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Disease severity in the coronary care unit
R J Teskey1, J E Calvin, I McPhail
1University of Ottawa Heart Institute, Canada.
Chest
|December 1, 1991
Summary
The Acute Physiology and Chronic Health Evaluation (APACHE 2) score effectively predicts in-hospital mortality in coronary care units. Higher APACHE 2 scores indicate increased mortality risk for cardiac patients.
Area of Science:
- Cardiology
- Critical Care Medicine
- Health Services Research
Background:
- In-hospital mortality in coronary care units (CCUs) remains a critical outcome measure.
- Assessing patient severity of illness is crucial for effective CCU management and resource allocation.
Purpose of the Study:
- To retrospectively analyze the impact of illness severity, measured by the APACHE 2 score, on in-hospital mortality.
- To evaluate the predictive value of the APACHE 2 score for mortality in a CCU patient cohort.
Main Methods:
- Retrospective cohort study of 386 patients admitted to a CCU.
- Severity of illness assessed using the Acute Physiology and Chronic Health Evaluation (APACHE 2) score.
- Statistical analyses included logistic regression and Receiver Operating Characteristic (ROC) curve analysis.
Main Results:
- Overall in-hospital mortality was 13 percent.
- Mortality was significantly influenced by admitting diagnosis (p=0.01), referral source (p=0.03), and APACHE 2 score (p<0.001).
- The APACHE 2 score demonstrated good predictive accuracy for mortality (Area Under Curve = 0.75 +/- 0.04).
Conclusions:
- The APACHE 2 score is a valuable tool for assessing and managing patients in the CCU.
- Both APACHE 2 score and admitting diagnosis are significant multivariate predictors of mortality.
- Findings support the utility of APACHE 2 in CCUs, similar to its use in multidisciplinary ICUs.