APACHE II scoring to predict outcome in post-cardiac arrest.

Area of Science:

• Critical Care Medicine
• Cardiovascular Medicine
• Medical Informatics

Background:

• Cardiac arrest (CA) management has advanced, yet mortality remains high.
• Few validated scoring systems exist to assess illness severity in post-CA patients.
• The Acute Physiology and Chronic Health Evaluation II (APACHE II) score's utility in this population is under investigation.

Purpose of the Study:

• To evaluate the effectiveness of the APACHE II score in predicting outcomes for patients after cardiac arrest.
• To assess the APACHE II score's performance at different time points post-cardiac arrest.

Main Methods:

• A prospective observational study included 228 adult post-cardiac arrest patients at a tertiary care center.
• In-hospital mortality and neurologic outcome were primary and secondary outcome variables, respectively.
• Logistic regression modeling was used to analyze APACHE II scores for outcome prediction.

Main Results:

• The cohort had a median age of 70 years, with 32% females. Median downtime was 15 minutes and initial lactate was 5.9 mmol/L.
• Overall in-hospital mortality was 55% (125/228), with 57% of deaths occurring before 72 hours.
• The area under the curve (AUC) for APACHE II score discrimination improved from 0.62 at 0 hours to 0.86 at 72 hours post-arrest.

Conclusions:

• APACHE II score is a poor predictor at time zero for out-of-hospital cardiac arrest (OHCA) patients.
• For in-hospital cardiac arrest (IHCA) at time zero, and for both IHCA and OHCA at 24 hours and beyond, APACHE II score demonstrated modest predictive ability for mortality and neurologic morbidity.