title: The utility of acute physiology and chronic health evaluation II scores for prediction of mortality among intensive care unit (ICU) and non-ICU patients with methicillin-resistant Staphylococcus aureus bacteremia.
abstract: OBJECTIVE
  Bloodstream infections due to methicillin-resistant Staphylococcus aureus (MRSA) have been associated with significant risk of in-hospital mortality. The acute physiology and chronic health evaluation (APACHE) II score was developed and validated for use among intensive care unit (ICU) patients, but its utility among non-ICU patients is unknown. The aim of this study was to determine the ability of APACHE II to predict death at multiple time points among ICU and non-ICU patients with MRSA bacteremia.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Secondary analysis of data from 200 patients with MRSA bacteremia at 2 hospitals.
  
  
  METHODS
  Logistic regression models were constructed to predict overall in-hospital mortality and mortality at 48 hours, 7 days, 14 days, and 30 days using APACHE II scores separately in ICU and non-ICU patients. The performance of APACHE II scores was compared with age adjustment alone among all patients. Discriminatory ability was assessed using the c-statistic and was compared at each time point using χ(2) tests. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test.
  
  
  RESULTS
  APACHE II was a significant predictor of death at all time points in both ICU and non-ICU patients. Discrimination was high in all models, with c-statistics ranging from 0.72 to 0.84, and was similar between ICU and non-ICU patients at all time points. APACHE II scores significantly improved the prediction of overall and 48-hour mortality compared with age adjustment alone.
  
  
  CONCLUSIONS
  The APACHE II score may be a valid tool to control for confounding or for the prediction of death among ICU and non-ICU patients with MRSA bacteremia.
authors.affiliation: Department of Pharmacy Practice, State University of New York School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Stevens
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Lodise
authors.forename: Brian
authors.initials: B
authors.lastname: Tsuji
authors.forename: Meagan
authors.initials: M
authors.lastname: Stringham
authors.forename: Jill
authors.initials: J
authors.lastname: Butterfield
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dodds Ashley
authors.forename: Kristen
authors.initials: K
authors.lastname: Brown
authors.forename: Alan
authors.initials: A
authors.lastname: Forrest
authors.forename: Jack
authors.initials: J
authors.lastname: Brown
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000401:mortality*; D015331:Cohort Studies; D003428:Cross Infection / Q000401:mortality*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000401:mortality*