Korean J Crit Care Med.  2014 Nov;29(4):288-296. 10.4266/kjccm.2014.29.4.288.

Acute Physiologic and Chronic Health Examination II and Sequential Organ Failure Assessment Scores for Predicting Outcomes of Out-of-Hospital Cardiac Arrest Patients Treated with Therapeutic Hypothermia

Affiliations
  • 1Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea. yongem@gilhospital.com

Abstract

BACKGROUND
The aim of this study was to assess the relationship between acute physiologic and chronic health examination (APACHE) II and sequential organ failure assessment (SOFA) scores and outcomes of post-cardiac arrest patients treated with therapeutic hypothermia (TH).
METHODS
Out-of-hospital cardiac arrest (OHCA) survivors treated with TH between January 2010 and December 2012 were retrospectively evaluated. We captured all components of the APACHE II and SOFA scores over the first 48 hours after intensive care unit (ICU) admission (0 h). The primary outcome measure was in-hospital mortality and the secondary outcome measure was neurologic outcomes at the time of hospital discharge. Receiver-operating characteristic and logistic regression analysis were used to determine the predictability of outcomes with serial APACHE II and SOFA scores.
RESULTS
A total of 138 patients were enrolled in this study. The area under the curve (AUC) for APACHE II scores at 0 h for predicting in-hospital mortality and poor neurologic outcomes (cerebral performance category: 3-5) was more than 0.7, and for SOFA scores from 0 h to 48 h the AUC was less than 0.7. Odds ratios used to determine associations between APACHE II scores from 0 h to 48 h and in-hospital mortality were 1.12 (95% confidence interval [CI], 1.03-1.23), 1.13 (95% CI, 1.04-1.23), and 1.18 (95% CI, 1.07-1.30).
CONCLUSIONS
APACHE II, but not SOFA score, at the time of ICU admission is a modest predictor of in-hospital mortality and poor neurologic outcomes at the time of hospital discharge for patients who have undergone TH after return of spontaneous circulation following OHCA.

Keyword

acute physiologic and chronic health examination; cardiopulmonary resuscitation; hypothermia, induced; organ dysfunction scores; outcome assessment; out-of-hospital cardiac arrest

MeSH Terms

APACHE
Area Under Curve
Cardiopulmonary Resuscitation
Hospital Mortality
Humans
Hypothermia*
Hypothermia, Induced
Intensive Care Units
Logistic Models
Odds Ratio
Organ Dysfunction Scores*
Out-of-Hospital Cardiac Arrest*
Outcome Assessment (Health Care)
Retrospective Studies
Survivors
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