Abstract 37: Calibration of APACHE II Score to Predict Mortality in Out-of-Hospital and In-Hospital Cardiac Arrest
Introduction: Severity of illness scores can predict outcomes in critically ill patients. However, the calibration of previously established scores in post-cardiac arrest is poorly established.
Objective: To assess the calibration of the Acute Physiology and Chronic Health Evaluation (APACHE II) score in out-of-hospital and in-hospital cardiac arrest.
Methods: A prospective observational study of adult cardiac arrest at an urban tertiary care hospital during the period from 12/2007 to 12/2010. Inclusion criteria: 1. Adult (>18 years); 2. OHCA; 3. Return of spontaneous circulation (RSOC). Traumatic cardiac arrests were excluded. We recorded baseline demographics, arrest event characteristics, follow-up vitals and laboratory data, and in-hospital mortality. APACHE II scores were calculated at the time of ROSC, and at 24hrs, 48hrs, and 72hrs. We used simple descriptive statistics to describe the study population. Univariate logistic regression was used to predict mortality with APACHE II as a continuous predictor variable. Discrimination of APACHE II scores was assessed using the area under the curve (AUC) of the receiver operator characteristic (ROC) curve.
Results: A total of 229 patients were analyzed. The median age was 70 years (IQR: 56 - 79) and 32% were female. APACHE II score was a significant predictor of mortality for both OHCA and IHCA at baseline and at all follow-up time points (all p < 0.01). Discrimination of the score increased over time and achieved very good discrimination after 24hrs (Table 1).
Conclusion: The ability of APACHE II score to predict mortality improves over time in the 72-hours following cardiac arrest. These data suggest that after 24-hours, APACHE II scoring is a useful severity of illness score in all post-cardiac arrest patients.
- © 2011 by American Heart Association, Inc.