Comparison of predictive values of Acute Physiology and Chronic Health Evaluation scores for mortality in sepsis: a systematic review and meta-analysis

BACKGROUND: Acute Physiology and Chronic Health Evaluation (APACHE) scores are widely used in emergency medicine and critical care settings, yet their prognostic accuracy for sepsis-related mortality across different versions remains to be assessed thoroughly. This study aimed to compare the pooled prognostic performance of APACHE II, III, and IV in predicting in-hospital mortality in patients with sepsis. METHODS: We conducted a systematic review and meta-analysis by searching for articles in the PubMed, Embase, Web of Science, and Cochrane databases, with a publication date range from February 23, 2016, to June 8, 2024. Random effects models were employed to analyse pooled data, focusing on key metrics such as the area under the curve (AUC), diagnostic odds ratio (DOR), sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR). RESULTS: 0.17-0.46). CONCLUSION: APACHE IV demonstrated the superior prognostic accuracy to the other versions for sepsis-related mortality. With the increasing adoption of automated calculations through standardized software, APACHE IV might be incorporated into routine clinical workflows.