A comparison of APACHE II and APACHE IV scoring systems in predicting outcome in patients with acute lung injury(ALI) and the adult respiratory distress syndrome (ARDS) in intensive care unit (ICU)

Objective: To compare APACHE IV and APACHE II scoring methods for patients admitted in an ICU with ALI and ARDS. Methodology: This comparative study was conducted in ICU Lady Reading Hospital, Peshawar, Pakistan from June 2011 to November 2012. All cases of ALI/ARDS were included in the study. Observed mortality rates were compared with predicted mortality rates for both the APACHE IV and APACHE II scoring systems, standardized mortality ratio (SMR) and sensitivity and specificity were determined. The mortality percentages were predicted via APACHE IV method and compared with the observed data. Data were analyzed with SPSS vs. 16. Results: There were 47 patients in the study. Mean age for males was 35+16.82, while 34+17.35 years for females. The overall mortality observed was 32% (15/47). APACHE IV predicted mortality rate sensitivity and specificity were 94.73% and 93.74% respectively, SMR of 0.94 and diagnostic value was 93.62%. APACHE II predicted mortality sensitivity and specificity were 100% and 87%, SMR of 0.79 and diagnostic value was 91%. Conclusion: APACHE IV scoring system is equally sophisticated as the APACHE II system in predicting mortality rate in ICU patients with ALI/ARDS. APACHE IV score (score>90) gives probably additional reliable prediction of high possibility of death in patients with ALI/ARDS than APACHE II (score>25). Supplementary comprehensive research work is needed in excellence of our conclusion with matching ICUs and distinct diseases. (Rawal Med J 2013; 38: 234238).