title: Comparison of Acute Physiology, Age, Chronic Health Evaluation III score with initial Sequential Organ Failure Assessment score to predict ICU mortality.
abstract: Critically ill patients are provided with highest level of monitoring, care and treatment in Intensive Care Unit (ICU), which is very expensive and consumes many hospital resources. Various scoring systems have been developed to predict outcome in ICU patients so as to help physicians to prioritize patient admission and management. The objective of this study was to compare Acute Physiology and Chronic Health Evaluation (APACHE) III score with initial Sequential Organ Failure Assessment (SOFA) score to predict ICU mortality. Hundred seventeen patients admitted consecutively in ICU were enrolled. APACHE III and initial SOFA score of individual patients were calculated based on worst values in first 24 hours of admission. Outcome was recorded as survivors or non survivors in ICU. Both the scores were significantly higher in non survivors (p<0.001). A positive and strong correlation was seen between the scores with Spearman's rho correlation coefficient of 0.866 (p<0.001). Discrimination for APACHE III and initial SOFA score was good with area under ROC curve of 0.895 and 0.879 respectively. Cut off point with best Youden index was e" 61 for APACHE III and e" 8 for initial SOFA score. ICU mortality differed significantly above and below cut off points (p<0.001). Hosmer Lemeshow test showed initial SOFA score to have better calibration than APACHE III score. Initial SOFA score is comparable to APACHE III score for mortality prediction in ICU and so can be helpful for better utilization of limited resources in ICU.
authors: Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal. gentlesunder@hotmail.com
authors: G S
authors: GS
authors: Shrestha
authors: R
authors: R
authors: Gurung
authors: R
authors: R
authors: Amatya
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D055815:Young Adult