Predictive scoring systems in multiorgan failure: A cohort study

Abstract

Objective: An evaluation is made of the hospital mortality predicting capacity of the main predictive scoring systems.

Design: A 2-year retrospective cohort study was carried out.

Setting: A third level ICU with surgical and medical patients.

Patients: All patients with multiorgan failure during the first day in the ICU.

Main variables: APACHE II and IV, SAPS II and III, MPM II and hospital mortality.

Results: A total of 568 patients were included. Mortality rate: 39.8% (226 patients). Discrimination (area under the ROC curve; 95% CI): APACHE IV (0.805; 0.751-0.858), SAPS II (0.755; 0.697-0.814), MPM II (0.748; 0.688-0.809), SAPS III (0.737; 0.675-0.799) and APACHE II (0.699; 0.633-0.765). MPM II showed the best calibration, followed by SAPS III. APACHE II, SAPS II and APACHE IV showed very poor calibration. Standard mortality ratio (95% CI): APACHE IV 1.9 (1.78-2.02); APACHE II 1.1 (1.07-1.13); SAPS III 1.1 (1.06-1.14); SAPS II 1.03 (1.01-1.05); MPM 0.9 (0.86-0.94).

Conclusions: APACHE IV showed the best discrimination, with poor calibration. MPM II showed good discrimination and the best calibration. SAPS II, in turn, showed the second best discrimination, with poor calibration. The APACHE II calibration and discrimination values currently disadvise its use. SAPS III showed good calibration with modest discrimination. Future studies at regional or national level and in certain critically ill populations are needed.

Keywords: APACHE; Disfunción multiorgánica; Escalas pronósticas; Hospital mortality; ICU; MPM; Mortalidad hospitalaria; Multi-organ failure; Predictive scoring systems; SAPS; UCI.