Key result
Incorporating first admission APACHE II predicted mortality to readmission APACHE II did not significantly improve discrimination for hospital mortality (AUC 0.792 vs 0.785; P=0.603).
Why the study?
Does incorporating first admission APACHE II score to readmission APACHE II score improve prediction of hospital mortality in patients readmitted to the ICU?
Observational (n=602)
Does incorporating first admission APACHE II score to readmission APACHE II score improve prediction of hospital mortality in patients readmitted to the ICU?
Severity of illness measured at the time of ICU readmission is more important than prior ICU admission severity for predicting hospital mortality.
Supports relying on readmission APACHE II alone for mortality prediction; leaves open incremental value of prior scores in other outcomes.
No specific prognostic model has been developed for patients readmitted to the intensive care unit (ICU) during the same hospitalisation. This study assesses the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II predicted mortality measured at the time of ICU readmission and whether incorporating information prior to the readmission will improve its performance to predict hospital mortality of patients readmitted to ICU during the same hospitalisation. A total of 602 readmissions during the same hospitalisation between 1987 and 2002 were identified. The first admission APACHE II predicted mortality was significantly associated with the hospital mortality only in the subgroup of patients readmitted within seven days of ICU discharge (odds ratio 1.16, 95% confidence interval 1.01 to 1.34; P = 0.035). In the subgroups of patients readmitted within seven days of discharge, the readmission APACHE II predicted mortality was also significantly better than the first admission APACHE II predicted mortality in discriminating between survivors and non-survivors (area under the receiver operating characteristic curve: 0.785 vs. 0.676, z statistic = 2.93; P = 0.003). Incorporating the first admission APACHE II predicted mortality to the readmission APACHE II predicted mortality, either by multilevel likelihood ratios or logistic regression, did not significantly improve its discrimination (area under the receiver operating characteristic curve: 0.792 vs. 0.785, z statistic = 0.52; P = 0.603). Our results suggested that information on prior ICU admission during the same hospitalisation is not as important as the severity of illness measured at the time of readmission in determining the mortality of intensive care readmissions during the same hospitalisation.
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Ho et al. (2008) conducted an observational in Intensive care unit (ICU) readmissions during the same hospitalisation (n=602). Incorporating first admission APACHE II predicted mortality to readmission APACHE II predicted mortality vs. Readmission APACHE II predicted mortality alone was evaluated on Discrimination of hospital mortality (area under the receiver operating characteristic curve) (p=0.603). Incorporating first admission APACHE II predicted mortality to readmission APACHE II did not significantly improve discrimination for hospital mortality (AUC 0.792 vs 0.785; P=0.603).
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