Transcript THE UTILITY OF APACHE II SCORE IN PREDICTING THE …

First Author: Ráduly Kinga
Author: Ráduly Orsolya
Coordinators: Dr. Zaharia Kézdi Iringo, Dr.
Nina Sincu
 APACHE
II was designed to measure the
severity of disease for adult patients
admitted to Intensive care units, for patients
aged 15 or older.
 This scoring system is used in many ways:
 can be used to describe the morbidity of a
patient when comparing the outcome with
other patients
 predicted mortalities are averaged for
groups of patients in order to specify the
group’s morbidity.
 The
-
Estimated Risk of Hospital Death
(ERHD), based on APACHE II score:
> 35% for APACHE II score > 20 pt
11-35% for APACHE II score of 10-20
pt
< 11% for APACHE II score < 10 pt
 We
have conducted a retrospective,
descriptive, transversal study on a sample of
29 patients admitted to Infectious Diseases
Clinic I from Tg-Mures, during 2009-2010.
 The study included patients aged 16 or older,
diagnosed with an infectious disease, who
required intensive care treatment.
 We analyzed the patients’ files and
calculated the APACHE II score.
 The results were analyzed by using a
statistic programme (GraphPad)
Valori Apache II
35
30
25
20
Valori Apache II
15
10
5
0
0
5
10
15
20
25
30
35
10
9
8
7
6
5
men
4
women
3
2
1
0
>20
10-20
APACHEII
<10
Age over ≥ 65 years: 6 out of 8 patients have deceased (75%)
< 65 years: 9 out of 21 patients (42.85%)
P 0.2148 - we did not find statistically significant association
RR: 1.750 CI 95%= 0.9267-3.305
57
60
47
50
40
33
30
20
10
0
>20
10.-20.
average age
<10
14
Mortality rate:
12
- 84.16% for APACHE II >
20 pt
- 30.76% - APACHE II 1020 pt
- 0% - APACHE II < 10 pt
10
8
6
4
2
0
>20
10.-20.
number of patients
< 10
number of deaths
herpes Zoster
severe pneumonia
pulmonary tuberculosis
acute meningoencephalitis
severe sepsis
0
1
2
3
number of patients
4
5
6
7
8
hemorrhagic herpes Zoster
severe pneumonia
acute meningoencephalitis
severe sepsis
0
1
2
number of patients
3
4
5
6
HIV infection
pulmonary tuberculosis
acute meningoencephalitis
0
0.2
0.4
number of patients
0.6
0.8
1
1.2
 The
mortality rate was higher than expected
in patients with APACHE II score > 20 pt
(84.16 % compared with an ERHD > 35 %)
 We did not find statistically significant
association between advanced age (over 65
years old) and mortality rate (p=0.2148).
 The severe illnesses, such as severe sepsis
and respiratory impairment were associated
with worse outcome.