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Disparity in outcome prediction between APACHE II, APACHE III and APACHE IV
Critical Care volume 12, Article number: P501 (2008)
A prospective collection of data concerning APACHE II and APACHE III, and a retrospective analysis of complimentary data necessary for APACHE IV mortality calculation. Discrimination was assessed by the area under the receiver operator curve (ROC) and calibration by the Hosmer–Lemeshow (HL) goodness-of-fit test. Results are expressed as the mean ± SD. P < 0.05 was considered significant.
The mean age was 31.2 ± 5.9 years. Seventy-five percent were delivered by caesarean section. Seventy-eight percent needed mechanical ventilation. Overall mortality was 11.23% (n = 71/641). Acute physiology scores (APS) of APACHE II and APACHE III were significantly different between survivors and nonsurvivors, respectively (7.2 ± 5 vs 20 ± 9 and 23.5 ± 18 vs 76 ± 39) (P < 0.001). See Table 1.
APACHE II mortality prediction is out of date. APACHE III and APACHE IV mortality have excellent discrimination but poor calibration. Considering the APS alone, the APACHE systems discriminate and calibrate well. APACHE IV can therefore be considered the best mortality prediction model. Incorporation of new predictor variables such as mechanical ventilation and importance of respiratory dysfunction explains part of this improvement. Regular recalibration of mortality prediction formulas is important and helps improve calibration for aggregate patient samples. For specific subgroups of patients, however, this measure is probably insufficient; we need to incorporate new specific variables.
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Haddad, Z., Falissard, B., Chokri, K. et al. Disparity in outcome prediction between APACHE II, APACHE III and APACHE IV. Crit Care 12, P501 (2008). https://doi.org/10.1186/cc6722
- Receiver Operator Curve
- Acute Physiology Score
- Mortality Prediction
- Prediction Formula
- Mortality Calculation