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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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Autores principales: Vandenbrande, Jeroen, Verbrugge, Laurens, Bruckers, Liesbeth, Geebelen, Laurien, Geerts, Ester, Callebaut, Ina, Gruyters, Ine, Heremans, Liesbeth, Dubois, Jasperina, Stessel, Bjorn
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225448/
https://www.ncbi.nlm.nih.gov/pubmed/34258059
http://dx.doi.org/10.1155/2021/5443083
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author Vandenbrande, Jeroen
Verbrugge, Laurens
Bruckers, Liesbeth
Geebelen, Laurien
Geerts, Ester
Callebaut, Ina
Gruyters, Ine
Heremans, Liesbeth
Dubois, Jasperina
Stessel, Bjorn
author_facet Vandenbrande, Jeroen
Verbrugge, Laurens
Bruckers, Liesbeth
Geebelen, Laurien
Geerts, Ester
Callebaut, Ina
Gruyters, Ine
Heremans, Liesbeth
Dubois, Jasperina
Stessel, Bjorn
author_sort Vandenbrande, Jeroen
collection PubMed
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.
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spelling pubmed-82254482021-07-12 Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV Score in COVID-19 Patients Vandenbrande, Jeroen Verbrugge, Laurens Bruckers, Liesbeth Geebelen, Laurien Geerts, Ester Callebaut, Ina Gruyters, Ine Heremans, Liesbeth Dubois, Jasperina Stessel, Bjorn Crit Care Res Pract Research Article 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. Hindawi 2021-06-19 /pmc/articles/PMC8225448/ /pubmed/34258059 http://dx.doi.org/10.1155/2021/5443083 Text en Copyright © 2021 Jeroen Vandenbrande et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Vandenbrande, Jeroen
Verbrugge, Laurens
Bruckers, Liesbeth
Geebelen, Laurien
Geerts, Ester
Callebaut, Ina
Gruyters, Ine
Heremans, Liesbeth
Dubois, Jasperina
Stessel, Bjorn
Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV Score in COVID-19 Patients
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
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225448/
https://www.ncbi.nlm.nih.gov/pubmed/34258059
http://dx.doi.org/10.1155/2021/5443083
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