Severity of illness assessment with application of the APACHE IV predicted mortality and outcome trends analysis in an academic cardiac intensive care unit

Courtney E. Bennett; R. Scott Wright; Jacob Jentzer; Ognjen Gajic; Dennis H. Murphree; Joseph G. Murphy; Sunil V. Mankad; Brandon M. Wiley; Malcolm R. Bell; Gregory W. Barsness

doi:10.1016/j.jcrc.2018.12.012

Severity of illness assessment with application of the APACHE IV predicted mortality and outcome trends analysis in an academic cardiac intensive care unit

Courtney E. Bennett, R. Scott Wright, Jacob Jentzer, Ognjen Gajic, Dennis H. Murphree, Joseph G. Murphy, Sunil V. Mankad, Brandon M. Wiley, Malcolm R. Bell, Gregory W. Barsness

Research output: Contribution to journal › Article › peer-review

34 Scopus citations

Abstract

Purpose: To assess trends in life support interventions and performance of the automated Acute Physiology and Chronic Health Evaluation (APACHE) IV model at mortality prediction compared with Oxford Acute Severity of Illness Score (OASIS) in a contemporary cardiac intensive care unit (CICU). Methods and materials: Retrospective analysis of adults (age ≥ 18 years) admitted to CICU from January 1, 2007, through December 31, 2015. Temporal trends were assessed with linear regression. Discrimination of each risk score for hospital mortality was assessed with use of area under the receiver operating characteristic curve (AUROC) values. Calibration was assessed with Hosmer-Lemeshow goodness-of-fit test. Results: The study analyzed 10,004 patients. CICU and hospital mortality rates were 5.7% and 9.1%. APACHE IV predicted death had an AUROC of 0.82 (0.81–0.84) for hospital death, compared with 0.79 for OASIS (P <.05). Calibration was better for OASIS than APACHE IV. Increases were observed in CICU and hospital lengths of stay (both P <.001), APACHE IV predicted mortality (P =.007), Charlson Comorbidity Index (P <.001), noninvasive ventilation use (P <.001), and noninvasive ventilation days (P =.02). Conclusions: Contemporary CICU patients are increasingly ill, observed in upward trends in comorbid conditions and life support interventions. APACHE IV predicted death and OASIS showed good discrimination in predicting death in this population. APACHE IV and OASIS may be useful for benchmarking and quality improvement initiatives in the CICU, the former having better discrimination.

Original language	English (US)
Pages (from-to)	242-246
Number of pages	5
Journal	Journal of Critical Care
Volume	50
DOIs	https://doi.org/10.1016/j.jcrc.2018.12.012
State	Published - Apr 2019

Keywords

Comorbidity
Critical care
Mortality
Quality improvement
Renal replacement therapy
Ventilation

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

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10.1016/j.jcrc.2018.12.012

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Bennett, C. E., Wright, R. S., Jentzer, J., Gajic, O., Murphree, D. H., Murphy, J. G., Mankad, S. V., Wiley, B. M., Bell, M. R., & Barsness, G. W. (2019). Severity of illness assessment with application of the APACHE IV predicted mortality and outcome trends analysis in an academic cardiac intensive care unit. Journal of Critical Care, 50, 242-246. https://doi.org/10.1016/j.jcrc.2018.12.012

Bennett, CE , Wright, RS, Jentzer, J, Gajic, O, Murphree, DH, Murphy, JG, Mankad, SV, Wiley, BM, Bell, MR & Barsness, GW 2019, 'Severity of illness assessment with application of the APACHE IV predicted mortality and outcome trends analysis in an academic cardiac intensive care unit', Journal of Critical Care, vol. 50, pp. 242-246. https://doi.org/10.1016/j.jcrc.2018.12.012

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title = "Severity of illness assessment with application of the APACHE IV predicted mortality and outcome trends analysis in an academic cardiac intensive care unit",

abstract = "Purpose: To assess trends in life support interventions and performance of the automated Acute Physiology and Chronic Health Evaluation (APACHE) IV model at mortality prediction compared with Oxford Acute Severity of Illness Score (OASIS) in a contemporary cardiac intensive care unit (CICU). Methods and materials: Retrospective analysis of adults (age ≥ 18 years) admitted to CICU from January 1, 2007, through December 31, 2015. Temporal trends were assessed with linear regression. Discrimination of each risk score for hospital mortality was assessed with use of area under the receiver operating characteristic curve (AUROC) values. Calibration was assessed with Hosmer-Lemeshow goodness-of-fit test. Results: The study analyzed 10,004 patients. CICU and hospital mortality rates were 5.7% and 9.1%. APACHE IV predicted death had an AUROC of 0.82 (0.81–0.84) for hospital death, compared with 0.79 for OASIS (P <.05). Calibration was better for OASIS than APACHE IV. Increases were observed in CICU and hospital lengths of stay (both P <.001), APACHE IV predicted mortality (P =.007), Charlson Comorbidity Index (P <.001), noninvasive ventilation use (P <.001), and noninvasive ventilation days (P =.02). Conclusions: Contemporary CICU patients are increasingly ill, observed in upward trends in comorbid conditions and life support interventions. APACHE IV predicted death and OASIS showed good discrimination in predicting death in this population. APACHE IV and OASIS may be useful for benchmarking and quality improvement initiatives in the CICU, the former having better discrimination.",

keywords = "Comorbidity, Critical care, Mortality, Quality improvement, Renal replacement therapy, Ventilation",

author = "Bennett, {Courtney E.} and Wright, {R. Scott} and Jacob Jentzer and Ognjen Gajic and Murphree, {Dennis H.} and Murphy, {Joseph G.} and Mankad, {Sunil V.} and Wiley, {Brandon M.} and Bell, {Malcolm R.} and Barsness, {Gregory W.}",

note = "Funding Information: This publication was partially supported by Grant Number UL1TR000135 from the National Center for Advancing Translational Sciences (NCATS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health (NIH). Funding Information: This publication was partially supported by Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health (NIH). Publisher Copyright: {\textcopyright} 2018 Elsevier Inc.",

year = "2019",

month = apr,

doi = "10.1016/j.jcrc.2018.12.012",

language = "English (US)",

volume = "50",

pages = "242--246",

journal = "Seminars in Anesthesia",

issn = "0883-9441",

publisher = "Elsevier BV",

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TY - JOUR

T1 - Severity of illness assessment with application of the APACHE IV predicted mortality and outcome trends analysis in an academic cardiac intensive care unit

AU - Bennett, Courtney E.

AU - Wright, R. Scott

AU - Jentzer, Jacob

AU - Gajic, Ognjen

AU - Murphree, Dennis H.

AU - Murphy, Joseph G.

AU - Mankad, Sunil V.

AU - Wiley, Brandon M.

AU - Bell, Malcolm R.

AU - Barsness, Gregory W.

N1 - Funding Information: This publication was partially supported by Grant Number UL1TR000135 from the National Center for Advancing Translational Sciences (NCATS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health (NIH). Funding Information: This publication was partially supported by Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health (NIH). Publisher Copyright: © 2018 Elsevier Inc.

PY - 2019/4

Y1 - 2019/4

N2 - Purpose: To assess trends in life support interventions and performance of the automated Acute Physiology and Chronic Health Evaluation (APACHE) IV model at mortality prediction compared with Oxford Acute Severity of Illness Score (OASIS) in a contemporary cardiac intensive care unit (CICU). Methods and materials: Retrospective analysis of adults (age ≥ 18 years) admitted to CICU from January 1, 2007, through December 31, 2015. Temporal trends were assessed with linear regression. Discrimination of each risk score for hospital mortality was assessed with use of area under the receiver operating characteristic curve (AUROC) values. Calibration was assessed with Hosmer-Lemeshow goodness-of-fit test. Results: The study analyzed 10,004 patients. CICU and hospital mortality rates were 5.7% and 9.1%. APACHE IV predicted death had an AUROC of 0.82 (0.81–0.84) for hospital death, compared with 0.79 for OASIS (P <.05). Calibration was better for OASIS than APACHE IV. Increases were observed in CICU and hospital lengths of stay (both P <.001), APACHE IV predicted mortality (P =.007), Charlson Comorbidity Index (P <.001), noninvasive ventilation use (P <.001), and noninvasive ventilation days (P =.02). Conclusions: Contemporary CICU patients are increasingly ill, observed in upward trends in comorbid conditions and life support interventions. APACHE IV predicted death and OASIS showed good discrimination in predicting death in this population. APACHE IV and OASIS may be useful for benchmarking and quality improvement initiatives in the CICU, the former having better discrimination.

AB - Purpose: To assess trends in life support interventions and performance of the automated Acute Physiology and Chronic Health Evaluation (APACHE) IV model at mortality prediction compared with Oxford Acute Severity of Illness Score (OASIS) in a contemporary cardiac intensive care unit (CICU). Methods and materials: Retrospective analysis of adults (age ≥ 18 years) admitted to CICU from January 1, 2007, through December 31, 2015. Temporal trends were assessed with linear regression. Discrimination of each risk score for hospital mortality was assessed with use of area under the receiver operating characteristic curve (AUROC) values. Calibration was assessed with Hosmer-Lemeshow goodness-of-fit test. Results: The study analyzed 10,004 patients. CICU and hospital mortality rates were 5.7% and 9.1%. APACHE IV predicted death had an AUROC of 0.82 (0.81–0.84) for hospital death, compared with 0.79 for OASIS (P <.05). Calibration was better for OASIS than APACHE IV. Increases were observed in CICU and hospital lengths of stay (both P <.001), APACHE IV predicted mortality (P =.007), Charlson Comorbidity Index (P <.001), noninvasive ventilation use (P <.001), and noninvasive ventilation days (P =.02). Conclusions: Contemporary CICU patients are increasingly ill, observed in upward trends in comorbid conditions and life support interventions. APACHE IV predicted death and OASIS showed good discrimination in predicting death in this population. APACHE IV and OASIS may be useful for benchmarking and quality improvement initiatives in the CICU, the former having better discrimination.

KW - Comorbidity

KW - Critical care

KW - Mortality

KW - Quality improvement

KW - Renal replacement therapy

KW - Ventilation

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JO - Seminars in Anesthesia

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SN - 0883-9441

ER -

Severity of illness assessment with application of the APACHE IV predicted mortality and outcome trends analysis in an academic cardiac intensive care unit

Abstract

Keywords

ASJC Scopus subject areas

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