Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV Score in COVID-19 Patients
Background. Severity scoring systems are inherent to ICU practice for multiple purposes. Acute Physiology and Chronic Health Evaluation (APACHE) scoring systems are designed for ICU mortality prediction. This study aims to validate APACHE IV in COVID-19 patients admitted to the ICU. Methods. All COV...
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Wiley
2021-01-01
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| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2021/5443083 |
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| author | Jeroen Vandenbrande Laurens Verbrugge Liesbeth Bruckers Laurien Geebelen Ester Geerts Ina Callebaut Ine Gruyters Liesbeth Heremans Jasperina Dubois Bjorn Stessel |
| author_facet | Jeroen Vandenbrande Laurens Verbrugge Liesbeth Bruckers Laurien Geebelen Ester Geerts Ina Callebaut Ine Gruyters Liesbeth Heremans Jasperina Dubois Bjorn Stessel |
| author_sort | Jeroen Vandenbrande |
| collection | DOAJ |
| description | Background. Severity scoring systems are inherent to ICU practice for multiple purposes. Acute Physiology and Chronic Health Evaluation (APACHE) scoring systems are designed for ICU mortality prediction. This study aims to validate APACHE IV in COVID-19 patients admitted to the ICU. Methods. All COVID-19 patients admitted to the ICU between March 13, 2020, and October 17, 2020, were retrospectively analyzed. APACHE II and APACHE IV scores as well as SOFA scores were calculated within 24 hours after admission. Discrimination for mortality of all three scoring systems was assessed by receiver operating characteristic curves. Youden index was determined for the scoring system with the best discriminative performance. The Hosmer–Lemeshow goodness-of-fit test was used to assess calibration. All analyses were performed for both the overall population as in a subgroup treated with anti-Xa adjusted dosages of LMWHs. Results. 116 patients were admitted to our ICU during the study period. 13 were excluded for various reasons, leaving 103 patients in the statistical analysis of the overall population. 57 patients were treated with anti-Xa adjusted prophylactic dosages of LMWH and were supplementary analyzed in a subgroup analysis. APACHE IV had the best discriminative power of the three scoring systems, both in the overall population (APACHE IV ROC AUC 0.67 vs. APACHE II ROC AUC 0.63) as in the subgroup (APACHE IV ROC AUC 0.82 vs. APACHE II ROC AUC 0.7). This model exhibits good calibration. Hosmer–Lemeshow p values for APACHE IV were 0.9234 for the overall population and 0.8017 for the subgroup. Calibration p values of the APACHE II score were 0.1394 and 0.6475 for the overall versus subgroup, respectively. Conclusions. APACHE IV provided the best discrimination and calibration of the considered scoring systems in critically ill COVID-19 patients, both in the overall group and in the subgroup with anti-Xa adjusted LMWH doses. Only in the subgroup analysis, discriminative abilities of APACHE IV were very good. This trial is registered with NCT04713852. |
| format | Article |
| id | doaj-art-12fe351250b846088df5f575dcd590a2 |
| institution | Kabale University |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2021-01-01 |
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| series | Critical Care Research and Practice |
| spelling | doaj-art-12fe351250b846088df5f575dcd590a22025-02-03T05:43:48ZengWileyCritical Care Research and Practice2090-13052090-13132021-01-01202110.1155/2021/54430835443083Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV Score in COVID-19 PatientsJeroen Vandenbrande0Laurens Verbrugge1Liesbeth Bruckers2Laurien Geebelen3Ester Geerts4Ina Callebaut5Ine Gruyters6Liesbeth Heremans7Jasperina Dubois8Bjorn Stessel9Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, BelgiumDepartment of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, BelgiumI-BioStat, Data Science Institute, Hasselt University, Martelarenlaan 42, Hasselt 3500, BelgiumDepartment of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, BelgiumDepartment of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, BelgiumDepartment of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, BelgiumDepartment of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, BelgiumDepartment of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, BelgiumDepartment of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, BelgiumDepartment of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, BelgiumBackground. Severity scoring systems are inherent to ICU practice for multiple purposes. Acute Physiology and Chronic Health Evaluation (APACHE) scoring systems are designed for ICU mortality prediction. This study aims to validate APACHE IV in COVID-19 patients admitted to the ICU. Methods. All COVID-19 patients admitted to the ICU between March 13, 2020, and October 17, 2020, were retrospectively analyzed. APACHE II and APACHE IV scores as well as SOFA scores were calculated within 24 hours after admission. Discrimination for mortality of all three scoring systems was assessed by receiver operating characteristic curves. Youden index was determined for the scoring system with the best discriminative performance. The Hosmer–Lemeshow goodness-of-fit test was used to assess calibration. All analyses were performed for both the overall population as in a subgroup treated with anti-Xa adjusted dosages of LMWHs. Results. 116 patients were admitted to our ICU during the study period. 13 were excluded for various reasons, leaving 103 patients in the statistical analysis of the overall population. 57 patients were treated with anti-Xa adjusted prophylactic dosages of LMWH and were supplementary analyzed in a subgroup analysis. APACHE IV had the best discriminative power of the three scoring systems, both in the overall population (APACHE IV ROC AUC 0.67 vs. APACHE II ROC AUC 0.63) as in the subgroup (APACHE IV ROC AUC 0.82 vs. APACHE II ROC AUC 0.7). This model exhibits good calibration. Hosmer–Lemeshow p values for APACHE IV were 0.9234 for the overall population and 0.8017 for the subgroup. Calibration p values of the APACHE II score were 0.1394 and 0.6475 for the overall versus subgroup, respectively. Conclusions. APACHE IV provided the best discrimination and calibration of the considered scoring systems in critically ill COVID-19 patients, both in the overall group and in the subgroup with anti-Xa adjusted LMWH doses. Only in the subgroup analysis, discriminative abilities of APACHE IV were very good. This trial is registered with NCT04713852.http://dx.doi.org/10.1155/2021/5443083 |
| spellingShingle | Jeroen Vandenbrande Laurens Verbrugge Liesbeth Bruckers Laurien Geebelen Ester Geerts Ina Callebaut Ine Gruyters Liesbeth Heremans Jasperina Dubois Bjorn Stessel Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV Score in COVID-19 Patients Critical Care Research and Practice |
| title | Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV Score in COVID-19 Patients |
| title_full | Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV Score in COVID-19 Patients |
| title_fullStr | Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV Score in COVID-19 Patients |
| title_full_unstemmed | Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV Score in COVID-19 Patients |
| title_short | Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV Score in COVID-19 Patients |
| title_sort | validation of the acute physiology and chronic health evaluation apache ii and iv score in covid 19 patients |
| url | http://dx.doi.org/10.1155/2021/5443083 |
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