Performance of APACHE IV in Medical Intensive Care Unit Patients: Comparisons with APACHE II, SAPS 3, and MPM0 III
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Background: In this study, we analyze the performance of the Acute Physiology and ChronicHealth Evaluation (APACHE) II, APACHE IV, Simplified Acute Physiology Score (SAPS) 3, andMortality Probability Model (MPM)0 III in order to determine which system best implementsdata related to the severity of medical intensive care unit (ICU) patients. Methods: The present study was a retrospective investigation analyzing the discriminationand calibration of APACHE II, APACHE IV, SAPS 3, and MPM0 III when used to evaluate medicalICU patients. Data were collected for 788 patients admitted to the ICU from January 1, 2015to December 31, 2015. All patients were aged 18 years or older with ICU stays of at least24 hours. The discrimination abilities of the three systems were evaluated using c-statistics,while calibration was evaluated by the Hosmer-Lemeshow test. A severity correction modelwas created using logistics regression analysis. Results: For the APACHE IV, SAPS 3, MPM0 III, and APACHE II systems, the area under thereceiver operating characteristic curves was 0.745 for APACHE IV, resulting in the highestdiscrimination among all four scoring systems. The value was 0.729 for APACHE II, 0.700 forSAP 3, and 0.670 for MPM0 III. All severity scoring systems showed good calibrations: APACHEII (chi-square, 12.540; P=0.129), APACHE IV (chi-square, 6.959; P=0.541), SAPS 3 (chi-square,9.290; P=0.318), and MPM0 III (chi-square, 11.128; P=0.133). Conclusions: APACHE IV provided the best discrimination and calibration abilities and wasuseful for quality assessment and predicting mortality in medical ICU patients.
Abstract
Background: In this study, we analyze the performance of the Acute Physiology and ChronicHealth Evaluation (APACHE) II, APACHE IV, Simplified Acute Physiology Score (SAPS) 3, andMortality Probability Model (MPM)0 III in order to determine which system best implementsdata related to the severity of medical intensive care unit (ICU) patients. Methods: The present study was a retrospective investigation analyzing the discriminationand calibration of APACHE II, APACHE IV, SAPS 3, and MPM0 III when used to evaluate medicalICU patients. Data were collected for 788 patients admitted to the ICU from January 1, 2015to December 31, 2015. All patients were aged 18 years or older with ICU stays of at least24 hours. The discrimination abilities of the three systems were evaluated using c-statistics,while calibration was evaluated by the Hosmer-Lemeshow test. A severity correction modelwas created using logistics regression analysis. Results: For the APACHE IV, SAPS 3, MPM0 III, and APACHE II systems, the area under thereceiver operating characteristic curves was 0.745 for APACHE IV, resulting in the highestdiscrimination among all four scoring systems. The value was 0.729 for APACHE II, 0.700 forSAP 3, and 0.670 for MPM0 III. All severity scoring systems showed good calibrations: APACHEII (chi-square, 12.540; P=0.129), APACHE IV (chi-square, 6.959; P=0.541), SAPS 3 (chi-square,9.290; P=0.318), and MPM0 III (chi-square, 11.128; P=0.133). Conclusions: APACHE IV provided the best discrimination and calibration abilities and wasuseful for quality assessment and predicting mortality in medical ICU patients.
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