APACHE II and SAPS II scoring systems demonstrated similar calibration for predicting mortality in ICU-admitted cancer patients, but neither was accurate enough for routine clinical management.
Cohort (n=261)
No
Do APACHE II and SAPS II scoring systems accurately predict mortality in cancer patients admitted to the ICU for acute medical complications?
APACHE II and SAPS II scores predict short-term ICU and hospital mortality in critically ill cancer patients, but long-term survival is primarily determined by underlying cancer characteristics.
OBJECTIVE: To validate and compare two severity scoring systems, the Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS) II and to determine their prognostic value for mortality during the hospital stay and after discharge in a specific group of cancer patients admitted to intensive care unit (ICU) for an acute medical complication. DESIGN: Prospective cohort study. SETTING: The medical ICU of a European cancer hospital. SUBJECTS: A total of 261 consecutive cancer patients admitted to ICU for an acute medical complication. MEASUREMENTS: Variables included into the APACHE II and SAPS II scores, as well as characteristics of the cancer, were collected during the first 24 hrs of the ICU stay. Hospital and in-ICU mortalities, overall survival, and survival after day 30 were measured. RESULTS: Observed hospital and ICU mortalities were 33% and 23%. Median survival time was 94 days and 1-yr survival rate was 23%. The mean predicted risk of death was 26.5% with APACHE II and 26.1% with SAPS II. Correlation between both systems was excellent. Calibration for mortality prediction ability of both scoring systems was similar. Discrimination between survivors and nonsurvivors was superior with SAPS II according to the area under the receiver operating characteristic curve but was better with APACHE II for survivors using thresholds minimizing the overall misclassification rates. Multivariate prognostic analysis showed that the scoring systems were the only significant factors for hospital and in-ICU mortalities, whereas characteristics related to the cancer (extent, phase) were the factors predicting survival after discharge. CONCLUSION: The prognosis of cancer patients admitted to ICU for a medical problem is first determined by the acute physiologic changes induced by the complication, as evaluated by the severity scores. There is no major difference between the two assessed scoring systems. They are, however, not accurate enough to be used in the routine management of these patients. After recovery from complications, characteristics related to the neoplastic disease, however, retrieve their independent influence on the further survival.
Sculier et al. (Tue,) conducted a cohort in cancer with acute medical complication requiring ICU admission (n=261). APACHE II and SAPS II scoring systems was evaluated on hospital and in-ICU mortalities, overall survival, and survival after day 30. APACHE II and SAPS II scoring systems demonstrated similar calibration for predicting mortality in ICU-admitted cancer patients, but neither was accurate enough for routine clinical management.