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[Prediction of mortality and quality of life in polytraumatized patients: APACHE II versus APACHE III]
L Cánovas Martínez1, M Domínguez García, A Diz Villar
1Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Cristal Piñor, Orense.
Objective:
To evaluate the APACHE II and III prognostic assessment systems as predictors of mortality in polytraumatized patients and to compare each system's admission assessments to the patient's quality of life one month, six months and one year later.
Patients And Methods:
A prospective study of 130 polytraumatized patients admitted to the critical care unit was carried out. A polytraumatized patient was defined as "presenting two or more traumatic lesions that were immediately or eventually life-threatening". We studied age, sex, type of trauma, mortality, mean APACHE II and APACHE III scores during the first three days in the critical care unit for patients who survived and those who died, estimating relative risk of mortality by APACHE II and APACHE III, and quality of life one month, six months and one year after admission using Karnofsky scores (KPS).
Results:
Mean patient age was 46.47 +/- 20.19 years; 78% were men and 22% women. Overall mortality was 20%. The most frequent trauma was craniocerebral (70.76%), followed by injuries ot the chest (53.8%) and extremities (46.15%). Mean APACHE II and APACHE III scores during the first three days were 10.22 +/- 5.33 and 32.75 +/- 16.42, respectively. Mean APACHE II and III scores were significantly higher (p = 0.02) in patients who died than in survivors (14.33 +/- 5.43 and 9.7 +/- 5.2, respectively, for APACHE II; and 43.27 +/- 17.68 and 30.16 +/- 15.79, respectively, for APACHE III). For each point increase of APACHE II or III scores, relative risk of mortality increased 1.09% (p = 0.03) and 1.02% (p = 0.03), respectively. Patients with APACHE II scores over 12 were 3.53 times more likely to die (p = 0.02). Patients with APACHE III scores over 35 were 3.05 times more likely to die (p = 0.02). One month after admission, 6.4% of patients had a KPS of 100 (normal, as before trauma), 35.8% achieved this score six months after admission and 82% after one year (p = 0.01). Mean APACHE III upon admission was significantly lower (p = 0.045) in patients who achieved KPS 100.
Conclusions:
The APACHE II and APACHE III prognostic systems predict relative risk of death in polytraumatized patients. APACHE III, but not APACHE II, at admission is significantly related to quality of life one year later.