Utilizing APACHE IV and GRACE Scores as Predictors of Mortality Compared with SAPS-3 Scores for Acute Coronary Syndrome Patients in the Cardiac Vascular Care Unit
DOI:
https://doi.org/10.21776/ub/hsj.2024.005.03.8Keywords:
Simplified Acute Physiology Score 3, Acute Physiology and Chronic Health Evaluation Score, Global Registry of Acute Coronary Events, intensive cardiovascular care unitAbstract
Background: Acute coronary syndromes (ACS) frequent cause of hospitalization in the cardiovascular care unit. Positive predictive data are being developed and shown to be effective for patients with ACS; the Global Registry of Acute Coronary Events, or GRACE, has shown the most accurate outcomes. In contrast, prognostic scores derived from diverse cohorts of critically ill patients are predominantly employed by intensive care clinicians. Prominent examples of such scores include APACHE IV and SAPS 3. The objective of this research endeavor was to assess and contrast the efficacy of these three scores across an unselected sample of ACS cases.
Objective: The Cardiovascular Care Unit of RSUD Dr. Saiful Anwar Malang treats Acute Coronary Syndrome patients. This study compares SAPS 3, GRACE, and APACHE IV score parameters through calibration and discrimination tests to predict patient mortality.
Methods: The study included all ACS patients admitted from August 2021 to November 2023. Hospital mortality prediction was assessed using score calibration and discrimination.
Results: There were 843 patients in total included. SAPS 3 could not be calibrated appropriately, whereas APACHE IV and GRACE could. Across all scores, discrimination was exceptional (area under the curve values of 0.811 for APACHE IV, 0.740 for GRACE, and 0.732 for SAPS 3).
Conclusions: GRACE and APACHE IV were calibrated thoroughly in this cohort of intensive care unit-admitted ACS patients; however, SAPS 3 lacked such calibration. All three scores exhibited exceptional discrimination. GRACE and APACHE IV may be utilized to predict the risk of mortality in patients with ACS.References
Lott JP, Iwashyna TJ, Christie JD, Asch DA, Kramer AA, Kahn JM. Critical illness outcomes in specialty versus general intensive care units. Am J Respir Crit Care Med. 2009;179(8):676-683. doi:10.1164/rccm.200808-1281OC
Prabhudesai AR, Srilakshmi MA, Santosh MJ, et al. Validation of the GRACE score for prognosis in Indian patients with acute coronary syndromes. Indian Heart J. 2012;64(3):263-269. doi:10.1016/S0019-4832(12)60084-4
Lattuca B, Kerneis M, Zeitouni M, et al. Elderly Patients with ST-Segment Elevation Myocardial Infarction: A Patient-Centered Approach. Drugs Aging. 2019;36(6):531-539. doi:10.1007/s40266-019-00663-y
Zhang J, Gajjala S, Agrawal P, et al. Fully automated echocardiogram interpretation in clinical practice: Feasibility and diagnostic accuracy. Circulation. 2018;138(16):1623-1635. doi:10.1161/CIRCULATIONAHA.118.034338
Choi JW, Park YS, Lee YS, et al. The Ability of the Acute Physiology and Chronic Health Evaluation (APACHE) IV Score to Predict Mortality in a Single Tertiary Hospital. The Korean Journal of Critical Care Medicine. 2017;32(3):275-283. doi:10.4266/kjccm.2016.00990
Nassar AP, Malbouisson LMS, Moreno R. Evaluation of simplified acute physiology score 3 performance: A systematic review of external validation studies. Crit Care. 2014;18(3). doi:10.1186/cc13911
Bennett CE, Wright RS, Jentzer J, et al. Severity of illness assessment with application of the APACHE IV predicted mortality and outcome trends analysis in an academic cardiac intensive care unit. J Crit Care. 2019;50:242-246. doi:10.1016/j.jcrc.2018.12.012
Muzakkir AF, Juzar DA, Zainuddin AA, et al. PERFORMA SIMPLIFIED ACUTE PHYSIOLOGY SCORE 3 SEBAGAI PREDIKTOR MORTALITAS PADA UNIT RAWAT INTENSIF KARDIOVASKULAR. Indonesian Journal of Cardiology. 2019;39(4). doi:10.30701/ijc.v39i4.702
Nassar Junior AP, Mocelin AO, Andrade FM, et al. SAPS 3, APACHE IV or GRACE: Which score to choose for acute coronary syndrome patients in intensive care units? Sao Paulo Medical Journal. 2013;131(3):173-178. doi:10.1590/1516-3180.2013.1313474
Pramudyo M, Bijaksana TL, Yahya AF, Putra ICS. Novel scoring system based on clinical examination for prediction of in-hospital mortality in acute coronary syndrome patients: A retrospective cohort study. Open Heart. 2022;9(2). doi:10.1136/openhrt-2022-002095
Neves VB, Roman RM, Vendruscolo T, et al. Validation of the Grace Risk Score to Predict In-Hospital and 6-Month Post-Discharge Mortality in Patients with Acute Coronary Syndrome. International Journal of Cardiovascular Sciences. 2022;35(2):174-180. doi:10.36660/ijcs.20210019
Choi JW, Park YS, Lee YS, et al. The Ability of the Acute Physiology and Chronic Health Evaluation (APACHE) IV Score to Predict Mortality in a Single Tertiary Hospital. The Korean Journal of Critical Care Medicine. 2017;32(3):275-283. doi:10.4266/kjccm.2016.00990
Le Gall JR, Lemeshow S, Saulnier F. A New Simplified Acute Physiology Score (SAPS II) Based on a European/North American Multicenter Study. Vol 270.; 1993.
Keegan MT, Gajic O, Afessa B. Comparison of APACHE III, APACHE IV, SAPS 3, and MPM0III and influence of resuscitation status on model performance. Chest. 2012;142(4):851-858. doi:10.1378/chest.11-2164
Bennett CE, Wright RS, Jentzer J, et al. Severity of illness assessment with application of the APACHE IV predicted mortality and outcome trends analysis in an academic cardiac intensive care unit. J Crit Care. 2019;50:242-246. doi:10.1016/j.jcrc.2018.12.012
Zhu Y, Zhang R, Ye X, Liu H, Wei J. SAPS III is superior to SOFA for predicting 28-day mortality in sepsis patients based on Sepsis 3.0 criteria. International Journal of Infectious Diseases. 2022;114:135-141. doi:10.1016/j.ijid.2021.11.015
Zheng X, Hu T, Liu T, Wang W. Simplified acute physiology score III is excellent for predicting in-hospital mortality in coronary care unit patients with acute myocardial infarction: A retrospective study. Front Cardiovasc Med. 2022;9. doi:10.3389/fcvm.2022.989561
Suridanda Danny S. The Current Concept and Role of Intensive Cardiovascular Care Units. Heart Science Journal. 2023;4(1):1-4. doi:10.21776/ub.hsj.2023.004.01.1
Silva E, Santos D, Minuzzo L, et al. Acute Coronary Syndrome Registry at a Cardiology Emergency Center.
Glance LG, Osler T, Shinozaki T. Effect of Varying the Case Mix on the Standardized Mortality Ratio and W Statistic* A Simulation Study Clinical Investigations in Critical Care.
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