regression analyses among the study participants were conducted to identify the best scoring system, after adjusting for potential confounders. Results Final analysis was done on 957 study participants (mean (±SD) age-58.4 (±12.9) years; males-62.2%). The mortality rate was 14.7%. APACHE II, SOFA, SAPS II, and REMS scores were significantly higher among the non-survivors as compared to the survivors (p<0.05). SAPS II was found to have the highest AUC of 0.981 (p<0.001). SAPS II score >58 had 93.6% sensitivity, 94.1% specificity, 73.3% PPV, 98.8% NPV, and 94.0% diagnostic accuracy in predicting mortality. This scoring system also had the best calibration. Binary logistic regression showed that all four scoring systems were significantly associated with ICU mortality. After adjusting for each other, only SAPS II remained significantly associated with ICU mortality. Conclusion Both SAPS II and APACHE II were observed to have good calibration and discriminatory power; however, SAPS II had the best prediction power suggesting that it may be a useful tool for clinicians and researchers in assessing the severity of illness and mortality risk in critically ill patients.
重症监护病房（ICU）采用多种评分系统来预测患者的发病率和死亡率。本研究旨在比较四种不同的严重程度评估评分系统，即急性生理与慢性健康状况评估II（APACHE II）、快速急诊医学评分（REMS）、序贯器官衰竭评估（SOFA）和简化急性生理评分II（SAPS II），以预测印度中部一家三级护理教学医院综合性内科ICU收治的所有患者的预后。方法：这项前瞻性观察性研究纳入了1136名年龄在18岁及以上、入住综合性内科ICU的患者。所有患者入院后均使用APACHE II、SOFA、REMS和SAPS II这四种评分系统进行严重程度评估。根据每个评分计算预测死亡率，并记录患者的实际结局。进行受试者工作特征曲线分析，以确定各个评分系统预测死亡率的最佳敏感性和特异性的临界值。采用校准和鉴别方法来确定每个评分模型的有效性。在研究参与者中进行二元和多变量逻辑回归分析，以在调整潜在混杂因素后确定最佳评分系统。结果：对957名研究参与者进行了最终分析（平均（±标准差）年龄为58.4（±12.9）岁；男性占62.2%）。死亡率为14.7%。与幸存者相比，非幸存者的APACHE II、SOFA、SAPS II和REMS评分显著更高（p<0.05）。发现SAPS II的曲线下面积（AUC）最高，为0.981（p<0.001）。SAPS II评分>58在预测死亡率方面具有93.6%的敏感性、94.1%的特异性、73.3%的阳性预测值、98.8%的阴性预测值和94.0%的诊断准确性。该评分系统还具有最佳校准。二元逻辑回归显示，所有四种评分系统均与ICU死亡率显著相关。在相互调整后，只有SAPS II仍与ICU死亡率显著相关。结论：观察到SAPS II和APACHE II均具有良好的校准和鉴别能力；然而，SAPS II具有最佳预测能力，表明它可能是临床医生和研究人员评估危重症患者疾病严重程度和死亡风险的有用工具。
