Application of APACHE-II and SOFA score as a predictive outcome in Ramathibodi surgical intensive care unit

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND| 2019. Background: Acute Physiology and Chronic Heatlh Evaluation II score (APACHE-II) and Initial Sequential Organ Failure Assessment score (SOFA) score are known as accepted severity scoring. From many studies, they both had good efficacy in predicting mortality for the critically ill patient in the intensive care unit. But in real practice, there are many factors that can affect the accuracy of this scoring system, such as the differences between each intensive care units or the pattern of patients. The aim of this study is to validate the performance of APACHE-II score and Initial SOFA score for predicting ICU mortality of Ramathibodi Surgical Intensive Care Unit. Materials and Methods: A retrospective reviewed for surgical patients who had been admitted to SICU between 1st May 2011 and 31st December 2011 at Ramathibodi Hospital, All surgical patients were included in this study. Patients, who were younger than 15 years, had ICU admission less than 48 hr for observation after elective surgery was excluded. Results: One hundred and eighty-five patients were enrolled in this study, twelve (6.5%) deaths were recorded in this SICU, the missing data were found to be 10%, Mean of APACHE-II score was 10.5 whereas mean of initial SOFA was 2.8. The factors that were related to ICU death were non-scheduled admission, sepsis, acute renal failure, APACHE-II score >10 and initial SOFA score >3. In univariate analysis, initial SOFA score had the strong correlation with mortality, especially if initial SOFA >3 (odd ratio = 14). The area under the receiver operating characteristic curve of APACHE-II was 0.85 and initial SOFA was 0.84. Conclusion: Both SOFA and APACHE-II had good discrimination for predicted ICU mortality for the surgical patients in Ramathibodi surgical intensive care unit. In the present study, we found that SOFA score is comparable to APACHE-II score.