Document Detail


Acute Physiology and Chronic Health Evaluation (APACHE) III outcome prediction after major vascular surgery.
MedLine Citation:
PMID:  18922428     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To investigate the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) III scoring system in patients admitted to the intensive care unit (ICU) after major vascular surgery. DESIGN: Retrospective cohort study. SETTING: A tertiary referral center. PARTICIPANTS: Three thousand one hundred forty-eight patients who underwent major vascular surgery between October 1994 and March 2006. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data were abstracted from an institutional APACHE III database. Standardized mortality ratios (SMRs) (with 95% confidence intervals) were calculated. The area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow C statistic were used to assess discrimination and calibration, respectively. The mean age of 3,148 patients studied was 70.5 years (+/- standard deviation 9.6). The mean Acute Physiology Score and the APACHE III score on the day of ICU admission were 31.0 (+/- 17.5) and 45.1 (+/- 18.8), respectively. The mean predicted ICU and hospital mortality rates were 3.2% (+/- 7.8%) and 5.0% (+/- 9.5%), respectively. The median (and interquartile range) ICU and hospital lengths of stay were 4.3 (3.6-5.1) and 14 days (11.9-16.8 days), respectively. The observed ICU mortality rate was 2.4% (75/3, 148 patients) and hospital mortality rate was 3.7% (116/3,148). The ICU and hospital SMRs were 0.74 (0.58-0.91) and 0.74 (0.61-0.88), respectively. The AUC of APACHE III-derived prediction of hospital mortality was 0.840 (95% confidence interval, 0.799-0.880), indicating excellent discrimination. The Hosmer-Lemeshow C statistic was 28.492, with a p value <0.01, indicating poor calibration. CONCLUSIONS: The APACHE III scoring system discriminates well between survivors and nonsurvivors after major vascular surgery, but calibration of the model is poor.
Authors:
Mark T Keegan; Francis X Whalen; Daniel R Brown; Tuhin K Roy; Bekele Afessa
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Publication Detail:
Type:  Journal Article     Date:  2008-03-28
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  22     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-16     Completed Date:  2009-01-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  713-8     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Division of Critical Care, Mayo Clinic, Rochester, MN 55905, USA. keegan.mark@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
APACHE*
Aged
Aortic Aneurysm, Abdominal / surgery
Area Under Curve
Cohort Studies
Female
Hospital Mortality
Humans
Intensive Care Units
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Vascular Surgical Procedures* / mortality

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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