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Original research
Cohort study of the APACHE II score and mortality for different types of intensive care unit patients
  1. Veli Sungono1,2,
  2. Hori Hariyanto3,
  3. Tri Edhi Budhi Soesilo4,
  4. Asri C Adisasmita5,
  5. Syahrizal Syarif5,
  6. Antonia Anna Lukito6,
  7. Allen Widysanto7,
  8. Vivien Puspitasari8,
  9. Oloan Eduard Tampubolon3,
  10. Bambang Sutrisna5,
  11. Mondastri Korib Sudaryo5
  1. 1 Epidemiology, University of Indonesia, Faculty of Public Health, Depok, Indonesia
  2. 2 Epidemiology, University of Pelita Harapan, Faculty of Medicine, Tangerang, Indonesia
  3. 3 Intensive Care Unit, Pelita Harapan University Faculty of Medicine, Tangerang, Indonesia
  4. 4 School of Environmental Science, University of Indonesia, Depok, Indonesia
  5. 5 Department of Epidemiology, University of Indonesia Faculty of Public Health Department of Epidemiology, Depok, Indonesia
  6. 6 Department of Cardiology and Vascular Medicine, Pelita Harapan University Faculty of Medicine, Tangerang, Indonesia
  7. 7 Pulmonology, Pelita Harapan University Faculty of Medicine, Tangerang, Indonesia
  8. 8 Neurology, Pelita Harapan University Faculty of Medicine, Tangerang, Indonesia
  1. Correspondence to Veli Sungono, Epidemiology, University of Indonesia Faculty of Public Health, Depok 16424, Indonesia; vsungono{at}gmail.com

Abstract

Objectives Find the discriminant and calibration of APACHE II (Acute Physiology And Chronic Health Evaluation) score to predict mortality for different type of intensive care unit (ICU) patients.

Methods This is a cohort retrospective study using secondary data of ICU patients admitted to Siloam Hospital of Lippo Village from 2014 to 2018 with minimum age ≥17 years. The analysis uses the receiver operating characteristic curve, student t-test and logistic regression to find significant variables needed to predict mortality.

Results A total of 2181 ICU patients: men (55.52%) and women (44.48%) with an average age of 53.8 years old and length of stay 3.92 days were included in this study. Patients were admitted from medical emergency (30.5%), neurosurgical (52.1%) and surgical (17.4%) departments, with 10% of mortality proportion. Patients admitted from the medical emergency had the highest average APACHE score, 23.14±8.5, compared with patients admitted from neurosurgery 15.3±6.6 and surgical 15.8±6.8. The mortality rate of patients from medical emergency (24.5%) was higher than patients from neurosurgery (3.5%) or surgical (5.3%) departments. Area under curve of APACHE II score showed 0.8536 (95% CI 0.827 to 0.879). The goodness of fit Hosmer-Lemeshow show p=0.000 with all ICU patients’ mortality; p=0.641 with medical emergency, p=0.0001 with neurosurgical and p=0.000 with surgical patients.

Conclusion APACHE II has a good discriminant for predicting mortality among ICU patients in Siloam Hospital but poor calibration score. However, it demonstrates poor calibration in neurosurgical and surgical patients while demonstrating adequate calibration in medical emergency patients.

  • adult intensive & critical care
  • epidemiology
  • intensive & critical care

Data availability statement

All data relevant to the study are included in the article. All data relevant to the study are included in the article or uploaded as supplementary information.

http://dx.doi.org/10.1136/postgradmedj-2021-140376

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    Data availability statement

    All data relevant to the study are included in the article. All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors Conception and designing research studies, have full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish:: VS, HH and BS. Data collection: HH, OET, AW and VP. Analysing data: VS, HH, BS and MKS. Interpretating the results: AAL, AW and VP. Critical revision of the article: TEBS, ACA and SS. Writing the manuscript: VS, HH and MKS.

    • Funding This work was supported by the Beasiswa Pendidikan Pasca Sarjana, Scholarship for Doctoral Programme, from the Ministry of Education, Republic of Indonesia.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.