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KMID : 0604020170320030275
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Korean Journal of Critical Care Medicine
2017 Volume.32 No. 3 p.275 ~ p.283
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The Ability of the Acute Physiology and Chronic Health Evaluation (APACHE) IV Score to Predict Mortality in a Single Tertiary Hospital
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Choi Jae-Woo
Park Young-Sun
Lee Young-Seok
Park Yeon-Hee
Chung Chae-Uk
Park Dong-Il
Kwon In-Sun
Lee Ju-Sang
Min Na-Eun
Park Jeong-Eun
Yoo Sang-Hoon
Chon Gyu-Rak
Sul Young-Hoon
Moon Jae-Young
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Abstract
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Background: The Acute Physiology and Chronic Health Evaluation (APACHE) II model has been widely used in Korea. However, there have been few studies on the APACHE IV model in Korean intensive care units (ICUs). The aim of this study was to compare the ability of APACHE IV and APACHE II in predicting hospital mortality, and to investigate the ability of APACHE IV as a critical care triage criterion.
Methods: The study was designed as a prospective cohort study. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test respectively. We also calculated the standardized mortality ratio (SMR).
Results: The APACHE IV score, the Charlson Comorbidity index (CCI) score, acute respiratory distress syndrome, and unplanned ICU admissions were independently associated with hospital mortality. The calibration, discrimination, and SMR of APACHE IV were good (H = 7.67, P = 0.465; C = 3.42, P = 0.905; AUROC = 0.759; SMR = 1.00). However, the explanatory power of an APACHE IV score >93 alone on hospital mortality was low at 44.1%. The explanatory power was increased to 53.8% when the hospital mortality was predicted using a model that considers APACHE IV >93 scores, medical admission, and risk factors for CCI >3 coincidentally. However, the discriminative ability of the prediction model was unsatisfactory (C index <0.70).
Conclusions: The APACHE IV presented good discrimination, calibration, and SMR for hospital mortality.
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KEYWORD
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APACHE IV, calibration, discrimination, intensive care units, triage
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