SESSION TYPE: New Insights into ARDS/Lung Injury
PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM
PURPOSE: Severity of illness scores are used in predicting the ICU outcomes, however limited data is available on the performance of comorbidity scores in predicting the outcomes of acute lung injury (ALI). We assessed and compared the performance of three most commonly used prediction scores i.e. Charlson comorbidity index (CCI), APACHE III and SOFA score in predicting mortality as an outcome following ALI.
METHODS: In a historical cohort design, from July 01, 2004 to December 31, 2010 all adults (≥ 18 years) admitted consecutively to Mayo Clinic hospital ICUs, from Olmsted County, Minnesota were included. ALI cases were ascertained during their hospital stay according to the American European Consensus Criteria (AECC) definition criteria. Patients who denied research authorization were excluded from the study. APACHE III, SOFA and CCI scores were computed from the patients’ electronic medical records. The area under Receiver operating characteristic (ROC) curve was used to compare the performance of three scores in predicting hospital and one year mortality, the difference in AUC was analyzed using z-statistics by DeLong et al’s method.
RESULTS: Out of 7594 adults admitted to the ICUs, 555 met the AECC definition criteria for ALI. The median age was 70 yrs (IQR 54-81), 295 (53%) males and 481 (87%) were Caucasians. The median (IQR) scores for APACHE III, SOFA day one and CCI among ALI patients were 81 (61-103), 6 (4-9), and 5 (3-7) respectively. The AUC for predicting the hospital mortality for APACHE III, SOFA and CCI was 0.67 (0.63 - 0.71), 0.63 (0.59 - 0.67) and 0.61 (0.57 - 0.65) respectively. There was significant difference in the AUC for predicting hospital mortality between APACHE III and SOFA scores (P value = 0.039). The AUC for predicting the one year mortality for APACHE III, SOFA and CCI was 0.65 (0.60 - 0.69), 0.57 (0.53 - 0.61) and 0.69 (0.65 - 0.73) respectively. Both APACHE III and CCI significantly predicted the one year mortality as compared to SOFA (P value <0.001). However, there was marginal advantage for APACHE III as compared to CCI at hospital discharge (P value = 0.049), which was inconsequential at long term (P value = 0.12)
CONCLUSIONS: All the three models moderately predicted hospital mortality for ALI patients; APACHE III was superior to SOFA in predicting hospital and one year mortality, whereas CCI was superior to SOFA only in predicting one year mortality.
CLINICAL IMPLICATIONS: Need for combined or new models for better prediction of mortality for ALI patients.
DISCLOSURE: The following authors have nothing to disclose: Balwinder Singh, Adil Ahmed, Michelle Biehl, Pablo Franco, Guangxi Li
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