Key result
APACHE III outperforms SOFA and SAPS II predicting in-hospital mortality for ICU patients with suspected infection.
Why the study?
The prognostic performance of ICU scoring systems across different ICU types in patients with suspected infection was unclear.
Does the prognostic performance of SOFA, APACHE III, and SAPS II scores for in-hospital mortality vary by ICU type in patients with suspected infection?
Observational (n=29,618)
Does the prognostic performance of SOFA, APACHE III, and SAPS II scores for in-hospital mortality vary by ICU type in patients with suspected infection?
Effect estimate: AUROC 0.807 (95% CI 0.799-0.814)
APACHE III provides the highest prognostic performance for in-hospital mortality among ICU patients with suspected infection, though accuracy varies significantly depending on the specific type of ICU.
Scoring systems' accuracy varies by ICU type; leaves open whether type-specific recalibration improves risk stratification in observational data.
We investigated the prognostic performance of scoring systems by the intensive care unit (ICU) type. This was a retrospective observational study using data from the Marketplace for Medical Information in the Intensive Care IV database. The primary outcome was in-hospital mortality. We obtained Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) III, and Simplified Acute Physiology Score (SAPS) II scores in each ICU type. Prognostic performance was evaluated with the area under the receiver operating characteristic curve (AUROC) and was compared among ICU types. A total of 29,618 patients were analyzed, and the in-hospital mortality was 12.4%. The overall prognostic performance of APACHE III was significantly higher than those of SOFA and SAPS II (0.807, [95% confidence interval, 0.799-0.814], 0.785 [0.773-0.797], and 0.795 [0.787-0.811], respectively). The prognostic performance of SOFA, APACHE III, and SAPS II scores was significantly different between ICU types. The AUROC ranges of SOFA, APACHE III, and SAPS II were 0.723-0.826, 0.728-0.860, and 0.759-0.819, respectively. The neurosurgical and surgical ICUs had lower prognostic performance than other ICU types. The prognostic performance of scoring systems in patients with suspected infection is significantly different according to ICU type. APACHE III systems have the highest prediction performance. ICU type may be a significant factor in the prognostication.
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Hwang et al. (2023) conducted an observational in Suspected infection (n=29,618). APACHE III score vs. SOFA and SAPS II scores was evaluated on In-hospital mortality (AUROC 0.807, 95% CI 0.799-0.814). The APACHE III score demonstrated significantly higher prognostic performance for in-hospital mortality (AUROC 0.807; 95% CI 0.799-0.814) than SOFA and SAPS II in ICU patients with suspected infection.
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