What is the clinical evidence from this study?

Study design: Observational. Population: Surgical intensive care unit (SICU) patients (n=1314). Intervention: APACHE IV model vs. APACHE II, SAPS 3, and Korean SAPS 3 models. Primary outcome: Discrimination for hospital mortality (AUC) (AUC 0.80, 95% CI 0.74-0.86).

What does this research mean for the field?

The APACHE IV model demonstrates good discrimination but poor calibration for predicting hospital mortality in a Korean surgical intensive care unit, performing similarly to the APACHE II, SAPS 3, and Korean SAPS 3 models. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2014Korean journal of anesthesiology51 citationsOpen Access

Validation of the APACHE IV model and its comparison with the APACHE II, SAPS 3, and Korean SAPS 3 models for the prediction of hospital mortality in a Korean surgical intensive care unit

HLHannah LeeThomas Jefferson University YSYoon-Jung ShonSeoul National University Hospital HKHyerim KimSeoul National University

Key Result

The APACHE IV model demonstrated good discrimination (AUC 0.80) but poor calibration for predicting hospital mortality, performing similarly to the APACHE II, SAPS 3, and Korean SAPS 3 models.

Study Design

Type

Observational (n=1,314)

Multicenter

Structured PICO

Does the APACHE IV model accurately predict hospital mortality compared to APACHE II, SAPS 3, and Korean SAPS 3 in a Korean surgical intensive care unit population?

Population

1,314 patients admitted to a surgical intensive care unit (SICU) from March 2011 to February 2012 in a Korean university hospital. Mean age 57.8 years, 57.8% male. Excluded pediatric (<18 years), cardiac, and medical patients, as well as those with SICU stay <24 h, hospital stay >365 days, readmissions, or cadaveric donors.

Intervention

APACHE IV prognostic model

Comparator

APACHE II, SAPS 3, and Korean SAPS 3 prognostic models

Outcome

Hospital mortality prediction (assessed via discrimination using AUC and calibration using Hosmer-Lemeshow test)hard clinical

The APACHE IV model demonstrates good discrimination but poor calibration for predicting hospital mortality in a Korean surgical ICU, indicating a need for local customization.

Main Result

Effect estimate: AUC 0.80 (95% CI 0.74-0.86)

Limitations

Conducted at a single surgical ICU, limiting generalizability to other ICUs.
Overall hospital mortality rate was very low, which might have affected the performance of each prognostic model.
Retrospective data abstraction carries a risk of error.
The equation in each prognostic model for the prediction of hospital mortality was not customized in the current study.
Single surgical ICU setting limits generalizability
Retrospective data collection carries a risk of error
The equation in each prognostic model for the prediction of hospital mortality was not customized in the current study

Abstract

BACKGROUND: The Acute Physiology and Chronic Health Evaluation (APACHE) IV model has not yet been validated in Korea. The aim of this study was to compare the ability of the APACHE IV with those of APACHE II, Simplified Acute Physiology Score (SAPS) 3, and Korean SAPS 3 in predicting hospital mortality in a surgical intensive care unit (SICU) population. METHODS: We retrospectively reviewed electronic medical records for patients admitted to the SICU from March 2011 to February 2012 in a university hospital. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow test, respectively. We calculated the standardized mortality ratio (SMR, actual mortality predicted mortality) for the four models. RESULTS: The study included 1,314 patients. The hospital mortality rate was 3.3%. The discriminative powers of all models were similar and very reliable. The AUCs were 0.80 for APACHE IV, 0.85 for APACHE II, 0.86 for SAPS 3, and 0.86 for Korean SAPS 3. Hosmer and Lemeshow C and H statistics showed poor calibration for all of the models (P < 0.05). The SMRs of APACHE IV, APACHE II, SAPS 3, and Korean SAPS 3 were 0.21, 0.11 0.23, 0.34, and 0.25, respectively. CONCLUSIONS: The APACHE IV revealed good discrimination but poor calibration. The overall discrimination and calibration of APACHE IV were similar to those of APACHE II, SAPS 3, and Korean SAPS 3 in this study. A high level of customization is required to improve calibration in this study setting.

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