Performance of Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS III), and Sequential Organ Failure Assessment (SOFA) Scores in a Medical Intermediate Care Unit.

METHODS

A retrospective observational study was conducted at the intermediate medical care unit (IMCU) in São Francisco Xavier Hospital, a Portuguese hospital, in the period from January to December 2019. Patients with incomplete records or IMCU stays shorter than 24 hours were excluded. Scores were calculated using MDCalc, and statistical analysis was performed using SPSS version 27.

RESULTS

Of the 211 patients included in this analysis, 14.69% (n=31) died, with 16.1% (n=5) of these deaths occurring in the IMCU. The average age of non-survivors was significantly higher at 76.26 years (p < 0.001). Acute Physiology and Chronic Health Evaluation (APACHE II) and Simplified Acute Physiology Score (SAPS III) scores demonstrated good discrimination, with AUCs of 0.79 and 0.83, respectively, but both scores tended to overestimate mortality. Sequential Organ Failure Assessment (SOFA) showed the lowest discrimination performance with an Area Under the Curve (AUC) of 0.74.

CONCLUSION

APACHE II and SAPS III provided good mortality prediction in the IMCU, with SAPS III showing the highest AUC. However, both scores overestimated mortality, indicating the need for calibration for IMCUs. The SOFA score was less effective due to its focus on organ failure. Further research is needed to adapt these models or develop new ones tailored specifically for IMCUs to improve predictive accuracy and clinical utility.