Pre-admission functional status impacts the performance of the APACHE IV model of mortality prediction in critically ill patients

Critical Care : the Official Journal of the Critical Care Forum
James S KrinsleySean M Bagshaw

Abstract

Functional status (FS) before intensive care unit (ICU) admission is associated with short-term and long-term outcomes among critically ill patients. However, measures of FS are generally not integrated into ICU-specific mortality prediction models. This retrospective cohort study used prospectively collected data from 9638 consecutive patients admitted to a single ICU between 1 October 2005 and 30 September 2015. For each ICU admission, FS was prospectively determined and classified into three discrete categories based on performance of basic daily living activities (FS1 - fully independent; FS2 - partly dependent; FS3 - completely dependent). We prospectively calculated Acute Physiology and Chronic Health Evaluation (APACHE) IV predicted mortality percentage (APIV PM) for each admission and calculated observed-expected mortality ratios (OEMR), stratified by FS category and APIV PM. We calculated area under the receiver operator characteristic curve (AUC) for APIV PM and mortality for the entire cohort and the three FS categories. Patients had a median (IQR) age of 67 (52-80) years and mean (SD) APIV PM was 18.3% (24.3%). Of these, 7714 (80.0%) were classified as FS1, 1728 (17.9%) as FS2 and 196 (2.0%) as FS3. FS1 patients wer...Continue Reading

References

Apr 16, 2010·Critical Care : the Official Journal of the Critical Care Forum·Jean-Louis Vincent, Rui Moreno
Sep 15, 2010·Critical Care Medicine·Mark T KeeganBekele Afessa
Sep 3, 2013·Current Opinion in Critical Care·Sean M Bagshaw, Robert C McDermid
Nov 28, 2013·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Sean M BagshawSumit R Majumdar
Feb 11, 2015·JAMA Internal Medicine·Lauren E FerranteThomas M Gill
Sep 25, 2015·The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences·An ZengKenneth Rockwood

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Citations

Sep 19, 2019·Acta Anaesthesiologica Scandinavica·Anna K HanstedMorten Vester-Andersen
Jul 6, 2019·Acta Anaesthesiologica Scandinavica·Anders GranholmMorten Hylander Møller
Dec 31, 2019·Acta Anaesthesiologica Scandinavica·Lenneke E M HaasNicolette F de Keizer
Jun 23, 2020·Critical Care Medicine·Wytske W GeenseMarieke Zegers
Jun 13, 2020·Critical Care : the Official Journal of the Critical Care Forum·Monika C KerckhoffsDiederik van Dijk
Sep 5, 2020·Critical Care Medicine·Nicholas E IngrahamChristopher J Tignanelli
Jun 6, 2021·Intensive Care Medicine·A M HigginsUNKNOWN PREDICT Study Investigators
Sep 7, 2021·Nihon Ronen Igakkai zasshi. Japanese journal of geriatrics·Hisanori OtsuboMasako Koshizaki

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Software Mentioned

APIV
MedCalc

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