Utility of the APACHE IV, PPI, and combined APACHE IV with PPI for predicting overall and disease-specific ICU and ACU mortality.
BACKGROUND
The Acute Physiology and Chronic Health Evaluation (APACHE) IV and Palliative Performance Index (PPI) are scales commonly used to assess prognosis in intensive care units (ICUs) and acute care units (ACUs).


OBJECTIVE
To compare the utility of APACHE IV, PPI, and combined APACHE IV with PPI for predicting overall and disease-specific mortality.


METHODS
This is a prospective cohort study using admission data during the first 24 hours. Chi-square contingency tables were used to analyze mortality data for each scale.


METHODS
This study was conducted at a community hospital.


METHODS
Participants were admitted between December 24, 2008 and April 2, 2010.


RESULTS
The APACHE IV, PPI, and APACHE IV plus PPI (n = 599) were significant for predicting overall mortality (P < .0001 each). The APACHE IV was also significant in predicting mortality in patients with congestive heart failure (CHF), pulmonary edema (PULEDEM), stroke (cerebrovascular accident [CVA]), terminal or metastatic cancer (CA), and dementia. The PPI was significant for predicting mortality in PULEDEM, CA, and dementia but not CVA or CHF, while the APACHE IV with PPI was significant for all diseases but CVA. The APACHE IV was the most robust in predicting ICU/ACU mortality. The combined APACHE IV and PPI improved the specificity of the PPI to predict mortality but caused a decline in sensitivity.


CONCLUSIONS
Limitations are due to the subjective nature of the PPI and Glasgow Coma scale (GCS), differences in illness trajectories, and a lack of reliable follow-up of all participants.


CONCLUSIONS
The benefits of combining scales were best exemplified in participants with dementia. Inconsistencies in the predictive value of specific participant populations are likely due to difference in the illness trajectories of disease processes.
Jackson Park Hospital Department of Geriatrics, Wound Care, and Palliative Care, Chicago, IL, USA. jenniferburkmar@hotmail.com
Jennifer A
JA
Burkmar
Rajesh
R
Iyengar
D018806:APACHE; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000458:organization & administration*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires / Q000592:standards*; D055815:Young Adult