Comparison of APACHE IV with APACHE II, SAPS 3, MELD, MELD-Na, and CTP scores in predicting mortality after liver transplantation

Sci Rep. 2017 Sep 7;7(1):10884. doi: 10.1038/s41598-017-07797-2.

Abstract

The Acute Physiology and Chronic Health Evaluation (APACHE) IV score and Simplified Acute Physiology Score (SAPS) 3 include liver transplantation as a diagnostic category. The performance of APACHE IV-liver transplantation (LT) specific predicted mortality, SAPS 3, APACHE II, Model for End-stage Liver Disease (MELD)-Na, MELD, and CTP scores in predicting in-hospital and 1 year mortality in liver transplant patients was compared using 590 liver transplantations in a single university hospital. In-hospital mortality and 1 year mortality were 2.9% and 4.2%, respectively. The APACHE IV-LT specific predicted mortality showed better performance in predicting in-hospital mortality (AUC 0.91, 95% CI [0.86-0.96]) compared to SAPS 3 (AUC 0.78, 95% CI [0.66-0.90], p = 0.01), MELD-Na (AUC 0.74, 95% CI [0.57-0.86], p = 0.01), and CTP (AUC 0.68, 95% CI [0.54-0.81], p = 0.01). The APACHE IV-LT specific predicted mortality showed better performance in predicting 1 year mortality (AUC 0.83, 95% CI [0.76-0.9]) compared to MELD-Na (AUC 0.67, 95% CI [0.55-0.79], p = 0.04) and CTP (AUC 0.64, 95% CI [0.53-0.75], p = 0.03), and also in all MELD groups and in both living and deceased donor transplantation. The APACHE IV-LT specific predicted mortality showed better performance in predicting in-hospital and 1 year mortality after liver transplantation.

MeSH terms

  • Decision Support Techniques*
  • Hospitals, University
  • Humans
  • Liver Diseases / pathology*
  • Liver Diseases / surgery*
  • Liver Transplantation*
  • Prognosis
  • Republic of Korea
  • Survival Analysis
  • Treatment Outcome