![]() For example, studies of kidney transplant recipients and patients with malignancies admitted to the ICU have shown the inability of the APACHE and SAPS scoring systems to accurately predict mortality in these patient groups. Mortality prediction models are likely to under- or over-estimate mortality in selected patient subpopulations which were not well-represented in the original cohort. APACHE III, originally published in 1991, has been used in a significant number of ICUs, especially in the United States, for the past 15 years. APACHE was introduced in the early 1980s and while minor modifications have been made over the years, only 3 major revisions have occurred. Such prognostic scoring systems include the Simplified Acute Physiology Score (SAPS), the Mortality Probability Model (MPM) and the Acute Physiology and Chronic Health Evaluation (APACHE) scoring system. Although there have been moves towards avoidance of ICU admission after transplantation, most patients still spend part of their post-operative course in the ICU.Ī variety of scoring systems have been used to quantify the severity of illness of patients admitted to the ICU and to predict their chances of survival to ICU and hospital discharge. Intensive care units (ICUs) have played a vital role in the practice of orthotopic liver transplantation (OLT). Though APACHE III has been shown to be valid in heterogenous populations and in certain groups of patients with specific diagnoses, it should be used with caution – if used at all – in recipients of liver transplantation. ConclusionĪPACHE III discriminates poorly between survivors and non-survivors of patients admitted to the ICU after OLT. The Hosmer-Lemeshow C statistic was 5.288 with a p value of 0.871 (10 degrees of freedom). In predicting mortality, the AUC of APACHE III prediction of hospital death was 0.65 (95% CI, 0.62 to 0.68). There were statistically significant differences in APS, APIII, predicted ICU and predicted hospital mortality between survivors and non-survivors. The standardized ICU and hospital mortality ratios with their 95% C.I. The observed ICU and hospital mortality rates were 1.1% and 3.4%, respectively. ![]() Mean (SD) predicted ICU and hospital mortality rates were 7.3% (15.4) and 10.6% (18.9), respectively. Mean (standard deviation ) APACHE III (APIII) and Acute Physiology (APS) scores on the day of transplant were 60.5 (25.8) and 50.8 (23.6), respectively. ResultsĪPACHE III data were available for 918 admissions after OLT. The area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow C statistic were used to assess, respectively, discrimination and calibration of APACHE III. Standardized mortality ratios (with 95% confidence intervals) were calculated by dividing the observed mortality rates by the rates predicted by APACHE III. Data were abstracted from the institutional APACHE III and liver transplantation databases and individual patient medical records. Patients admitted to the ICU after OLT between July 1996 and May 2008 were identified. We hypothesized that APACHE III would perform satisfactorily in patients after OLT MethodsĪ retrospective cohort study was performed. The Acute Physiology and Chronic Health Evaluation (APACHE) III prognostic system has not been previously validated in patients admitted to the intensive care unit (ICU) after orthotopic liver transplantation (OLT).
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