Performance of APACHE IV in Medical Intensive Care Unit Patients: Comparisons with APACHE II, SAPS 3, and MPM0 III

Mihye Ko; Miyoung Shim; Sang-Min Lee; Yujin Kim; Soyoung Yoon

doi:10.4266/acc.2018.00178

Performance of APACHE IV in Medical Intensive Care Unit Patients: Comparisons with APACHE II, SAPS 3, and MPM₀ III

Acute Crit Care. 2018 Nov;33(4):216-221. doi: 10.4266/acc.2018.00178. Epub 2018 Nov 21.

Authors

Mihye Ko¹, Miyoung Shim¹, Sang-Min Lee^{1

2}, Yujin Kim¹, Soyoung Yoon¹

Affiliations

¹ Seoul National University Hospital, Seoul, Korea.
² Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Abstract

Background: In this study, we analyze the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE IV, Simplified Acute Physiology Score (SAPS) 3, and Mortality Probability Model (MPM)₀ III in order to determine which system best implements data related to the severity of medical intensive care unit (ICU) patients.

Methods: The present study was a retrospective investigation analyzing the discrimination and calibration of APACHE II, APACHE IV, SAPS 3, and MPM₀ III when used to evaluate medical ICU patients. Data were collected for 788 patients admitted to the ICU from January 1, 2015 to December 31, 2015. All patients were aged 18 years or older with ICU stays of at least 24 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 model was created using logistics regression analysis.

Results: For the APACHE IV, SAPS 3, MPM₀ III, and APACHE II systems, the area under the receiver operating characteristic curves was 0.745 for APACHE IV, resulting in the highest discrimination among all four scoring systems. The value was 0.729 for APACHE II, 0.700 for SAP 3, and 0.670 for MPM₀ III. All severity scoring systems showed good calibrations: APACHE II (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 was useful for quality assessment and predicting mortality in medical ICU patients.

Keywords: APACHE; Mortality Probability Model; Simplified Acute Physiology Score; intensive care unit; severity of illness index.