Role of some Scoring Systems in Predicting Outcome in Respiratory ICU

Abstract

Background: Scoring systems for use in intensive care unit (ICU) patients allow assessment of severity of the disease and provide an estimate of in hospital mortality. Also for quantify severity of illness for hospital and health care system administrative and to assess ICU performance and compare the quality of care of different ICUs and within the same ICU over time and used to assess the impact on patient outcomes of planned changes in the ICU, such as changes in bed number, staffing ratios, and medical coverage and to assess the prognosis of individual patients. Aim of the work: This study to detect the ability of APACHE IV score, ASOFA score in predicting outcome of patients in respiratory ICU. Patients and methods: A prospective observational cohort study was performed at the respiratory ICU of Bab El- Sharia and Al-Hussein Al- Azhar university Hospitals. The study includes all critically ill patients admitted to the respiratory ICU between November 2014 and April 2015.Data were collected from 100 patients (42 female and 58 male) consecutively admitted to the respiratory ICU (aged 18 years or older, ICU stay at least 24 hours). Patients were excluded from the study were younger than 18 years of age, had coronary artery bypass grafting surgery (CABG) and died or discharged within 24 hours of admission to the respiratory ICU.Means of APACHE IV score, length of stay and predicted mortality rate were calculated during the 1st 24 hours. Means of sofa score and length of stay were calculated during the admission. Data were analyzed with SPSS vs 15. Results: In total of 100 patients the observed mortality rate was 49 %.The mean age in survived patients was 57.216 ± 12.588 and in non-survived patients was 62.694 ± 10.304.There were 26 female and 25 male survived patients and there were 16 female and 33 male non-survived patients. APACHE IV score >81 was kept as cutoff point with sensitivity81.6 % and specificity 80.4 % with AUROC 0.841 . SOFA score >7 was kept as cutoff point with sensitivity95.9% and specificity 100% with AUROC 0.997. Conclusion: the mortality prediction by APACHE IV and ASOFA scoring systems performs acceptably in our patients and can be utilized as a performance assessment tool in our RICUs and both scores showed good discrimination between survived and non-survived patients with SOFA more accurate in predicting mortality than APACHE IV.