J Korean Med Sci.  2008 Jun;23(3):383-389. 10.3346/jkms.2008.23.3.383.

The Clinical Efficacy of GOCA Scoring System in Patients with Acute Respiratory Distress Syndrome

• Jegal Y
• Lee SI
• Lee KH
• Oh YM
• Shim TS
• Lim CM
• Lee SD
• Kim WS
• Kim DS
• Kim WD
• Koh Y

• KMID: 1786873
• DOI: http://doi.org/10.3346/jkms.2008.23.3.383

Abstract

To explore the following hypotheses: 1) Gas exchange, Organ failure, Cause, Associated disease (GOCA) score, which reflects both general health and the severity of lung injury, would be a better mortality predictor of acute respiratory distress syndrome (ARDS) than acute physiology and chronic health evaluation (APACHE II) or simplified acute physiology score (SAPS II), which are not specific to lung injury, and lung injury score (LIS) that focuses on the lung injury; 2) the performance of APACHE II and SAPS II will be improved when reinforced by LIS, we retrospectively analyzed ARDS patients (N=158) admitted to a medical intensive care unit for five years. The overall mortality of the ARDS patients was 53.2%. Calibrations for all models were good. The area under the curve of (AUC) of LIS (0.622) was significantly less than those of APACHE II (0.743) and SAPS II (0.753). The AUC of GOCA (0.703) was not better than those of APACHE II and SAPS II. The AUCs of APACHE II and SAPS II tended to further increase when reinforced by LIS. In conclusion, GOCA was not superior to APACHE II or SAPS II. The performance of the APACHE II or SAPS II tended to improve when combining a general scoring system with a scoring system that focused on the severity of lung injury.

Keyword

Respiratory Distress Syndrome, Adult; APACHE; SAPS II; GOCA; LIS; Severity Scoring System; Mortality; Patients

MeSH Terms

APACHE
Adult
Aged
Critical Illness/mortality
Female
Humans
Intensive Care
Male
Middle Aged
Predictive Value of Tests
Prognosis
*Pulmonary Gas Exchange
ROC Curve
Respiratory Distress Syndrome, Adult/*mortality/*physiopathology
Retrospective Studies
Risk Factors
Sensitivity and Specificity
*Severity of Illness Index
Survival Analysis

Figure

• 

  Fig. 1 Calibration curves for APAHCE II, SAPS II, GOCA, and LIS. Unmarked lines represent the line of perfect correspondence between actual and predicted risk of death; marked lines represent the calibration curves. The models used for calibration curves were made using patient location before MICU admission in addition to severity scores.

• 

  Fig. 2 ROC curves of severity scores. The discriminative power of LIS was inferior to both APACHE II and SAPS II (A). When the models incorporated patient location before MICU admission in addition to severity scores, all the areas under the curves were increased (B).

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