U Ludwigs1, M Csatlos, J Hulting. 1. Department of Medicine, Söder Hospital, Stockholm, Sweden. ulf.ludwigs@divmed.ks.se
Abstract
OBJECTIVE: To study the usefulness of the Second Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system for prognostication of in-hospital mortality in patients with acute myocardial infarction treated with thrombolysis. DESIGN: A prospective validation study was conducted at a medical intensive care unit at a university hospital. Over a 3-year period, 1714 patients with acute myocardial infarction were studied (mean age 72+/-10 years). Thrombolytic therapy was the prescribed treatment for 316 patients and total hospital mortality was 16%. RESULTS: The patients who received thrombolysis were younger, had higher blood pressure, lower heart and respiratory rates and higher Glasgow Coma Scale scores. Total in-hospital mortality was 9.5% in patients treated with thrombolysis and 17.1% in untreated patients (p < 0.01). Corresponding APACHE II predictions of mortality were 11.8 and 15.8% (p < 0.01). There was no significant difference between observed and predicted mortality. When a decision rule of 50% predicted risk of death was employed, sensitivity was 20% and specificity 99% in the thrombolytic group, while the corresponding figures in the nonthrombolytic group were 31% and 97%, respectively. CONCLUSIONS: In-hospital mortality in groups of patients treated with or without thrombolysis for acute myocardial infarction could be predicted with the APACHE II scoring system. Prognostication in individual patients is not possible with the APACHE II system.
OBJECTIVE: To study the usefulness of the Second Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system for prognostication of in-hospital mortality in patients with acute myocardial infarction treated with thrombolysis. DESIGN: A prospective validation study was conducted at a medical intensive care unit at a university hospital. Over a 3-year period, 1714 patients with acute myocardial infarction were studied (mean age 72+/-10 years). Thrombolytic therapy was the prescribed treatment for 316 patients and total hospital mortality was 16%. RESULTS: The patients who received thrombolysis were younger, had higher blood pressure, lower heart and respiratory rates and higher Glasgow Coma Scale scores. Total in-hospital mortality was 9.5% in patients treated with thrombolysis and 17.1% in untreated patients (p < 0.01). Corresponding APACHE II predictions of mortality were 11.8 and 15.8% (p < 0.01). There was no significant difference between observed and predicted mortality. When a decision rule of 50% predicted risk of death was employed, sensitivity was 20% and specificity 99% in the thrombolytic group, while the corresponding figures in the nonthrombolytic group were 31% and 97%, respectively. CONCLUSIONS: In-hospital mortality in groups of patients treated with or without thrombolysis for acute myocardial infarction could be predicted with the APACHE II scoring system. Prognostication in individual patients is not possible with the APACHE II system.
Authors: Mohammed I M Gubari; Abdolreza Norouzy; Mostafa Hosseini; Fadhil A Mohialdeen; Mohammad Javad Hosseinzadeh-Attar Journal: Medicina (Kaunas) Date: 2019-08-15 Impact factor: 2.430
Authors: Jae Woo Choi; Young Sun Park; Young Seok Lee; Yeon Hee Park; Chaeuk Chung; Dong Il Park; In Sun Kwon; Ju Sang Lee; Na Eun Min; Jeong Eun Park; Sang Hoon Yoo; Gyu Rak Chon; Young Hoon Sul; Jae Young Moon Journal: Korean J Crit Care Med Date: 2017-08-31