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Predictive scoring systems in multiorgan failure: A cohort study
M Sánchez-Casado1, V A Hostigüela-Martín2, A Raigal-Caño1
1Unidad de Cuidados Intensivos, Complejo Hospitalario de Toledo, Toledo, España.
Medicina Intensiva
|May 30, 2015
Summary
APACHE IV best predicted mortality, but MPM II offered the best balance of prediction and calibration. APACHE II is not recommended due to poor performance in predicting hospital mortality.
Area of Science:
- Critical Care Medicine
- Health Outcomes Research
- Biostatistics
Background:
- Accurate prediction of hospital mortality is crucial for critical care management.
- Several scoring systems exist to predict outcomes in intensive care units (ICUs).
Purpose of the Study:
- To evaluate and compare the predictive performance of major scoring systems for hospital mortality.
- To assess the discrimination and calibration of APACHE II, APACHE IV, SAPS II, SAPS III, and MPM II.
Main Methods:
- A retrospective cohort study included 568 patients with multiorgan failure in a third-level ICU.
- The study analyzed APACHE II, APACHE IV, SAPS II, SAPS III, and MPM II for predicting hospital mortality.
Main Results:
- APACHE IV demonstrated the highest discrimination (AUC 0.805), but poor calibration.
- MPM II showed good discrimination (AUC 0.748) and the best calibration.
- APACHE II exhibited the lowest discrimination and poor calibration, advising against its use.
Conclusions:
- APACHE IV offers superior discrimination, yet MPM II provides a better overall predictive model due to its calibration.
- APACHE II's performance is insufficient for clinical use in predicting hospital mortality.
- Further research is needed to validate these findings in diverse critical care populations.