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APACHE II score for critically ill patients with a solid tumor: A reclassification study.

F D Martos-Benítez1, I Cordero-Escobar2, A Soto-García3

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Summary

A new scoring system, the APACHE II score for critically ill patients with a solid tumor (APACHE IICCP score), significantly improves mortality prediction in cancer patients. This enhanced model offers superior accuracy over the general APACHE II score for this vulnerable population.

Keywords:
APACHECancerCritically ill patientCáncerEscala pronósticaMortalidadMortalityPaciente críticamente enfermoPrognostic score

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Area of Science:

  • Critical Care Medicine
  • Oncology
  • Health Outcomes Research

Background:

  • The Acute Physiology and Chronic Health Evaluation (APACHE) II score is a widely used tool for predicting mortality in intensive care unit (ICU) patients.
  • Critically ill cancer patients represent a unique population with distinct physiological characteristics that may impact the accuracy of existing scoring systems.
  • Improving mortality prediction in this group is crucial for resource allocation and clinical decision-making.

Purpose of the Study:

  • To enhance the predictive accuracy of the APACHE II model specifically for hospital mortality in critically ill cancer patients with solid tumors.
  • To introduce and validate a modified scoring system, termed the APACHE II score for critically ill patients with a solid tumor (APACHE IICCP score).

Main Methods:

  • A prospective cohort study involving 522 ICU patients with solid tumors.
  • Development of the APACHE IICCP score by incorporating specific variables relevant to critically ill cancer patients into the general APACHE II score.
  • Evaluation of model calibration using the Hosmer-Lemeshow (H-L) test and discrimination using the area under the receiver operating characteristic curve (AROC).
  • Assessment of predictive improvement using reclassification analyses, including integrated discrimination improvement (IDI) and net reclassification improvement (NRI).

Main Results:

  • The hospital mortality rate in the study cohort was 13%.
  • The APACHE IICCP score demonstrated significantly superior discrimination (AROC=0.91) compared to the general APACHE II score (AROC=0.62).
  • The APACHE IICCP score also showed better calibration (H-L test P=.267) than the general APACHE II score (P=.001).
  • Reclassification analyses confirmed improved mortality prediction with the APACHE IICCP score (IDI=0.2994, total qNRI=134.3%, total NRI=41.5%).

Conclusions:

  • The APACHE IICCP score significantly outperforms the general APACHE II score in predicting mortality for critically ill patients with solid tumors.
  • The findings suggest that the APACHE IICCP score is a more accurate and reliable tool for this specific patient population.
  • Further external validation studies are recommended to confirm the generalizability and robustness of the APACHE IICCP score.