Investig Clin Urol.  2017 Nov;58(6):453-459. 10.4111/icu.2017.58.6.453.

Validation of APACHE II scoring system at 24 hours after admission as a prognostic tool in urosepsis: A prospective observational study

• VijayGanapathy S
• Karthikeyan VS
• Sreenivas
• Mallya A
• Keshavamurthy R

• KMID: 2414774
• DOI: http://doi.org/10.4111/icu.2017.58.6.453

Abstract

PURPOSE
Urosepsis implies clinically evident severe infection of urinary tract with features of systemic inflammatory response syndrome (SIRS). We validate the role of a single Acute Physiology and Chronic Health Evaluation II (APACHE II) score at 24 hours after admission in predicting mortality in urosepsis.
MATERIALS AND METHODS
A prospective observational study was done in 178 patients admitted with urosepsis in the Department of Urology, in a tertiary care institute from January 2015 to August 2016. Patients >18 years diagnosed as urosepsis using SIRS criteria with positive urine or blood culture for bacteria were included. At 24 hours after admission to intensive care unit, APACHE II score was calculated using 12 physiological variables, age and chronic health.
RESULTS
Mean±standard deviation (SD) APACHE II score was 26.03±7.03. It was 24.31±6.48 in survivors and 32.39±5.09 in those expired (p<0.001). Among patients undergoing surgery, mean±SD score was higher (30.74±4.85) than among survivors (24.30±6.54) (p<0.001). Receiver operating characteristic (ROC) analysis revealed area under curve (AUC) of 0.825 with cutoff 25.5 being 94.7% sensitive and 56.4% specific to predict mortality. Mean±SD score in those undergoing surgery was 25.22±6.70 and was lesser than those who did not undergo surgery (28.44±7.49) (p=0.007). ROC analysis revealed AUC of 0.760 with cutoff 25.5 being 94.7% sensitive and 45.6% specific to predict mortality even after surgery.
CONCLUSIONS
A single APACHE II score assessed at 24 hours after admission was able to predict morbidity, mortality, need for surgical intervention, length of hospitalization, treatment success and outcome in urosepsis patients.

Keyword

APACHE; Morbidity; Mortality; Urinary tract infection

MeSH Terms

APACHE*
Area Under Curve
Bacteria
Hospitalization
Humans
Intensive Care Units
Mortality
Observational Study*
Prospective Studies*
ROC Curve
Survivors
Systemic Inflammatory Response Syndrome
Tertiary Healthcare
Urinary Tract
Urinary Tract Infections
Urology

Figure

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  Fig. 1 Receiver operating characteristic curves: (A) prediction of mortality by APACHE; (B) prediction of morbidity by APACHE; (C) prediction of mortality by APACHE among patients who underwent surgery. APACHE, Acute Physiology and Chronic Health Evaluation.

Reference

1. Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med. 2003; 348:138–150. PMID: 12519925.

2. Rué M, Artigas A, Alvarez M, Quintana S, Valero C. Performance of the Mortality Probability Models in assessing severity of illness during the first week in the intensive care unit. Crit Care Med. 2000; 28:2819–2824. PMID: 10966256.

3. 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; 270:2957–2963. PMID: 8254858.

4. Markgraf R, Deutschinoff G, Pientka L, Scholten T. Comparison of acute physiology and chronic health evaluations II and III and simplified acute physiology score II: a prospective cohort study evaluating these methods to predict outcome in a German interdisciplinary intensive care unit. Crit Care Med. 2000; 28:26–33. PMID: 10667495.

5. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992; 101:1644–1655. PMID: 1303622.

6. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003; 31:1250–1256. PMID: 12682500.

7. Varpula M, Tallgren M, Saukkonen K, Voipio-Pulkki LM, Pettilä V. Hemodynamic variables related to outcome in septic shock. Intensive Care Med. 2005; 31:1066–1071. PMID: 15973520.

8. Dünser MW, Takala J, Ulmer H, Mayr VD, Luckner G, Jochberger S, et al. Arterial blood pressure during early sepsis and outcome. Intensive Care Med. 2009; 35:1225–1233. PMID: 19189077.

9. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013; 41:580–637. PMID: 23353941.

10. Orebaugh SL. Initiation of mechanical ventilation in the emergency department. Am J Emerg Med. 1996; 14:59–69. PMID: 8630160.

11. Burtin P, Bollaert PE, Feldmann L, Nace L, Lelarge P, Bauer P, et al. Prognosis of stroke patients undergoing mechanical ventilation. Intensive Care Med. 1994; 20:32–36. PMID: 8163755.

12. Dindo D, Clavien PA. What is a surgical complication? World J Surg. 2008; 32:939–941. PMID: 18414942.

13. Graefen M. The modified Clavien system: a plea for a standardized reporting system for surgical complications. Eur Urol. 2010; 57:387–389. PMID: 20022421.

14. Wong DT, Crofts SL, Gomez M, McGuire GP, Byrick RJ. Evaluation of predictive ability of APACHE II system and hospital outcome in Canadian intensive care unit patients. Crit Care Med. 1995; 23:1177–1183. PMID: 7600824.

15. Gupta R, Arora VK. Performance evaluation of APACHE II score for an Indian patient with respiratory problems. Indian J Med Res. 2004; 119:273–282. PMID: 15243165.

16. Desai S, Lakhani JD. Utility of SOFA and APACHE II score in sepsis in rural set up MICU. J Assoc Physicians India. 2013; 61:608–611. PMID: 24772695.

17. Chen FG, Koh KF, Goh MH. Validation of APACHE II score in a surgical intensive care unit. Singapore Med J. 1993; 34:322–324. PMID: 8266203.

18. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991; 100:1619–1636. PMID: 1959406.

19. Bastos PG, Knaus WA. APACHE III study: a summary. Intensive Care World. 1991; 8:35–38. PMID: 10148199.

20. Zimmerman JE, Kramer AA. Outcome prediction in critical care: the Acute Physiology and Chronic Health Evaluation models. Curr Opin Crit Care. 2008; 14:491–497. PMID: 18787439.

21. Beck DH, Taylor BL, Millar B, Smith GB. Prediction of outcome from intensive care: a prospective cohort study comparing Acute Physiology and Chronic Health Evaluation II and III prognostic systems in a United Kingdom intensive care unit. Crit Care Med. 1997; 25:9–15. PMID: 8989170.

22. Tang CH, Yang CM, Chuang CY, Chang ML, Huang YC, Huang CF. A comparative study of clinical severity scoring systems in ICUs in Taiwan. Tzu Chi Med J. 2005; 17:239–245.

23. Rowan KM, Kerr JH, Major E, McPherson K, Short A, Vessey MP. Intensive Care Society's APACHE II study in Britain and Ireland--II: Outcome comparisons of intensive care units after adjustment for case mix by the American APACHE II method. BMJ. 1993; 307:977–981. PMID: 8241909.

24. Livingston BM, MacKirdy FN, Howie JC, Jones R, Norrie JD. Assessment of the performance of five intensive care scoring models within a large Scottish database. Crit Care Med. 2000; 28:1820–1827. PMID: 10890627.