PREDICTIVE EFFICASY OF APACHE IV AT ICU.s OF CHK

Abstract

Introduction:APACHE IV is a successful scoring system for assessing severity of illness and prognosis of ICU patients. In some countries it is being used by intensivists after proved valid.Since no study has been conducted regarding APACHE IV in our setup. This study was conducted in our set up for the first time to see the applicability of APACHE IV in ICUs of civil hospital Karachi (CHK) to evaluate the predictive accuracy of apache IV scoring system, and to evaluate the prognostic outcome of scoring system in NICU, MICU and SICU patients at CHK. As the APACHE IV score increases the risk increases and outcomes are measured as the death before the discharge from ICU.APACHE IV shows mortality prediction better than APACHE III and APACHE II. This scoring system is also used to evaluate efficacy of ICUsPatients and Method:It is an Observational Prospective cohort study at CHK in its ICUs. 163 patients were enrolled for the study: 69 patients of SICU, 37 patients of NICU and 55 patients of MICU). Included patients stayed more than 24 hours in ICUs. Study was conducted from 28th Jan, 2009 to 12th Sep, 2009. Data was collected from ICU database.Results:Among 163 enrolled patients average age was 38.024 years (63.6%), with minimum age of 9 months and maximum age of 90.0 years. 46.91% of patients were males and 53.08% were females. 147 (90.18%) have complete labs. 120 patients had complete data while 43 (26.38%) patients did not have complete data. The mean APACHE IV score was 63.78 having maximum APACHE IV score150 and minimum 0, with standard deviation of 29.821. Mean Predicted mortality of overall patient was found to be 25.7 % while observed mortality was 28.4% with SD of 0.439 and SMR=1.09. The no. of patients who survive were 104 (64.2 %) while the out come of remaining 12 (7.4 %) patient was not recorded by hospital whether they survived or not. Mean APACHE IV score of survivors was found to be 54.55, while mean APACHE IV score of nonsurvivorwas 85.07 which is significantly higher. 63.9% patients have APACHE IV score <60, out of these 79.7% were discharged from ICU and 14.8% don’t survive. 27.8% patients have APACHE IV score >81 out of these 31.7% were discharged from ICU and 65.8% do not survive (p<0.001). The 62.1% of overall population show the same outcome as predicted by APACHE IV (p=0.61).Conclusion:The present study demonstrates that the mortality prediction and LOS predicted by APACHE IV system performs acceptably in our patients and can be utilized as a performance assessment tool in our ICUs.