PURPOSE: In evaluation of critically ill patients, several prognostic models have been developed to predict morbidity and mortality. One of the most frequently used models is the Acute Physiology and Chronic Health II (APACHE II) scoring system. Although not used in most algorithms, B-type Natriuretic Peptide (BNP) levels may useful as a stand alone factor estimating morbidity and mortality.
METHODS: Prospective, observational study of consecutive patients evaluated for MICU admission in a large, tertiary referral hospital. Data collected included patient characteristics, clinical and laboratory data, and 6-month mortality.
RESULTS: A total of 143 patients (39% male) were enrolled in the study. Total mortality at 6 months was 36% (n=51). Table 1 displays all measured data including APACHE II score (17.6 ± 5.5), age (73.8 ± 11.7 yrs), and BNP (751 ± 1047). Within 48 hours of evaluation, 10% of patients were transferred to MICU, 4% died and 5% were made hospice. The remaining patients were rejected from MICU and treated. All patients were followed up at 6 months. Mean BNP of patients that died within 6 months vs. those living was 1,144 (±1392) vs. 533 (±714) respectively; p<0.001. Figure 1 shows APACHE II quartiles against 6 month mortality. Top quartile APACHE II (25 + 4.1) was associated with greater than 60% mortality. BNP data in figure 2 mirrors the APACHE II findings with a top quartile BNP (2113.8 + 1320.5) associated with greater than 50% mortality.
CONCLUSION: Our observations show that both APACHE II scores and BNP levels correlate with 6 month mortality. Overall, APACHE II scores were superior to BNP alone in predicting mortality. Additional studies are needed to examine these two variables in conjunction.
CLINICAL IMPLICATIONS: In the future, a thoroughly refined scoring system incorporating both values will expedite physician evaluation of patients considered for ICU admission and improve patient care by decreasing overall morbidity and mortality.
DISCLOSURE: Phillip Kadaj, No Financial Disclosure Information; No Product/Research Disclosure Information