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Mortality discrimination in acute myocardial infarction: comparison between APACHE III and SAPS II prognosis systems.
1Servicio de Medicina Crítica y Urgencias, Hospital Virgen de las Nieves, Granada, Spain.
Objective:
To compare the Acute Physiology, Age and Chronic Health Evaluation (APACHE) III with the Simplified Acute Physiology Score (SAPS II) in discriminating in-hospital mortality for intensive care unit (ICU) patients with acute myocardial infarction (AMI).
Design:
Prospective, observational, multicenter study.
Setting:
70 Spanish ICUs.
Patients And Participants:
1711 patients with AMI and representative of Spanish ICUs.
Measurements And Results:
APACHE III score, APACHE III system probability of death (APACHE III probability), SAPS II score and in-hospital mortality were noted for each patient. Two hundred and twenty three (13.0 %) patients died in the hospital. The sensitivity (+/- SE), specificity (+/- SE), and accuracy (+/- SE) for the APACHE III score were, respectively, 75.8 +/- 2.9, 75.9 +/- 1.1, and 75.9 +/- 1.0. The corresponding figures for APACHE III probability were 75.3 +/- 2.9, 79.2 +/- 1.1, and 78.7 +/- 1.0, and for SAPS II 72.2 +/- 3.0, 75.9 +/- 1.1, and 75.4 +/- 1.0.
Conclusions:
The results indicate good discrimination by the three tests. APACHE III probability shows a statistically significant improvement in accuracy and specificity when compared with the two scores.
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