Korean J Crit Care Med.  2017 Aug;32(3):275-283. 10.4266/kjccm.2016.00990.

The Ability of the Acute Physiology and Chronic Health Evaluation (APACHE) IV Score to Predict Mortality in a Single Tertiary Hospital

Affiliations
  • 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Cheongju St. Mary's Hospital, Cheongju, Korea.
  • 2Department of Nursing Care, Chungnam National University Hospital, Daejeon, Korea.
  • 3Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
  • 4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea. diffable@hanmail.net
  • 5Clinical Trial Center, Chungnam National University Hospital, Daejeon, Korea.
  • 6Division of Pulmonology, Department of Internal Medicine, Chamjoeun Hospital, Gwangju, Korea.
  • 7Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Korea.

Abstract

BACKGROUND
The Acute Physiology and Chronic Health Evaluation (APACHE) II model has been widely used in Korea. However, there have been few studies on the APACHE IV model in Korean intensive care units (ICUs). The aim of this study was to compare the ability of APACHE IV and APACHE II in predicting hospital mortality, and to investigate the ability of APACHE IV as a critical care triage criterion.
METHODS
The study was designed as a prospective cohort study. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test respectively. We also calculated the standardized mortality ratio (SMR).
RESULTS
The APACHE IV score, the Charlson Comorbidity index (CCI) score, acute respiratory distress syndrome, and unplanned ICU admissions were independently associated with hospital mortality. The calibration, discrimination, and SMR of APACHE IV were good (H = 7.67, P = 0.465; C = 3.42, P = 0.905; AUROC = 0.759; SMR = 1.00). However, the explanatory power of an APACHE IV score >93 alone on hospital mortality was low at 44.1%. The explanatory power was increased to 53.8% when the hospital mortality was predicted using a model that considers APACHE IV >93 scores, medical admission, and risk factors for CCI >3 coincidentally. However, the discriminative ability of the prediction model was unsatisfactory (C index <0.70).
CONCLUSIONS
The APACHE IV presented good discrimination, calibration, and SMR for hospital mortality.

Keyword

APACHE IV; calibration; discrimination; intensive care units; triage
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