Fatih Doğu GEYİK, Gülbin ALTUN TÖRE, Necati ÇİTAK, Tülin AYAZOĞLU AKARSU

Genel yoğun bakım Ünitesinde apache ıı ve apache ıv skorlama sistemlerinin karşılaştırılması

Amaç: Genel yoğun bakım ünitesinde (YBÜ) izlediğimiz olguların "Acute Physiology and Chronic Health Evaluation (APACHE)" II ve IV skorlarına göre gözlenen mortalite hızlarını karşılaştırmaktır. Yöntem: YBÜde takip ve tedavi edilen 94 olgu retrospektif olarak incelendi. lk 24 saatteki en kötü fizyolojik verilere göre APACHE II ve IV skoru hesaplandı. APACHE II ve APACHE IV skorları ve tahmini ölüm oranları hesaplanarak kayıt altına alındı. Skorlama sistemlerinin etkinliğinin değerlendirilmesi için ROC analizleri (Receiver-Operating Characteristics Curve) yapıldı. Bulgular: Olguların (48 erkek / 46 kadın) yaş ortalaması 63.5±18.1 idi. Yüzde 26.5i (n=25) postoperatif dönemde YBÜde takip edilen hastalardı. Yüzde 73.5inin (n=68) dahili hastalıkları (DM, inme, SVH, HT) vardı. Kırk dokuz hasta (%52.2) eksitus oldu. Cinsiyetin mortalite üzerine etkisi yoktu (p=0.993). Ancak 65 yaş üstünde olmak, MV ihtiyacı ve YBÜ yatış nedeninin dahili nedenli olması mortaliteye etki eden faktörlerdi (p=0.008, p

A comparison of apache ii and apache iv scoring systems in patients admitted to an intensive care unit

Objective: We aimed to compare the mortality rates of the patients in Intensive Care Unit (ICU) according to the "Acute Physiology and Chronic Health Evaluation (APACHE)" II and IV scores. Method: Ninety-four patients who were followed in the ICU were retrospectively analyzed. APACHE II and APACHE IV scores and mortality rates were recorded according to the worst physiological data in the first 24 hours. Efficacies of the scoring systems were evaluated with ROC (Receiver-Operating Characteristics Curve) analysis. Results: Mean age of the patients was 63.5±18.1. Of these patients, 26.5% (n=25) were in postoperative period and 73.5% (n=68) were hospitalized due to a non-surgical condition (such as DM, stroke, CVA, HT). Forty-nine patients (52.2%) were lost in ICU. Mortality rates were similar in both sexes (p=0.993) but being over 65, need for mechanic ventilation and hospitalization due to a non-surgical were the reasons to increase the mortality rates (p=0.008, p<0.001, p=0.001, respectively). APACHE II was calculated as 28.7±7.7 , which was significantly high in patients who died in the ICU whereas it was 13.6±8.4 in patients who were survived (p<0.001). APACHE IV was as 65.1±18.5 in the patients who died in the ICU, which was significantly higher compared to the patients who survived (p<0.001). Predictive mortality rate (PMR) was 52.2% in ICU, whereas in APACHE II, it was %43.4±28.1. In APACHE IV, PMR was found as 18.2±18.9%. APACHE II is found to be a significantly better tool to predict mortality than APACHE IV (AUC; APACHE II=0.912, APACHE IV=0.822) (p=0.02). Conclusion: PMR APACHE II and mortality in ICU patients was similar in the present study. APACHE II was found superior in predicting mortality than APACHE IV.

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