Value of APACHE II score to predict mortality in cardiogenic shock patients of a cardiologic ICU

Introduction

APACHE II score was primarily designed to predict mortality in general patients in ICUs. In patients with specific diseases (such as severe trauma, COPD and acute pancreatitis), however, other score systems were more sensitive

Hypothesis

The aim of this study was to establish the value of the APACHE II score in predicting mortality of patients with cardiogenic shock admitted to a cardiologic ICU of a university hospital

Methods

This was a retrospective analysis of a prospective cohort observational study of 84 patients with cardiogenic shock admitted to a cardiologic ICU. Clinical and laboratory data to calculate the APACHE II score were recorded on admission. The outcome measure was mortality. Logistic regression was used to estimate the predictive ability of the APACHE II score, and the chi-square test was used to compare the difference between predicted and observed mortality.

Results

Patients had a mean age of 54 ± 20 years, 65.5% were male, ICU length of stay was 17.3 ± 20.2 days, mean ejection fraction (EF) was 25 ± 5% and mean APACHE II score was 15 ± 6. Observed mortality was 62% and the corresponding APACHE II prediction was 21.9%. There was a significant difference between observed and predicted mortality (P < 0.001).

Conclusion

These data show that mortality in cardiogenic shock cannot be predicted by the APACHE II scoring system. In this population new assessment tools should be determined for better outcome prediction.