The utility of acute physiology and chronic health evaluation II scores for prediction of mortality among intensive care unit (ICU) and non-ICU patients with methicillin-resistant Staphylococcus aureus bacteremia.

Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America
Vanessa StevensJack Brown

Abstract

Bloodstream infections due to methicillin-resistant Staphylococcus aureus (MRSA) have been associated with significant risk of in-hospital mortality. The acute physiology and chronic health evaluation (APACHE) II score was developed and validated for use among intensive care unit (ICU) patients, but its utility among non-ICU patients is unknown. The aim of this study was to determine the ability of APACHE II to predict death at multiple time points among ICU and non-ICU patients with MRSA bacteremia. Retrospective cohort study. Secondary analysis of data from 200 patients with MRSA bacteremia at 2 hospitals. Logistic regression models were constructed to predict overall in-hospital mortality and mortality at 48 hours, 7 days, 14 days, and 30 days using APACHE II scores separately in ICU and non-ICU patients. The performance of APACHE II scores was compared with age adjustment alone among all patients. Discriminatory ability was assessed using the c-statistic and was compared at each time point using χ(2) tests. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test. APACHE II was a significant predictor of death at all time points in both ICU and non-ICU patients. Discrimination was high in all models, wi...Continue Reading

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