EVALUATION OF APACHE- IV & SAPS- II SCORING SYSTEMS AND CALCULATION OF STANDARDISED MORTALITY RATE IN SEVERE SEPSIS AND SEPTIC SHOCK PATIENTS- A PROSPECTIVE OBSERVATIONAL STUDY.

Corresponding Author:
Dr. Sarbari Swaika,
Associate Professor,
Department of Anaesthesiology and Critical Care,
Institute of Post Graduate Medical Education and Research,
Kolkata, West Bengal, India.
E-mail: dr.s.swaika@gmail.com

ABSTRACT

BACKGROUND

Sepsis and septic shock are major causes of mortality in the intensive care units worldwide. The scoring systems are very useful to predict risk of mortality and evaluating outcome in critically ill patients. In this study, we aimed to research the effectiveness of SAPS II and APACHE IV scoring systems in the evaluation of prognosis in severe sepsis and septic shock patients hospitalized in ICU.

MATERIALS AND METHODS

A prospective observational study was conducted on 50 consecutive patients of severe sepsis and septic shock admitted to ICU between April 2016 to April 2017. Predicted mortality was calculated using online calculator. Standardised mortality rate  (SMR) was calculated with 95% confidence intervals. Calibration was assessed using Hosmer-Lemeshow test, statistic and Cohen’s kappa statistic. Discrimination was assessed using receiver operating characteristic curves.

RESULTS

The actual mortality rate in this study was 52%. Predicted mortality rate of APACHE IV and SAPS II were 39.21% (SMR 1.32) and 45.85% (SMR 1.13) respectively. The Cohen’s kappa for APACHE IV and SAPS II were 0.369 and 0.426 respectively. Hosmer-Lemeshow goodness of fit statistic indicates good logistic regression model fit for both APACHE IV and SAPS II scoring system (p value > 0.05). AUROC of APACHE IV and SAPS II were 0.748 and 0.760 respectively.

CONCLUSION

SAPS II had a closer prediction and better discriminative ability than APACHE IV.

KEY WORDS

APACHE, SAPS II, Severe Sepsis, Septic Shock, ICU