Comparative evaluation of Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scoring systems in patients admitted to the cardiac intensive care unit

Abstract

Purpose: To assess and compare the performance of Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores in the cardiac intensive care unit (CICU).

Methods: A single-center, prospective cohort study in a CICU admitting patients with acute cardiovascular diseases was conducted. Both APACHE II and SOFA were calculated on admission. The area under the receiver operating characteristic curve (AUC) was used to evaluate the discriminative ability for predicting CICU survival, hospital survival, and survival 6 months after hospital discharge. Goodness of fit was assessed using the Hosmer-Lemeshow and the Brier scores. All analyses were conducted separately for the patients with acute coronary syndrome.

Results: Of the 300 consecutively admitted patients, 206 had acute coronary syndrome. Both scores exhibited good discriminative ability (AUC range, 0.84-0.92), and their AUCs did not differ significantly. The Hosmer-Lemeshow test P values were numerically higher (.151-.949 vs .033-.531), and the Brier score closer to zero (0.0864-0.1570 vs 0.1039-0.1264) for APACHE II compared with SOFA score models. The Acute Physiology and Chronic Health Evaluation was the best single risk factor for CICU mortality (odds ratio, 1.24; 95% confidence interval, 1.13-1.37; P < .001).

Conclusion: Both APACHE II and SOFA scores have good and comparable discriminative ability for predicting outcome. Calibration and accuracy indices are superior for APACHE II.

Keywords: APACHE II; Acute coronary syndrome; Cardiac intensive care unit; Prognosis; SOFA.