- Poster presentation
- Open Access
ICU scoring systems: which one to use in patients with sepsis?
© Juneja et al. 2011
- Published: 27 October 2011
- Septic Patient
- Sequential Organ Failure Assessment
- Standardize Mortality Ratio
- Simplify Acute Physiology Score
- Chronic Health Evaluation
Disease-severity scoring systems have been developed for stratification of ICU patients. These systems have been tested and validated in various general medical and surgical ICU patients. However, the validity and efficacy of these systems, especially the newer generation, has not been assessed in patients with sepsis, which is the commonest indication for admission to a medical ICU. Hence, we conducted this study to assess the performance of various ICU scoring systems - Acute Physiology and Chronic Health Evaluation (APACHE) II, III, IV; Simplified Acute Physiology Score (SAPS) II, III; Mortality Prediction Model (MPM) II0, III0; and Sequential Organ Failure Assessment (SOFA) scores - in septic patients admitted to a medical ICU.
A prospective, observational study was conducted in a tertiary care medical ICU and consecutive patients fulfilling the diagnostic criteria for sepsis during the first 24 hours of ICU admission were included over a 2-year period. Data related to patient demographics and that required to compute various scores were recorded. Predicted mortality was calculated using original regression formulas. The standardized mortality ratio (SMR) was computed for mortality prediction. Calibration was assessed by calculating the Lemeshow-Hosmer goodness-of-fit C-statistic. Discrimination was assessed by calculating the area under the receiver operating characteristic (AUROC) curves. ICU mortality was the primary outcome measure.
Comparison of the actual and predicted mortality rates for the various scoring systems
Area under the curve for predicting ICU mortality for various scoring systems
0.845 to 0.914
0.847 to 0.914
0.848 to 0.916
0.808 to 0.890
0.838 to 0.907
0.807 to 0.891
0.835 to 0.909
0.857 to 0.922
Overall, the newer generation of scoring systems performed better than their older counterparts and was more accurate. Older scoring systems had a tendency to overpredict mortality. However, all the scores tested had good efficacy and the difference in efficacy was not statistically significant.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.