Unit:
Κατεύθυνση Αναπνευστική Ανεπάρκεια και Μηχανικός ΑερισμόςLibrary of the School of Health Sciences
Supervisors info:
Ροβήνα Νικολέττα , Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή ,ΕΚΠΑ
Βασιλειάδης Ιωάννης , Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ντάγανου Μαρία , Διδάσκουσα ΠΜΣ , Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Η αξία του APACHE II score ως προγνωστικού δείκτη θνητότητας στη ΜΕΘ σε ασθενείς με COVID-19
Translated title:
APACHE II score as a predictor of outcome in critically ill COVID-19 patients
Summary:
The APACHE II score clinical severity score has been found to be particularly useful in predicting the risk of death in patients hospitalized in the Intensive Care Unit (ICU). Also, the Charlson Comorbidity Index (CCI) is a simple method of estimating the risk of death from comorbidities. Both the APACHE II score and the CCI have not been validated in patients with COVID-19 infection.
Aim: To investigate the prognostic value of the APACHE II score and the CCI in hospitalized patients with COVID-19 in the ICU.
Method: We performed a retrospective analysis of prospectively collected data in a cohort of COVID-19 patients admitted to a 50-bed ICU between October 2020 and April 2022. APACHE II score and CCI were estimated the first day of hospitalization in the ICU. ROC analysis was used to evaluate the performance of the APACHE II score and the CCI , and the optimal cut-off point for predicting mortality was determined.
Results: The sample consisted of 783 patients (66% men) with a positive PCR for SARS-COV-2 and respiratory failure, with a mean age of 66 (±14.3) years. 80.9% of patients had at least one comorbidity and 92% required invasive mechanical ventilation. The mean APACHE II score and CCI scores were 20.3 (±8.5) and 1.25 (±1.74), respectively. The ICU mortality rate was 44.7%. Patients who died were significantly older (p<0.001) than those who survived. The mortality rate was significantly higher in patients with chronic obstructive pulmonary disease, chronic renal or heart failure, atrial fibrillation, and malignancy. Also, the APACHE II score [25.2 (±7.9) vs. 16.3 (±6.7), p<0.001] and the CCI [1.88 (±2.06) vs. 0.73 (± 1.20), p<0.001] were significantly higher in patients who died than in those who survived. The ROC analysis showed that the APACHE II score (AUROC=0.81; 95% CI: 0.78–0.84) had a significantly greater predictive value for outcome than the CCI (AUROC=0.69 95 % CI: 0.65–0.73). At a cut-off value of 19.5 APACHE II score could predict death with a sensitivity of 77.1% (95% CI: 72.4% – 81.4%) and a specificity of 70.7% (95% CI: 66, 1% – 74.9%). At a cut-off value of 1 CCI score could predict death with a sensitivity of 69.3% (95% CI: 64.1% – 74.1%) and a specificity of 58.6% (95% CI: 53.7% – 63.4%).
Conclusions: The APACHE II score is an effective tool for predicting mortality in critically ill patients with COVID-19. An APACHE II score cut-off value of 19.5 can be used for risk stratification in this patient population. The performance of CCI as a predictive tool is low
Main subject category:
Health Sciences
Keywords:
APACHE II score , COVID-19, Charlson Comorbidity Indej, Mortality, Intensive Care Unit
File:
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Matsko_Marina_MSc..pdf
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