The predictive value of serial acute physiology score (APS) and simplified acute physiology score II (SAPS II) in post-operative liver transplant patients

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Purpose

To evaluate the predictive value of daily acute physiology score (APS) of the APACHE II system and simplified acute physiology score II (SAPS II) in postoperative liver transplant patients.

Methods

Records of 20 consecutive postoperative liver transplant patients were reviewed. Daily APS and SAPS II scores were calculated for the first three days. Outcome at hospital discharge was documented. Values were compared using paired t-test and Kruskal-Wallis test.

Results

APS and SAPS II were not significantly different between survivors and nonsurvivors on day 1 and 2 but were different on day 3 (see Table). APS and SAPS II decreased from day 1 to 2 in both survivors and nonsurvivors (-29% vs -31%, P=NS for APS, -24% vs-21%, P=NS for SAPS II). However, while APS and SAPS II continued to decrease from day 2 to 3 in survivors it increased in nonsurvivors (-15% vs +8%, P=0.03 for APS, -7% vs +5%, P=0.26).

Conclusions

In the postoperative liver transplant patients, the following are concluded: 1) in contrast to the progressive decrease in APS and SAPS II in survivors, these scores increased in nonsurvivors between day 2 and 3 after an initial drop; 2) day 3 APS and SAPS II scores better differentiated survivors from nonsurvivors than day 1 and 2 scores; 3) a mortality prediction system based on day 3 score or on serial scores is likely to be more accurate than the traditional systems using the first 24 h data.

Table 1