The Prognostic Value of the First Day and Daily Updated Scores of the APACHE III System in Sepsis

Lim, Chae Man; Lee, Jae Kyun; Lee, Sung Soon; Koh, Younsuck; Kim, Woo Sung; Kim, Dong Soon; Kim, Won Dong; Park, Pyung Hwan; Choi, Jong Moo

Abstract

BACKGROUND
The index which could predict the prognosis of critically ill patients is needed to find out high risk patients and to individualize their treatment. The APACHE III scoring system was established in 1991, but there has been only a few studies concerning its prognostic value. We wanted to know whether the APACHE III scores have prognostic value in discriminating survivors from nonsurvivors in sepsis.
METHODS
In 48 patients meeting the Bones criteria for sepsis, we retrospectively surveyed the day 1 (Dl), day 2(D2) and day 3(D3) scores of patients who were admitted to intensive care unit. The scores of the sepsis survivors and nonsurvivors were compared in respect to the Dl score, and also in respect to the changes of the updated D2 and D3 scores.
RESULTS
1) Of the 48 sepsis patients, 21(43.5%) survived and 27(56.5%) died. The nonsurvivors were older(62.7+/-12.6 vs 51.1+/-18.1 yrs), presented with lower mean arterial pressure(56.9+/-26.2 vs 67.7 +/-14.2 mmHg) and showed greater number of multisystem organ failure(1.2+/-0.8 vs 0.2+/-0.4) than the survivors(p <0.05, respectively). There were no significant differences in sex and initial body temperature between the two groups. 2) The Dl score was lower in the survivors (n=21) than in the nonsurvivors (44.1 +/-14.6, 78.5+/- 18.6, p=0.0001). The D2 and D3 scores significantly decreased in the survivors (Dl vs D2, 44.1+/- 14.6: 37.9+/-15.0, p=0.035; D2 vs D3, 37.9+/-15.0: 30.1 +/-9.3, p=0.0001) but showed a tendency to increase in the nonsurvivors (Dl vs D2 (n=21), 78.5+/-18.6: 81.3+/-23.0, p=0.1337; D2 vs D3 (n=11), 68.2+/-19.3: 75.3+/-18.8, p=0.0078). 3) The D1 scores of 12 survivors and 6 nonsurvivors were in the same range of 42~67 (mean D1 score, 53.8+/-10.0 in the survivors, 55.3+/-10.3 in the nonsurvivors). The age, sex, initial body temperature, and mean arterial pressure were not different between the two groups. In this group, however, D2 and D3 was significantly decreased in the survivors(Dl vs D2, 53.3+/-10.0: 43.6+/- 16.4, p=0.0278; D2 vs D3, 43.6+/-16.4: 31.2+/-10.3, p=0.0005), but showed a tendency to increase in the nonsurvivors(Dl vs D2 (n=6), 55.3+/-10.3:66.7+/-13.9, p=0.1562; D2 vs D3 (n=4), 64.0+/- 16.4:74.3+/-18.6, p=0.1250). Among the individual items of the first day APACHE III score, only the score of respiratory rate was capable of discriminating the nonsurvivors from the survivors (5.5 +/-2.9 vs 1.9+/-3.7, p=0.046) in this group.
CONCLUSION
In sepsis, nonsurvivors had higher first day APACHE III score and their updated scores on the following days failed to decline but showed a tendency to increase. Survivors, on the other hand, had lower first day score and showed decline in the updated APACHE scores. These results suggest that the first day and daily updated APACHE III scores are useful in predicting the outcome and assessing the response to management in patients with sepsis.