Clinical audit of a respiratory intensive care unit – evaluating outcomes via the acute physiology and chronic health evaluation II system

Muralidhar Anakapalli; Hanumantha R. Mangu; Pawan B. Nanaiah; Arulmurugan Balasubramanian; Hari R. Nair; Avinash Maheswarappa

doi:10.18203/2320-6012.ijrms20263491

Authors

Muralidhar Anakapalli Department of Anaesthesia, Ahalia Medical Group, Abu Dhabi, UAE
Hanumantha R. Mangu Department of Anaesthesia, Sri Balaji Medical College Hospital and Research Institute, Tirupati, Andhra Pradesh, India
Pawan B. Nanaiah Department of Orthopaedic Surgery, Ahalia Medical Group, Abu Dhabi, UAE
Arulmurugan Balasubramanian Department of Anaesthesia, Phoenix Hospital, Abu Dhabi, UAE
Hari R. Nair Department of Anaesthesia, Ahalia Medical Group, Abu Dhabi, UAE
Avinash Maheswarappa Department of Anaesthesia, Ahalia Medical Group, Abu Dhabi, UAE

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263491

Keywords:

APACHE II, Respiratory intensive care unit, Mortality, Severity scoring, Critical care

Abstract

Background: The acute physiology and chronic health evaluation II (APACHE II) score is widely used to assess illness severity and predict mortality in critically ill patients. This study evaluated its usefulness for mortality prediction in a respiratory intensive care unit (RICU).

Methods: A prospective observational study included 80 consecutive RICU admissions over six months at a tertiary-care hospital. APACHE II scores were calculated using the worst physiological values recorded during the first 24 hours of admission. Predicted mortality was compared with observed mortality, and associations with age, sex, APACHE II score, and diagnostic category were assessed.

Results: Of 80 patients, 54 survived and 26 died, giving an observed mortality of 32.5%. Mean age was 42.1±20.642.1/pm 20.642.1±20.6 years, mean APACHE II score was 12.43±10.812.43/pm 10.812.43±10.8, and mean predicted mortality was 23.9%. Non-survivors were older and had significantly higher APACHE II scores than survivors (p=0.0001, p=0.0001, p=0.0001 and p=0.001, p=0.001, p=0.001, respectively). Mortality increased with advancing age and higher APACHE II score categories, reaching 80% among patients with scores of 30–34 and >34. Male patients had higher observed mortality than female patients (44.68% versus 15.15%; p=0.006, p=0.006, p=0.006). Respiratory and trauma cases had the highest observed mortality (66.66% each).

Conclusions: APACHE II is a useful tool for early risk stratification of RICU patients. Higher APACHE II scores and older age were strongly associated with mortality; however, the score underestimated overall mortality in this cohort. Periodic local validation is recommended.

References

Sarkar R, Martin C, Mattie H, Gichoya JW, Stone DJ, Celi LA. Performance of intensive care unit severity scoring systems across different ethnicities in the USA: a retrospective observational study. Lancet Digit Health. 2021;3(4):e241-9.

Kuo PJ, Chou SE, Liu HT, Tsai CH, Hsieh CH. Daily Improvement in APACHE II Score (APACHE/m) and Outcomes in ICU Trauma Patients. Risk Manag Healthc Policy. 2025;18:3609-19.

Pellathy TP, Pinsky MR, Hravnak M. Intensive Care Unit Scoring Systems. Crit Care Nurse. 2021;41(4):54-64.

Fernandes S, Sérvio R, Patrício P, Pereira C. Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II Score in COVID-19 Patients Admitted to the Intensive Care Unit in Times of Resource Scarcity. Cureus. 2023;15(2):e34721.

Yildrim S, Kirakli C. Accuracy of conventional disease severity scores in predicting COVID-19 ICU mortality: retrospective single-center study in Turkey. Ann Saudi Med. 2022;42(6):408-14.

Shahi S, Paneru H, Ojha R, Karn R, Rajbhandari R, Gajurel BP. SOFA and APACHE II scoring systems for predicting outcome of neurological patients admitted in a tertiary hospital intensive care unit. Ann Med Surg (Lond). 2024;86(4):1895-900.

Mumtaz H, Ejaz MK, Tayyab M, Vohra LI, Sapkota S, Hasan M, et al. APACHE scoring as an indicator of mortality rate in ICU patients: a cohort study. Ann Med Surg (Lond). 2023;85(3):416-21.

Sungono V, Hariyanto H, Soesilo TEB, Adisasmita AC, Syarif S, Lukito AA, et al. Cohort study of the APACHE II score and mortality for different types of intensive care unit patients. Postgrad Med J. 2022;98(1166):914-8.

Beigmohammadi MT, Amoozadeh L, Rezaei Motlagh F, Rahimi M, Maghsoudloo M, Jafarnejad B, et al. Mortality Predictive Value of APACHE II and SOFA Scores in COVID-19 Patients in the Intensive Care Unit. Can Respir J. 2022;2022:5129314.

Chang YC, Invernizzi J, Mcizana T. Validation of the APACHE‑II scoring system in critically ill patients diagnosed with COVID‑19 and admitted at a regional‑level hospital intensive care unit: A retrospective study. South Afr J Crit Care. 2025;41(2):e1522.

Nagar VS, Sajjan B, Chatterjee R, Parab NM. The comparison of apache II and apache IV score to predict mortality in intensive care unit in a tertiary care hospital. Int J Res Med Sci. 2019;7(5):1598-603.

Tian Y, Yao Y, Zhou J, Diao X, Chen H, Cai K, et al. Dynamic APACHE II Score to Predict the Outcome of Intensive Care Unit Patients. Front Med. 2022;8:744907.

Hashmi M, Asghar A, Rashid S, Hameed F. APACHE II analysis of a surgical intensive care unit population in a tertiary care hospital in Karachi (Pakistan). Anaesth Pain Intens Care. 2019;18(4):338-44.

Bloria SD, Chauhan R, Sarna R, Gombar S, Jindal S. Comparison of APACHE II and APACHE IV score as predictors of mortality in patients with septic shock in intensive care unit: A prospective observational study. J Anaesthesiol Clin Pharmacol. 2023;39(3):355-9.

Apichartvongvanich H, Soonhong N, Chanviruch P, Poomsaard S, Nakapong Y, Boonsinsukh T. Predicting factor for mortality rate in surgical intensive care units. J Emerg Med Trauma Acute Care. 2023;2:17.