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Category: Volume 07 Issue 11 November 2019
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Title: Comparison of Mortality Prediction, of APACHE II, SAPS II and SOFA ICU Scoring Systems in Patients with Severe Sepsis and Septic Shock in ICU of A Tertiary Care Hospital

Authors: Dr Mohini Singh, Dr Vasista Palnati, Dr S.R. Ramakrishnan

 DOI: https://dx.doi.org/10.18535/jmscr/v7i11.108

Abstract

Severe sepsis accounts for one in five admissions to intensive care units (ICUs) and is the leading cause of death in the noncoronary ICU.  Unfortunately, the outcome of sepsis has remained unacceptably high to the tune of 30%–40% despite the development and availability of an increasing array of higher-generation antibiotics with broader spectrum of coverage and advances in intensive supportive measures. Mortality Prediction Systems have been introduced as tools for assessing the performance of ICUs. They help in individual patient outcome prediction by reducing uncertainty and provide an opportunity for improved decision making.

Aims and Objectives: To assess the mortality of patients with sepsis and septic shock and to prognosticate the patients by using defined scores like SAPS II, APACHE II and SOFA scores.

Materials and Methods: This observational study included 120 patients with severe sepsis and septic shock and Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiological Score II (SAPS II) and Sequential Organ Failure Assessment (SOFA) indices were calculated at baseline to assess the severity of illness.

Results: In this study the maximum number of patients were from the age groups 40 to 50 years (46 patients) and 60 to 80 years (45 years). Out of 120 patients 43 patients did not survive. Male to female distribution in this study noted was 49 and 71patients respectively. Respiratory and urosepsis was noted in 45% and 30% respectively. Among 120 patients, 35 patients had an increasing SOFA trend, out of which 34 did not survive (p<0.05). In this study it was observed that the SAPS II had the highest sensitivity (0.721) and APACHE II scoring had the highest specificity (0.766). When comparing individually all the three scoring systems were significant (p<0.05) in predicting the mortality, but SAPS II had the most area under the ROC curve (p value 0.047) with odds ratio of 1.449.

Conclusion: Individually, all the three scoring systems can be used to detect the outcome of the patient with sepsis and severe sepsis.

Keywords: APACHEE II scoring system, SAPS II scoring system, SOFA scoring system, Sepsis.

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Corresponding Author

Dr S.R. Ramakrishnan

Professor, Sri Ramachanra Institute of higher Education and Research, Chennai, India