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

Courtney 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 journalArticle

4 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)242-246
Number of pages5
JournalJournal of Critical Care
Volume50
DOIs
StatePublished - Apr 1 2019

Fingerprint

APACHE
Intensive Care Units
Mortality
Noninvasive Ventilation
Hospital Mortality
ROC Curve
Calibration
Length of Stay
Benchmarking
Quality Improvement
Comorbidity
Linear Models
Population

Keywords

  • Comorbidity
  • Critical care
  • Mortality
  • Quality improvement
  • Renal replacement therapy
  • Ventilation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Severity of illness assessment with application of the APACHE IV predicted mortality and outcome trends analysis in an academic cardiac intensive care unit. / Bennett, Courtney; Wright, R. Scott; Jentzer, Jacob; Gajic, Ognjen; Murphree, Dennis H.; Murphy, Joseph G.; Mankad, Sunil V.; Wiley, Brandon M.; Bell, Malcolm R.; Barsness, Gregory W.

In: Journal of Critical Care, Vol. 50, 01.04.2019, p. 242-246.

Research output: Contribution to journalArticle

Bennett, Courtney ; Wright, R. Scott ; Jentzer, Jacob ; Gajic, Ognjen ; Murphree, Dennis H. ; Murphy, Joseph G. ; Mankad, Sunil V. ; Wiley, Brandon M. ; Bell, Malcolm R. ; Barsness, Gregory W. / Severity of illness assessment with application of the APACHE IV predicted mortality and outcome trends analysis in an academic cardiac intensive care unit. In: Journal of Critical Care. 2019 ; Vol. 50. pp. 242-246.
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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.",
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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

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.

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Y1 - 2019/4/1

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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