title: APACHE II score and mortality in respiratory failure due to cardiogenic pulmonary edema.
abstract: We reviewed retrospectively 88 patients to assess whether the APACHE II severity of disease classification system can predict mortality in patients with respiratory failure due to cardiac pulmonary edema. Mean score for survivors was higher than for nonsurvivors (24.5 +/- 6.7 vs. 20.7 +/- 5.7, p less than .01), and increasing APACHE II scores were not associated with increasing mortality. Mortality was 54% for APACHE II scores less than or equal to 18, 43% for scores greater than 18 and less than or equal to 24, 22% for scores greater than 24 and less than or equal to 31, and 25% for scores between 32 and 40. The relationship of APACHE II scores to mortality did not improve when the 25 patients with ICU stays less than 48 h were analyzed; the mean score of survivors in this group was 24.3 +/- 5.2 vs. 18.8 +/- 4.6 for nonsurvivors, p less than .001. The presence of myocardial infarction (MI) was associated with a high mortality. Mortality in the 51 MI patients was 52.9% vs. 13.5% in the 37 patients without MI (p less than .001), but APACHE II scores were similar (22.6 +/- 6.6 and 23.7 +/- 6.4, respectively). The relationship between APACHE II scores and mortality did not improve if patients with and without MI are analyzed separately. For patients with MI, mortality was 78.6% for scores between 12 and 17, 56.2% for scores between 18 and 23, 33.3% for scores between 24 and 29, and 33.3% for scores greater than 29.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Medicine, University of Rochester Medical Center, Rochester General Hospital, NY 14621.
authors.forename: A J
authors.initials: AJ
authors.lastname: Fedullo
authors.forename: A J
authors.initials: AJ
authors.lastname: Swinburne
authors.forename: G W
authors.initials: GW
authors.lastname: Wahl
authors.forename: K R
authors.initials: KR
authors.lastname: Bixby
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000150:complications* / Q000209:etiology; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000145:classification* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index