title: APACHE II scoring to predict outcome in post-cardiac arrest.
abstract: BACKGROUND
  Despite advancements in management of cardiac arrest, mortality remains high and few severity of illness scoring systems have been calibrated in this population. The goal of the current investigation was to assess the Acute Physiology and Chronic Health Evaluation II score in post-cardiac arrest.
  
  
  METHODS
  This is a prospective observational study of adult post-cardiac arrest patients at a tertiary-care center. The primary outcome variable was in-hospital mortality and secondary outcome variable was neurologic outcome. APACHE II scores were used to predict outcomes using logistic modeling.
  
  
  RESULTS
  A total of 228 subjects were included in the analysis. The median age of the cohort was 70 (IQR: 64-71) and 32% (72/228) of the patients were female. The median downtime was 15 min (IQR: 7-27) and initial lactate 5.9 mmol/L (IQR: 3.5-8.4). 71 (57%) of deaths occurred prior to the 72-h follow-up and overall in-hospital mortality was 55% (125/228). Discrimination of APACHE II score in all cardiac arrest patients increased in stepwise fashion from 0-h to 72-h follow-up (AUC: 0-h: 0.62; 24-h: 0.75; 48-h: 0.82; 72-h: 0.86).
  
  
  CONCLUSIONS
  APACHE II score is a poor predictor of outcome at time zero for out-of-hospital cardiac arrest (OHCA) post-arrest patients consistent with the original development of the score in the critically ill. For in-hospital cardiac arrest (IHCA) at time zero and for both IHCA and OHCA at 24h and beyond, the APACHE II score was a modest indicator of illness severity and predictor of mortality/neurologic morbidity.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. mdonnino@bidmc.harvard.edu
authors.forename: Michael W
authors.initials: MW
authors.lastname: Donnino
authors.forename: Justin D
authors.initials: JD
authors.lastname: Salciccioli
authors.forename: Andre
authors.initials: A
authors.lastname: Dejam
authors.forename: Tyler
authors.initials: T
authors.lastname: Giberson
authors.forename: Brandon
authors.initials: B
authors.lastname: Giberson
authors.forename: Cristal
authors.initials: C
authors.lastname: Cristia
authors.forename: Shiva
authors.initials: S
authors.lastname: Gautam
authors.forename: Michael N
authors.initials: MN
authors.lastname: Cocchi
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index