Clinical Utility of APACHE III Scoring System as a Method for Predicting the Patient with Cardiovascular Disease admitted in Coronary Care Unit (CCU)

Lee, Goung Sup

Abstract

BACKGROUND AND OBJECTIVES: Risk assessment methods specially designed for coronary care unit (CCU) are lacking. The aims of this study were first to assess the utility of the Acute Physiology and Chronic Health Evaluation III (APACHE III) scoring system for the prediction of mortality in CCU patients and second to derive an equation for estimation of death risk. MATERIALS AND METHOD: 310 patients were retrospectively investigated. The day 1-scores of APACHE III were determinated. An equation for estimation of death risk was derived, using multivariate logistic regression analysis. A receiver operating characteristic (ROC) curve for APACHE III score was plotted.
RESULTS
The average APACHE III scores of non-survivors were significantly higher than those of survivors (P<0.01). Multivariate logistic regression analysis showed that the APACHE III scores and the diagnoses on admission were two significant predictors of mortality. we formulated an equation which could predict outcomes : Probability of death =eX / 1+X, where X = -8.64 +diagnostic category weight +(0.10xAPACHE III scores). The ROC curve for APACHE III confirmed it as a predictor of mortality, with an area under the curve of 0.933 (standard error(SE)=.016). The sensitivity (95% confidence limit(CL)), specificity (95%CL) for APACHE III scores were, respectively, 0.84 (0.72-0.92), 0.88 (0.83-0.92).
CONCLUSION
We conclude that the APACHE III scoring system is a useful tool for the overall assessment and management of cardiovascular disease patients in CCUs.