Publication: EFFECTIVENESS OF SCORING IN OUTCOME PREDICTION OF ELDERLY PATIENTS IN INTENSIVE CARE UNITS
Abstract
Giriş: Hastalık şiddetini tanımlayan skorlama sistemleri, yoğun bakım ünitelerindeki (YBÜ) mortalite riskini de öngörmektedir. Bu çalışmanın amacı; YBÜ'de takip edilen yaşlı hastalarda sağ-kalımın öngörülmesinde APACHE II ve SAPS II skorlarının duyarlı olup olmadığının belirlenmesidir. Gereç ve Yöntem: Çalışmaya 2006-2011 yılları arasında YBÜ'ne yatırılan 70 yaş üstü hastalar dahil edildi. Demografik veriler, yatış tanısı, ek hastalıklar, YBÜ'de yatış süresi, sağ kalım/mortalite, APACHE II ve SAPS II skorları ile standardize mortalite oranı (SMR) kaydedildi. APACHE II ve SAPS II skorlarının ölüm ve sağkalım için spesifisite, duyarlılık ve tahmin değerleri hesaplandı. Bulgular: YBÜ'nde ortalama 8.4±10.3 (1-67) gün takip edilen 70-94 (ort±ss=79.8±5.3 yıl) yaş arası 176 hastanın (88 erkek, 88 kadın) mortalite oranı %36.9 idi. APACHE II ve SAPS II skorları ile mortalite oranı arasında anlamlı bir ilişki vardı. APACHE II için eğri altında kalan alanın anlamlı lığı SAPS II skorundan daha yüksek idi. 80-85 ile >90 yaş hastalar için skorlar anlamlı olarak artmıştı. APACHE II ve SAPS II skorları için cut-off değerleri sırasıyla 22,5 ve 43,5 idi. APACHE II, APACHE II-adjusted ve SAPS II ile öngörülen mortalite oranları için SMR sırasıyla %77, %82 ve %80 idi. Sonuç: APACHE II ve SAPS II skorlama sistemleri mortalite ve sağkalımı öngörmede YBU nde takip edilen genel hasta popülasyonuna benzer şekilde 70 yaş üstü hastalarda da başarılı öngörme oranlarına sahiptir.
Introduction: Scoring systems defining the severity of illnesses also predict the risk of mortality in intensive care units (ICUs). The aim of this study is to detect if APACHE II and SAPS II scores are highly sensitive in the prediction of survival in elderly in the ICU. Materials and Method: Patients >70 years, admitted to the ICU during 2006-2011 were included. Demographic information, diagnosis at admission, comorbidities, duration of ICU stay, survival/mortality and, APACHE II, SAPS II scores at admission and standardized mortality rate (SMR) were recorded. The specificity and sensitivity predictive values of APACHE II and SAPS II scores were calculated on death or survival. Results: A total of 176 patients aged 70-94 (mean±sd=79.8±5.3) years stayed in the ICU for 1-67 (mean±SD: 8.4±10.3) days, and the mortality rate (MR) was 36.9%. There was a significant relationship of APACHE II and SAPS II scores with the MR. The significance of area under the curve was greater for the APACHE II score than SAPS II score, and the significance scores increased for patients aged 80-85 and >90 years. The cut-off values were 22.5 and 43.5 for the APACHE II and SAPS II scores. SMRs were 77%, 82% and 80% for APACHE II predicted, APACHE II adjusted and SAPS II predicted MRs. Conclusion: Success rate similar to that in the general population could be achieved in the ICU with the elderly, and APACHE II and SAPS II scores showed similar accuracy in the prediction of mortality and both were reliable for patients aged >70 years.
Introduction: Scoring systems defining the severity of illnesses also predict the risk of mortality in intensive care units (ICUs). The aim of this study is to detect if APACHE II and SAPS II scores are highly sensitive in the prediction of survival in elderly in the ICU. Materials and Method: Patients >70 years, admitted to the ICU during 2006-2011 were included. Demographic information, diagnosis at admission, comorbidities, duration of ICU stay, survival/mortality and, APACHE II, SAPS II scores at admission and standardized mortality rate (SMR) were recorded. The specificity and sensitivity predictive values of APACHE II and SAPS II scores were calculated on death or survival. Results: A total of 176 patients aged 70-94 (mean±sd=79.8±5.3) years stayed in the ICU for 1-67 (mean±SD: 8.4±10.3) days, and the mortality rate (MR) was 36.9%. There was a significant relationship of APACHE II and SAPS II scores with the MR. The significance of area under the curve was greater for the APACHE II score than SAPS II score, and the significance scores increased for patients aged 80-85 and >90 years. The cut-off values were 22.5 and 43.5 for the APACHE II and SAPS II scores. SMRs were 77%, 82% and 80% for APACHE II predicted, APACHE II adjusted and SAPS II predicted MRs. Conclusion: Success rate similar to that in the general population could be achieved in the ICU with the elderly, and APACHE II and SAPS II scores showed similar accuracy in the prediction of mortality and both were reliable for patients aged >70 years.