Skip to main content
  • Original article
  • Open access
  • Published:

Effectiveness of APACHE II and SAPS II scoring models in foreseeing the outcome of critically ill COPD patients

Abstract

Background

Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scoring systems are the two models that are greatly used by the majority of ICUs to predict clinical consequence.

Objective

The aim of the study was to assess the performance of APACHE II and SAPS II scoring methods in foreseeing death among critically ill chronic obstructive pulmonary disease (COPD) patients.

Materials and methods

This prospective research included 104 COPD patients who were admitted to the respiratory intensive care unit (RICU) at Assiut University Hospital. The patients were classified as survivors and nonsurvivors. Each scoring system was assessed for its discrimination, calibration, and overall performance.

Results

On the basis of the outcome of the study population, 36 (34.6%) patients were non-survivors while 68 (65.4%) patients were survivors. Both APACHE II and SAPS II scores were significantly higher in nonsurvivors. The discriminative power of both models was good as determined by the receiver operating characteristic curve. At a cutoff point greater than 20 for APACHE II and greater than 48 for SAPS II, survival or death can be predicted. The Lemeshow–Hosmer goodness-of-fit C statistics showed good performance and good calibration for both models. APACHE II score had the least Brier score and reliability but had the highest resolution.

Conclusion

The conclusions made were first, APACHE II and SAPS II have nearly similar performance in predicting mortality among COPD patients but with some preference for APACHE. Second, Both models have good discrimination and good calibration.

References

  1. May SM, Li JT. Burden of chronic obstructive pulmonary disease: healthcare costs and beyond. Allergy Asthma Proc 2015; 36:4–10.

    Article  Google Scholar 

  2. Khilnani GC, Banga A, Sharma SK. Predictors of mortality of patients with acute respiratory failure secondary to chronic obstructive pulmonary disease admitted to an intensive care unit: a one year study. BMC Pulm Med 2004; 4:12.

    Article  CAS  Google Scholar 

  3. Rapsang AG, Shyam DC. Scoring systems in the intensive care unit: a compendium. Indian J Crit Care Med. 2014; 18:220–228.

    Article  Google Scholar 

  4. Fadaizadeh L, Tamadon R, Saeedfar K, Jamaati H. Performance assessment of Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score II in a referral respiratory intensive care unit in Iran. Acta Anaesthesiol Taiwanica 2012; 50:59–62.

    Article  Google Scholar 

  5. Faruq MO, Mahmud MR, Begum T, Ahsan TS, Fatema K, Ahmed F, et al. A comparison of severity systems APACHE II and SAPS II in critically ill patients. Bangladesh Crit Care J 2013; 1:27–32.

    Article  Google Scholar 

  6. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classifi cation system. Crit Care Med 1985; 13:818–829.

    Article  CAS  Google Scholar 

  7. Le Gall JR, Lemeshow S, Saulnier F. A new simplifi ed acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993; 270:2957–2963.

    Article  Google Scholar 

  8. Hnley J, McNeil B. The meaning and the use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143:29–36.

    Article  Google Scholar 

  9. Lemeshow S, Hosmer DW. A review of goodness of fit statistics for use in the development of logistic regres-sion models. Am J Epidemiol 1982; 115:92–106.

    Article  CAS  Google Scholar 

  10. Brier GW. Verification of forecasts expressed in terms of probability. Mon Weather Rev 1950; 78:1e3.

    Article  Google Scholar 

  11. Ghoneim A, Hussein R, El-Ghamry R, Mahmoud L. Patterns of admitted cases to Respiratory Intensive Care Unit at Zagazig University Hospitals. Egypt EJCT 2013; 62:661–668.

    Google Scholar 

  12. El-Shahat H, Salama S, Wafy S, Bayoumi H. Risk factors for hospital mortality among mechanically ventilated patients in respiratory ICU. Egypt J Bronchol 2015; 9:231–237.

    Article  Google Scholar 

  13. Khalil MM, Salem HR, El Tohamy MF. Characteristics and clinical outcome of patients treated in the respiratory ICU of Abbassia Chest Hospital. Egypt J Bronchol 2019; 13:93–99.

    Google Scholar 

  14. Mohan A, Bhatt SP, Mohan C, Arora S, Luqman-Arafath TK, Guleria R. Derivation of a prognostic equation to predict in-hospital mortality and requirement of invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease. Indian J Chest Dis Allied Sci 2008; 50:335–342.

    CAS  PubMed  Google Scholar 

  15. Timmers TK, Verhofstad MHJ, Moons KGM, Leenen LPH. Validation of six mortality prediction systems for ICU surgical populations. Neth J Crit Care 2011; 15:118–130.

    Article  Google Scholar 

  16. Aminiahidashti H, Bozorgi F, Montazer SH, Baboli M, Firouzian A. Comparison of APACHE II and SAPS II Scoring systems in prediction of critically ill patients’ outcome. Emergency 2017; 5:e4.

    PubMed  PubMed Central  Google Scholar 

  17. Godinjak A, Iglica A, Rama A, Tančica I, Jusufović S, Ajanović A. Predictive value of SAPS II and APACHE II scoring systems for patient outcome in medical intensive care unit. Acta Med Acad 2016; 45:89–95.

    Article  Google Scholar 

  18. Haq A, Patil S, Parcells AL, Chamberlain RS. The Simplified Acute Physiology Score III Is Superior to the Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation II in Predicting Surgical and ICU Mortality in the ‘Oldest Old’. Curr Gerontol Geriatr Res 2014; 2014:934852.

    Article  Google Scholar 

  19. Kandil A, Kenawi M, Samir A, Hussein K. Traumatic brain injury predictive value of common intensive care severity scores. Res Opinion Anesth Intensive Care 2017; 4:124–128.

    Article  Google Scholar 

  20. Katsaragakis S, Papadimitropoulos K, Antonakis P, Strergiopoulos S, Konstadoulakis MM, Androulakis G. Comparison of acute physiology and chronichealth evaluation II (APACHE II) and simplified acute physiology score II (SAPS II) scoring systems in a single Greek intensive care unit. Crit Care Med 2000; 28:426–432.

    Article  CAS  Google Scholar 

  21. Moreno R, Morais P. Outcome prediction in intensive care: results of a prospective, multicentre, Portuguese study. Intensive Care Med 1997; 23:177–186.

    Article  CAS  Google Scholar 

  22. Arabi Y, Haddad S, Goraj R, Al-Shimemeri A, Al-Malik S. Assessment of performance of four mortality prediction systems in a Saudi Arabian intensive care unit. Crit Care 2002; 6:166–174.

    Article  Google Scholar 

  23. Nouira S, Belghith M, Elatrous S, Jaafoura M, Ellouzi M, Boujdaria R. Predictive value of severity scoring systems: comparison of four models in Tunisian adult intensive care units. Crit Care Med 1998; 26:852.

    Article  CAS  Google Scholar 

  24. Tan IK. APACHE II and SAPS II are poorly calibrated in a Hong Kong intensive care unit. Ann Acad Med Singapore 1998; 27:318–322.

    CAS  PubMed  Google Scholar 

  25. Naqvi IH, Mahmood K, Ziaullaha S, Kashif SM, Sharif A. Better prognostic marker in ICU-APACHE II, SOFA or SAP II!. Pak J Med Sci 2016; 32: PMC5103123.

    Google Scholar 

  26. Khwannimit B, Geater A. A comparison of APACHE II and SAPS II scoring systems in predicting hospital mortality in Thai adult intensive care units. J Med Assoc Thai 2007; 90:643–652.

    PubMed  Google Scholar 

  27. Del Bufalo C, Morelli A, Bassein L, Fasano L, Quarta CC, Pacilli AM, et al. Severity scores in respiratory intensive care: APACHE II predicted mortality better than SAPS II. Respir Care 1995; 40:1042–1047.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yousef Ahmed MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahmed, Y., Adam, M. & Bakkar, L.M. Effectiveness of APACHE II and SAPS II scoring models in foreseeing the outcome of critically ill COPD patients. Egypt J Bronchol 13, 654–659 (2019). https://doi.org/10.4103/ejb.ejb_72_19

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejb.ejb_72_19

Keywords