APACHE Ⅱ for Severity Evaluation and Prognosis Prediction of Patients Undergoing Cardiac Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIXiao-mi ,  HANHong-guang , LIXin-min , WANGHui-shan , XULi-ying , MENGQing-tao , LIZhi-wen

Department of Cardiovascular Surgery, The General Hospital of Shenyang Military Region, Shenyang 110016, P. R. China;

Corresponding author：

HANHong-guang, Email: lixiaomi027925@163.com

Keywords：

Acute physiology and chronic health evaluation Ⅱ; Perioperative period; Cardiac surgery; Prognosis

DOI：

10.7507/1007-4848.20150008

Video：

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Objective To investigate acute physiologic and chronic health evaluation Ⅱ(APACHE Ⅱ) score system for severity evaluation and prognosis prediction of patients undergoing cardiac surgery. Methods A total of 3 566 patients who were admitted in ICU after cardiac surgery in the Department of Cardiovascular Surgery of General Hospital of Shenyang Military between December 1, 2011 and August 31, 2013 were enrolled in this study. There were 1 873 males and 1 693 females with their average age of 45.8±23.7 years (range, 10 days to 82 years). All the patients were evaluated with APACHE Ⅱ and expected mortality was calculated. Receiver operating characteristic(ROC) curve was drawn to compare expected and actual mortality and evaluate predictive value of APACHE Ⅱ. Results A total of 3 373 patients survived the operation, and 193 patients died postoperatively with the mortality of 5.41%. The area under the ROC curve was 0.917 (P=0.000) with 95% confidence interval of[0.885,0.949]. The cut-off point of APACHE Ⅱ was 15.50, with a sensitivity of 80.3%,a specificity of 95.6%,an accuracy rate of 79.5%,a positive predictive value of 86.9%,and a negative predictive value of 93.1%. Expected and actual mortality increased with increasing APACHE Ⅱ,which were both positively correlated. Conclusion APACHE Ⅱ score system can be used to evaluate severity and predict prognosis of patients undergoing cardiac surgery, which provides reference for rational utilization of ICU resource.

Citation： LIXiao-mi, HANHong-guang, LIXin-min, WANGHui-shan, XULi-ying, MENGQing-tao, LIZhi-wen. APACHE Ⅱ for Severity Evaluation and Prognosis Prediction of Patients Undergoing Cardiac Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(1): 28-30. doi: 10.7507/1007-4848.20150008 Copy

1.	Anderson AJ, Barros Neto FX, Costa Mde A, et al. Predictors of mortality in patients over 70 years-old undergoing CABG or valve surgery with cardiopulmonary bypass. Rev Bras Cir Cardiovasc, 2011, 26(1):69-75.
2.	房勤, 谷天祥, 刘波, 等. 老年危重心瓣膜病的外科治疗与围术期处理. 中国胸心血管外科临床杂志, 2013, 20(1):111-112.
3.	Ho KM, Dobb GJ, Knuiman M, et al. A comparison of admission and worst 24-hour Acute Physiology and Chronic Health Evaluation Ⅱ scores in predicting hospital mortality:a retrospective cohort study. Crit Care, 2006, 10(1):R4.
4.	顾伟, 殷文明, 李春盛. 肌钙蛋白I 和APACHE Ⅱ评分在危重病患者预后中的应用价值. 中国实用内科杂志, 2007, 27(17):1373-1375.
5.	董桂祥. 氧合指数与APACHE 评分对肝移植手术后急性呼吸窘迫综合征患者预后影响的比较研究. 中华临床医师杂志:电子版, 2012, 6(11):2921-2923.
6.	Vesely MR, Kelemen MD. Cardiac risk assessment:matching intensity of therapy to risk. Cardial Clin, 2006, 24(1):67-78.
7.	周国鹏, 宋以信, 赵志杰, 等. APACHE Ⅱ评价系统对75 岁以上老年重症病人预后评价价值. 中华内科杂志, 2005, 44(4):251-253.
8.	陈洁茹, 陈伟燕, 熊旭明. APACHE Ⅱ评分系统在综合ICU 中的应用. 广东医学, 2013, 34(1):86-89.
9.	Knaus WA, Draper EA, Wanger DP, et al. APACHE Ⅱ:a severity of disease classification system. Crit Care Med, 1985, 13(10):818-829.
10.	Kim TK, Yoon JR. Comparison of the predictive power of the LODS and APACHE Ⅱ scoring systems in a neurological intensive care unit. J Int Med Res, 2012, 40(2):777-786.
11.	Fedullo AJ, Swinburne AJ, Wahl GW, et al. APACHE Ⅱ scoring and mortality in respiratory failure due to cardiogenic pulmonary edema. Crit Care Med, 1988, 16(12):1218-1221.
12.	王仲. 围术期APACHE Ⅱ动态评分在老年肝胆外科患者预后评估中的价值. 中国老年病杂志, 2013, 33(12):6168-6169.
13.	Lapinsky SE, Hallett D, Collop N, et al. Intensive care unit morbidity and mortality from eclampsia:an evaluation of the Acute Physiology and Chronic Health Evaluation Ⅱ score and the Glasgow Coma Scale score. Crit Care Med, 2010, 22(10):1-7.
14.	顾伟, 殷文明, 李春盛. 肌钙蛋白I 和APACHE Ⅱ评分在危重症患者预后中的应用价值. 中国实用内科杂志, 2007, 27(17):1373-1375.
15.	Schmidt H, Hoyer D, Rauchhaus M, et al. ACE-inhibitor therapy and survival among patients with multiorgan dysfunction syndrome (MODS) of cardiac and non-cardiac origin. Int J Cardiol, 2010, 140(3):296-303.
16.	Liang J, Zhou Z. Application of APACHE Ⅱ Scoring in ICU trauma patients. Chin J Traumatol, 1998, 1(1):58-60.
17.	李娟, 姜辉, 罗俊华. APACHE Ⅱ评分在老年危重症患者中的应用价值. 现代中西医结合杂志, 2012, 21(7):695-699.
18.	丁文军, 魏强, 孙勇新, 等. 主动脉内球囊反搏在高危患者非体外循环冠状动脉旁路移植术中的应用. 中国胸心血管外科临床杂志, 2013, 20(1):11-14.
19.	Lavana JD, Fmser JF, Smith SE, et al. Influence of timing of intraaortic balloon placement in cardiac surgical patients. J Thorac Cardiovasc Surg, 2010, 140(1):80-85.

1. Anderson AJ, Barros Neto FX, Costa Mde A, et al. Predictors of mortality in patients over 70 years-old undergoing CABG or valve surgery with cardiopulmonary bypass. Rev Bras Cir Cardiovasc, 2011, 26(1):69-75.
2. 房勤, 谷天祥, 刘波, 等. 老年危重心瓣膜病的外科治疗与围术期处理. 中国胸心血管外科临床杂志, 2013, 20(1):111-112.
3. Ho KM, Dobb GJ, Knuiman M, et al. A comparison of admission and worst 24-hour Acute Physiology and Chronic Health Evaluation Ⅱ scores in predicting hospital mortality:a retrospective cohort study. Crit Care, 2006, 10(1):R4.
4. 顾伟, 殷文明, 李春盛. 肌钙蛋白I 和APACHE Ⅱ评分在危重病患者预后中的应用价值. 中国实用内科杂志, 2007, 27(17):1373-1375.
5. 董桂祥. 氧合指数与APACHE 评分对肝移植手术后急性呼吸窘迫综合征患者预后影响的比较研究. 中华临床医师杂志:电子版, 2012, 6(11):2921-2923.
6. Vesely MR, Kelemen MD. Cardiac risk assessment:matching intensity of therapy to risk. Cardial Clin, 2006, 24(1):67-78.
7. 周国鹏, 宋以信, 赵志杰, 等. APACHE Ⅱ评价系统对75 岁以上老年重症病人预后评价价值. 中华内科杂志, 2005, 44(4):251-253.
8. 陈洁茹, 陈伟燕, 熊旭明. APACHE Ⅱ评分系统在综合ICU 中的应用. 广东医学, 2013, 34(1):86-89.
9. Knaus WA, Draper EA, Wanger DP, et al. APACHE Ⅱ:a severity of disease classification system. Crit Care Med, 1985, 13(10):818-829.
10. Kim TK, Yoon JR. Comparison of the predictive power of the LODS and APACHE Ⅱ scoring systems in a neurological intensive care unit. J Int Med Res, 2012, 40(2):777-786.
11. Fedullo AJ, Swinburne AJ, Wahl GW, et al. APACHE Ⅱ scoring and mortality in respiratory failure due to cardiogenic pulmonary edema. Crit Care Med, 1988, 16(12):1218-1221.
12. 王仲. 围术期APACHE Ⅱ动态评分在老年肝胆外科患者预后评估中的价值. 中国老年病杂志, 2013, 33(12):6168-6169.
13. Lapinsky SE, Hallett D, Collop N, et al. Intensive care unit morbidity and mortality from eclampsia:an evaluation of the Acute Physiology and Chronic Health Evaluation Ⅱ score and the Glasgow Coma Scale score. Crit Care Med, 2010, 22(10):1-7.
14. 顾伟, 殷文明, 李春盛. 肌钙蛋白I 和APACHE Ⅱ评分在危重症患者预后中的应用价值. 中国实用内科杂志, 2007, 27(17):1373-1375.
15. Schmidt H, Hoyer D, Rauchhaus M, et al. ACE-inhibitor therapy and survival among patients with multiorgan dysfunction syndrome (MODS) of cardiac and non-cardiac origin. Int J Cardiol, 2010, 140(3):296-303.
16. Liang J, Zhou Z. Application of APACHE Ⅱ Scoring in ICU trauma patients. Chin J Traumatol, 1998, 1(1):58-60.
17. 李娟, 姜辉, 罗俊华. APACHE Ⅱ评分在老年危重症患者中的应用价值. 现代中西医结合杂志, 2012, 21(7):695-699.
18. 丁文军, 魏强, 孙勇新, 等. 主动脉内球囊反搏在高危患者非体外循环冠状动脉旁路移植术中的应用. 中国胸心血管外科临床杂志, 2013, 20(1):11-14.
19. Lavana JD, Fmser JF, Smith SE, et al. Influence of timing of intraaortic balloon placement in cardiac surgical patients. J Thorac Cardiovasc Surg, 2010, 140(1):80-85.

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APACHE Ⅱ for Severity Evaluation and Prognosis Prediction of Patients Undergoing Cardiac Surgery

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