Prognostic scoring systems value (APACHE II,SAPS II) in terms of outcome for hospitalized in an ICU patients

ABSTRACT

Background: Severity indicators are useful tools for the intensive care unit staff, as they can predict the outcome of patients. However, it is important to check their prognostic value.

Aim: Τo compare the prognostic capacity of the SAPS II and APACHE II score, both in terms of outcome and length of stay in an ICU.

Method: This is a prospective observational study, using a sample of 68 patients who were hospitalized in an ICU of a hospital in Athens. APACHE II and SAPS II were calculated considering the worst values of the first 24 hours of hospitalization. The area under the curve (AUC) was used to test the discrimination in predicting survival, while the Hosmer-Lemeshow test was used to calibrate the indicators. Multiple linear regression was performed to recognize the prognostic factors of the length of stay and multiple logistic regression to highlight the prognostic factors of the patient΄s outcome.

Results: 64.7% of patients (n=68) were male. The mean (± SA) age was 58.88 (± 18.11) years. 44.1% (n=30) were admitted by surgery. 82.4% of patients needed mechanical support. 23.5% of patients died and the length of hospital stay was 25.00 (15.00 - 38.50) days. The mean score on the APACHE II scale was 16.35 (± 7.96), and SAPS II score was 35.01 (± 27.11). The mean predicted mortality based on the APACHE II scale was 29.27% (± 19.44%) and on the SAPS II scale 35.01% (± 27.11). Predictors of outcome were the scores and the duration of mechanical ventilation. The length of stay had a positively statistically significant correlation with both scores. Prognostic factors of the duration of hospitalization were the two scores and the duration of mechanical ventilation.

Conclusions: Both scores have good discrimination and calibration to predict the outcome. They are also predictive factors of the length of stay of patients in the ICU.

Keywords: intensive care units, outcome, length of stay, APACHE II, SAPS II