| Acute Physiology and Chronic Health Evaluation (APACHE) III outcome prediction after major vascular surgery. | |
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MedLine Citation:
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PMID: 18922428 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Mark T Keegan; Francis X Whalen; Daniel R Brown; Tuhin K Roy; Bekele Afessa |
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Publication Detail:
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Type: Journal Article Date: 2008-03-28 |
Journal Detail:
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Title: Journal of cardiothoracic and vascular anesthesia Volume: 22 ISSN: 1532-8422 ISO Abbreviation: J. Cardiothorac. Vasc. Anesth. Publication Date: 2008 Oct |
Date Detail:
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Created Date: 2008-10-16 Completed Date: 2009-01-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9110208 Medline TA: J Cardiothorac Vasc Anesth Country: United States |
Other Details:
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Languages: eng Pagination: 713-8 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology, Division of Critical Care, Mayo Clinic, Rochester, MN 55905, USA. keegan.mark@mayo.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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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