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

• Kim SJ
• Lim YS
• Cho JS
• Kim JJ
• Park WB
• Yang HJ

• KMID: 2227736
• DOI: http://doi.org/10.4266/kjccm.2014.29.4.288

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

Figure

• 

  Fig. 1. Comparison of receiver operating characteristic curves for serial APACHE II scores to predict in-hospital mortality using the area under the curve. The white dots on each curved line indicate the cutoff values at serial time points. APACHE: acute physiologic and chronic health examination; AUC: area under the curve; CV: cutoff values.

• 

  Fig. 2. Comparison of receiver operating characteristic curves for serial APACHE II scores to predict neurologic outcomes at the time of hospital discharge using the area under the curve. The white dots on each curved line indicates the cutoff values at serial time points. CPC: cerebral performance category; APACHE: acute physiologic and chronic health examination; AUC: area under the curve; CV: cutoff values.

Reference

References

1). Ro YS, Shin SD, Song KJ, Lee EJ, Kim JY, Ahn KO, et al. A trend in epidemiology and outcomes of out-of-hospital cardiac arrest by urbanization level: a nationwide observational study from 2006 to 2010 in South Korea. Resuscitation. 2013; 84:547–57.

2). Laver S, Farrow C, Turner D, Nolan J. Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med. 2004; 30:2126–8.

3). Giberson TA, Bivens S, Cocchi M, Giberson B, Salciccoli J, Donnino M. The etiology of postarrest mortality stratified by location of arrest. Circulation. 2011; 124:A184.

4). Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002; 346:549–56.

5). Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002; 346:557–63.

6). Peberdy MA, Callaway CW, Neumar RW, Geocadin RG, Zimmerman JL, Donnino M, et al. Part 9: post-cardiac arrest care: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010; 122:S768–86.

7). Püttgen HA, Geocadin R. Predicting neurological outcome following cardiac arrest. J Neurol Sci. 2007; 261:108–17.

8). Donnino MW, Salciccioli JD, Dejam A, Giberson T, Giberson B, Cristia C, et al. APACHE II scoring to predict outcome in post-cardiac arrest. Resuscitation. 2013; 84:651–6.

9). Adrie C, Cariou A, Mourvillier B, Laurent I, Dabbane H, Hantala F, et al. Predicting survival with good neurological recovery at hospital admission after successful resuscitation of out-of-hospital cardiac arrest: the OHCA score. Eur Heart J. 2006; 27:2840–5.

10). Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010; 3:63–81.

11). Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985; 13:818–29.

12). Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA. 1993; 270:2957–63.

13). Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European society of intensive care medicine. Intensive Care Med. 1996; 22:707–10.

14). Livingston BM, Mackenzie SJ, MacKirdy FN, Howie JC. Should the pre-sedation glasgow coma scale value be used when calculating acute physiology and chronic health evaluation scores for sedated patients? Scottish intensive care society audit group. Crit Care Med. 2000; 28:389–94.

15). Cummins RO, Chamberlain DA, Abramson NS, Allen M, Baskett PJ, Becker L, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein style. A statement for health professionals from a task force of the American heart association, the European resuscitation council, the heart and stroke foundation of Canada, and the Australian resuscitation council. Circulation. 1991; 84:960–75.

16). Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American heart association, European resuscitation council, Australian resuscitation council, New Zealand resuscitation council, heart and stroke foundation of Canada, InterAmerican heart foundation, resuscitation council of Southern Africa). Circulation. 2004; 63:233–49.

17). Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975; 1:480–4.

18). Akobeng AK. Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Paediatr. 2007; 96:644–7.

19). Bohnen JM, Mustard RA, Oxholm SE, Schouten BD. APACHE II score and abdominal sepsis. A prospective study. Arch Surg. 1988; 123:225–9.

20). Kim YH, Yeo JH, Kang MJ, Lee JH, Cho KW, Hwang S, et al. Performance assessment of the SOFA, APACHE II scoring system, and SAPS II in intensive care unit organophosphate poisoned patients. J Korean Med Sci. 2013; 28:1822–6.

21). Hwang SY, Lee JH, Lee YH, Hong CK, Sung AJ, Choi YC. Comparison of the sequential organ failure assessment, acute physiology and chronic health evaluation II scoring system, and trauma and injury severity score method for predicting the outcomes of intensive care unit trauma patients. Am J Emerg Med. 2012; 30:749–53.

22). Lee HN, Choi EY, Kim YH. Validation of APACHE II score and comparison of the performance of APACHE II and adjusted APACHE II models in a surgical intensive care unit. Korean J Crit Care Med. 2011; 26:232–7.

23). Polderman KH. Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med. 2009; 37:186–202.

24). Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001; 286:1754–8.

25). Roberts BW, Kilgannon JH, Chansky ME, Mittal N, Wooden J, Parrillo JE, et al. Multiple organ dysfunction after return of spontaneous circulation in postcardiac arrest syndrome. Crit Care Med. 2013; 41:1492–501.

26). Salciccioli JD, Cristia C, Chase M, Giberson T, Graver A, Gautam S, et al. Performance of SAPS II and SAPS III scores in post-cardiac arrest. Minerva Anestesiol. 2012; 78:1341–7.

27). Bisbal M, Jouve E, Papazian L, de Bourmont S, Perrin G, Eon B, et al. Effectiveness of SAPS III to predict hospital mortality for post-cardiac arrest patients. Resuscitation. 2014; 85:939–44.

28). Hunziker S, Bivens MJ, Cocchi MN, Miller J, Salciccioli J, Howell MD, et al. International validation of the out-of-hospital cardiac arrest score in the United States. Crit Care Med. 2011; 39:1670–4.