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Scoring systems (APACHE II and Simplified Acute Physiology Score II) for predicting outcome in status asthmaticus

Introduction

The scoring systems (SS) can be used globally to estimate the severity of critically ill patients. In status asthmaticus (SA), these SS were not evaluated to predict mortality. Our aim is to evaluate the ability of nonspecific scores (APACHE II and Simplified Acute Physiology Score (SAPS) II) to predict outcome in SA in a medical ICU.

Methods

A prospective and monocentric study during 8 years (2000 to 2007) included all patients who were admitted to our unit for SA. Demographic and clinical data were collected at admission. We collected also therapeutic aspects in all patients. Daily, a follow-up of the SS value was calculated with their average. We defined a subgroup that has been mechanically ventilated to evaluate the value of SS in SA, because mechanical ventilation is a main prognostic factor among others. Modulus evaluation required a discriminative application using receiver operating characteristic curves. The statistic analysis has been based on SPSS 11.0 for windows.

Results

A total of 246 cases of SA (9.7% of all patients admitted in our unit) have been counted during the duration of study. The mean value of APACHE II and of SAPS II was 8 ± 5 and 20 ± 10, respectively. The mortality rate was 12%. In the subgroup, 90% of patients had APACHE II score ≤ 8 and 77% of them had SAPS II <20. Both scoring systems had a weak discrimination, with an area under the curve (receiver operating characteristic) 0.655 and 0.557 for SAPS II and APACHE II, respectively.

Conclusion

APACHE II and SAPS II are not good prognostic tools for status asthmaticus. A new and more adapted evaluation tool is required.

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Hachimi, A., Charra, B., Benslama, A. et al. Scoring systems (APACHE II and Simplified Acute Physiology Score II) for predicting outcome in status asthmaticus. Crit Care 13, P505 (2009). https://doi.org/10.1186/cc7669

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Keywords

  • Receiver Operating Characteristic
  • Mechanical Ventilation
  • Scoring System
  • Characteristic Curf
  • Evaluation Tool