PURPOSE: To determine the predictive capabilities of the commonly used critical illness severity scores namely Acute Physiology And Chronic Health Evaluation II (APACHE II), Therapeutic Intervention Scoring System (TISS), Sequential Organ Failure Assessment (SOFA) and Multiple Organ Dysfunction Score (MODS) among Indian critically ill patients.
METHODS: Over a period of 6 months, 259 consecutive patients were included prospectively. All the severity score assessments were done simultaneously at the time of admission to the ICU. Patients were followed up till the time of hospital outcome in terms of survival. Severity scores were compared between the survivors and non- survivors and ROC curves were constructed to compare the predictive capabilities.
RESULTS: Many patients were aged more than 60 years (n=112, 43.2%) and majority were males (n=167, 64.5%). Sepsis was the largest diagnostic group (n=93, 28.4%) followed by patients with exacerbation of COPD, pneumonia, asthma and hepatic failure. There was a statistically significant difference between all the prognostic scores in patients who survived and those who did not (APACHE II 14.6±7.2 vs.17.7±7.7, P=0.001; TISS 26.4±13.4 vs.40.6±11.0, P<0.001; SOFA 10.2±3.4 vs.12.6±3.3, P<0.001; MODS 8.1±4.2 vs.13.0±4.2, P<0.001). The area under the ROC curve was 0.61 (0.55–0.68, P=0.002) for APACHE II, 0.78 (0.73–0.84, P<0.001) for TISS, 0.67 (0.61–0.74, P<0.001) for SOFA and 0.79 (0.74–0.84, P<0.001) for MODS.
CONCLUSION: Among the commonly used prognostic scores, MODS and TISS seem to perform reasonably well in predicting outcome in critically ill patients. APACHE II appears to be the least accurate in predicting mortality.
CLINICAL IMPLICATIONS: MODS and TISS should be the preferred modalities for predicting the outcome of critically ill Indian patients.
DISCLOSURE: Rajesh Chawla, None.