PURPOSE: Determination of the APACHE IV score that is associated with higher risk of death in patients with severe sepsis.
METHODS: Prospectively all patients with the diagnosis of severe sepsis or septic shock who where admitted to our intensive care unit in a 14 month period were included in the study. Mortality rates were determined for patients with APACHE II >24 (high risk of death) and for patients with APACHE II <25 (low risk of death). Mortality rates based on APACHE IV intervals of 5's were compared and the score that is associated with a higher mortality rate than the APACHE II low risk of death rate was determined and patients were divided into two groups based on this score. Then APACHE II results were stratified based on APACHE IV groups and the results were analyzed.
RESULTS: 190 patients were included in the study with an average APACHE II score of 22.2, 126 (66%) had APACHE II score <25 with mortality rate of 24% compared to 64 patients (34%) with APACHE II >24 and mortality rate of 55%. Therefore a high risk of death rate was considered to be >24%. In APACHE IV groups hospital mortality rates were consistently >24% starting at a score of 60 with a rate of 50% in the group of >59 and 5.7% in the group of <60. When APACHE II groups were subgrouped based on APACHE IV >59 and <60; total of 60 patients (47%) who were considered low risk patients according to APACHE II system had APACHE IV >59 with mortality rate of 43% (>24% cutoff) compared to 64 patients with APACHE IV <60 and mortality rate of 6% (P <0.05).
CONCLUSION: APACHE IV (score of ≥60) is probably a more reliable prediction of high risk of death in patients with severe sepsis than APACHE II (score >24).
CLINICAL IMPLICATIONS: Specific therapeutic modalities that are used for patients with severe sepsis at higher risk of death should be re-evaluated based on APACHE IV.
DISCLOSURE: Mazen Kherallah, No Financial Disclosure Information; No Product/Research Disclosure Information