Performance of the Acute Physiology and Chronic Health Evaluation II (APACHE II) in the prediction of hospital mortality in a mixed ICU in Singapore

Charles Chin Han Lew, Gabriel Jun Yung Wong, Chee Keat Tan, Michelle Miller

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Background: The Acute Physiology and Chronic Health Evaluation II (APACHE II) is used to quantify disease severity and hospital mortality risk in critically ill patients. It is widely used in intensive care units (ICUs) in Singapore, but its prognostic validity remains questionable as it has not been thoroughly assessed by established statistical methods. Objectives: This study aimed to: (a) evaluate the discrimination and calibration accuracy of the APACHE II in the prediction of hospital mortality in a mixed ICU, and (b) customise the APACHE II in an effort to maximise its prognostic performance. Methods: A prospective cohort study was conducted and all adult patients with >24 h of ICU admission in a tertiary care institution in Singapore were included. The outcome measure was hospital mortality, and all patients were followed-up until hospital discharge or death for up to one year after ICU admission. Results: There were 503 patients, and their mean (SD) age and APACHE II score were 61.2 (15.8) years and 24.5 (8.2), respectively. Hospital mortality was 31%, and no patients were lost to follow-up. The APACHE II has good discrimination (receiver operating characteristic: 0.76) but poor calibration (Hosmer–Lemeshow C test: <0.001). Customisation did not significantly improve calibration accuracy. Conclusions: The APACHE II and its customised version should not be used in the local setting as they both have poor calibration. There is an urgent need for larger studies to perform second-level customisation or to develop a new prognostic model tailored to the Singapore critical care setting.

    Original languageEnglish
    Pages (from-to)147-152
    Number of pages6
    JournalProceedings of Singapore Healthcare
    Volume28
    Issue number3
    DOIs
    Publication statusPublished - 1 Sep 2019

    Keywords

    • APACHE II
    • critical care
    • mortality
    • prognosis

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