Abstract
Background
This study was designed to evaluate and compare the prognostic value of the APACHE
II, APACHE IV, and SAPSII scores for predicting in-hospital mortality in the ED on
a large sample of patients. Earlier studies in the ED setting have either used a small
sample or focused on specific diagnoses.
Methods
A prospective study was conducted to include patients with higher risk of mortality
from March 2016 to March 2017 in the ED of Emam Reza Hospital, northeast of Iran.
Logistic regression was used to develop three models. Evaluation was performed in
terms of the overall performance (Brier Score, BS, and Brier Skill Score, BSS), discrimination
(Area Under the Curve, AUC), and calibration (calibration graph).
Results
A total of 2205 patients met the study criteria (53% male and median age of 64, IQR:
50–77). In-hospital mortality amounted to 19%. For APACHE II, APACHE IV, and SAPS
II the BS was 0.132, 0.125 and 0.133 and the BSS was 0.156, 0.2, and 0.144, respectively.
The AUC was 0.755 (0.74 to 0.779) for APACHE II, 0.794 (0.775 to 0.818) for APACHE
IV, and 0.751 (0.727 to 0.776) for SAPS II. The APACHE IV showed significantly greater
AUC in comparison to the APACHE II and SAPS II. The graphical evaluation revealed
good calibration of the APACHE IV model.
Conclusion
APACHEIV outperformed APACHEII and SAPSII in terms of discrimination and calibration.
More validation is needed for using these models for decision-making about individual
patients, although they would perform best at a cohort level.
Keywords
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Article Info
Publication History
Published online: May 23, 2020
Accepted:
May 17,
2020
Received in revised form:
May 10,
2020
Received:
August 27,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
