Efficacy of the APACHE II score at ICU discharge in predicting post-ICU mortality and ICU readmission in critically ill surgical patients

• Published in: Anaesthesia and intensive care Vol. 43; no. 2; pp. 175 - 186
• Main Authors: Lee, H, Lim, C W, Hong, H P, Ju, J W, Jeon, Y T, Hwang, J W, Park, H P
• Format: Journal Article
• Language: English
• Published: United States Sage Publications Ltd 01-03-2015
• Subjects: Aged; APACHE; Critical Illness; Female; Hospital Mortality; Humans; Intensive Care Units - statistics & numerical data; Male; Middle Aged; Odds Ratio; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Postoperative Complications - mortality; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; ROC Curve; Seoul; Seoul; admission APACHE II score; prediction; discharge APACHE II score; readmission; hospital mortality
• ISSN: 0310-057X; 1448-0271
• DOI: 10.1177/0310057x1504300206

In this study, we evaluated the efficacy of the discharge Acute Physiology and Chronic Health Evaluation (APACHE) II score in predicting post-intensive care unit (ICU) mortality and ICU readmission during the same hospitalisation in a surgical ICU. Of 1190 patients who were admitted to the ICU and stayed >48 hours between October 2007 and March 2010, 23 (1.9%) died and 86 (7.2%) were readmitted after initial ICU discharge, with 26 (3.0%) admitted within 48 hours. The area under the receiver operating characteristics curve of the discharge and admission APACHE II scores in predicting in-hospital mortality was 0.631 (95% confidence interval [CI] 0.603 to 0.658) and 0.669 (95% CI 0.642 to 0.696), respectively (P=0.510). The area under the receiver operating characteristics curve of discharge and admission APACHE II scores for predicting all forms of readmission was 0.606 (95% CI 0.578 to 0.634) and 0.574 (95% CI 0.545 to 0.602), respectively (P=0.316). The area under the receiver operating characteristics curve of discharge APACHE II score in predicting early ICU readmissions was, however, higher than that of admission APACHE II score (0.688 [95% CI 0.660 to 0.714] versus 0.505 [95% CI 0.476 to 0.534], P=0.001). The discharge APACHE II score (odds ratio [OR] 1.1, 95% CI 1.01 to 1.22, P=0.024), unplanned ICU readmission (OR 20.0, 95% CI 7.6 to 53.1, P=0.001), eosinopenia at ICU discharge (OR 6.0, 95% CI 1.34 to 26.9, P=0.019), and hospital length-of-stay before ICU admission (OR 1.02, 95% CI 1.01 to 1.03, P=0.021) were significant independent factors in predicting post-ICU mortality. This study suggests that the discharge APACHE II score may be useful in predicting post-ICU mortality and is superior to the admission APACHE II score in predicting early ICU readmission in surgical ICU patients.