(1454) Dynamic APACHE IV Score to Predict the Severity of Critically Ill Patients With Sepsis in the ICU

Monday, January 22, 2024

10:15 AM – 11:15 AM MT

Location: Connections Central - RST 15

First Author(s)

Antony Arumairaj, MD

Attending Physician
New York City Health Hospitals Corporation
Jersey City

Co-Author(s)

HP

Hansang Park, MD

Fellow
New York Medical College, United States
JV

Julio Valencia, MD

Fellow
New York Medical College, United States
IH

Imnett Habtes, MD

Attending Physician
New York Medical College, Metropolitan Hospital Center, United States
JA

Jennifer Arzu, MPH

Biostatistician
Physician Affiliate Group of New York, United States
SC

Shobhana Chaudhari, MD

Program Director
New York Medical College, Metropolitan Hospital Center, United States
JM

Joseph Mattana, MD

Director, Department of Medicine
New York Medical College, Metropolitan Hospital Center, United States
TN

Thomas Newman, MD

Attending Physician
New York Medical College, Metropolitan Hospital Center, United States

Introduction: Early identification and intervention in critically ill patients at high mortality risk are associated with lower mortality rates. The Acute Physiology and Chronic Health Evaluation (APACHE) IV score is considered a highly accurate predictor of mortality and incorporates admission diagnosis and physiological and laboratory parameters with multivariate linear regression. This study aimed to compare the APACHE IV score on days one and three to predict the mortality of critically ill patients with sepsis admitted in the ICU.

Methods: A retrospective chart review was done of adult ICU patients admitted with sepsis from July 2017 until July 2019. APACHE IV scores were calculated on each patient admitted to the ICU on day one of ICU admission and again on day three of ICU stay. Each patient was evaluated for the outcome of inpatient mortality. The outcome of hospital mortality was then compared between the day one and the day three APACHE IV scores.

Results: In total, there were 176 patients enrolled in the study. Statistical analysis used logistic regression to calculate unadjusted odds ratios (ORs) of hospital mortality for APACHE IV scores on days one and three. The discriminatory performance of the APACHE IV score on days one and three in predicting hospital mortality was examined by creating receiver operating characteristic curves (ROC) and computing the area under the curves (AUC). Among the patients enrolled, the overall hospital mortality was 32%. The average APACHE IV score to predict hospital mortality on day one was 80.8 ± 25.8; on day three, it was 79.7 ± 26.8. In logistic regression models, higher APACHE IV scores on day one and day three were significantly associated with increased odds of hospital mortality compared to no hospital mortality with a p-value of < 0.001. When the area under the ROC curve was examined, the APACHE IV score on day three (AUC, 0.79) had better discriminatory power than the APACHE IV score on day one (AUC, 0.67), with a p-value of 0.003. Day three APACHE score of 57 was the best cut-off for defining patients at high mortality risk.

Conclusions: In critically ill patients with sepsis, the day three APACHE IV score was a better optical biomarker in predicting hospital mortality than the day one score.