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Development of a new prognostic system and validation of APACHE II for surgical ICU mortality: a multicenter study in
H S Kuo1, J H Chuang, G J Tang
1Department of Social Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
Background:
To develop and to validate a new prognostic prediction system for patients admitted to the surgical intensive care unit (ICU), and to compare its performance with the Acute Physiology and Chronic Health Evaluation (APACHE) II system.
Methods:
The database was derived from three surgical ICUs in three hospitals. For each patient, demographic data, diagnosis, APACHE II score and hospital survival data were collected. The accuracy in outcome prediction of the APACHE II was assessed by means of receiver operating characteristic (ROC) analysis. The new prognostic system was developed by using a multiple logistic regression in the developmental data set and validated with the validation data set.
Results:
A total of 1,248 patients were included from three ICUs. The area under the ROC curve was 0.74 for the APACHE II score. The new prognostic system includes 18 variables. Goodness-of-fit tests indicated that the model performed well in the developmental and validation samples (p = 0.235 in the developmental data set and p = 0.297 in the validation set). The area under the ROC curve was 0.84 in the developmental sample and 0.77 in the validation sample for the new prognostic score. The area under the ROC curve was 0.71 in the validation sample for the APACHE II score.
Conclusions:
Although APACHE II correlates with mortality for surgical ICU patients in Taiwan, its accuracy is not as good as in the original study. Mortality prediction performance improved with the use of the new, local scoring system.