Author/Authors :
Choi, Jae Woo Department of Internal Medicine - Cheongju St. Mary’s Hospital, Cheongju , Park, Young Sun Department of Nursing Care - Chungnam National University Hospital, Daejeon , Lee, Young Seok Department of Internal Medicine - Korea University Guro Hospital - Korea University College of Medicine, Seoul , Park, Yeon Hee Department of Internal Medicine - Chungnam National University Hospital - Chungnam National University College of Medicine, Daejeon , Chung, Chaeuk Department of Internal Medicine - Chungnam National University Hospital - Chungnam National University College of Medicine, Daejeon , Park, Dong Il Department of Internal Medicine - Chungnam National University Hospital - Chungnam National University College of Medicine, Daejeon , Kwon, In Sun Chungnam National University Hospital, Daejeon , Lee, Ju Sang Department of Nursing Care - Chungnam National University Hospital, Daejeon , Min, Na Eun Department of Nursing Care - Chungnam National University Hospital, Daejeon , Park, Jeong Eun Department of Nursing Care - Chungnam National University Hospital, Daejeon , Yoo, Sang Hoon Department of Internal Medicine - Chamjoeun Hospital, Gwangju , Chon, Gyu Rak Department of Internal Medicine - Cheongju St. Mary’s Hospital, Cheongju , Sul, Young Hoon Department of Surgery - Chungbuk National University College of Medicine - Cheongju, Korea , Moon, Jae Young Department of Internal Medicine - Chungnam National University Hospital - Chungnam National University College of Medicine, Daejeon
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.
Keywords :
APACHE IV , calibration , discrimination , intensive care units , triage
