Prognostic value of acute physiology and chronic health evaluation II score in post-operative of cardiac surgery

Background and objectives: The Acute Physiology and Chronic Health Evaluation (APACHE II) score allows predicting in-hospital mortality in patients admitted to intensive care units. However, it is not validated for patients undergoing cardiac surgery, since it does not have a good discriminatory capacity in this clinical scenario. The aim of this study is to determine prognostic value of APACHE II score in post-operative of cardiac surgery. Materials and methods: The study was performed using the cardiac surgery database. Patients undergoing surgery between 2017 and 2018, with APACHE II score calculated at the admission were included. The receiver operating characteristic (ROC) curve was used to determine a cut-off value. The primary endpoint was in-hospital death. Secondary endpoints included low cardiac output (LCO), stroke, surgical bleeding, and dialysis requirement. A multivariable logistic regression model was developed to adjust to various variables of interest. Results: The study evaluated 559 patients undergoing cardiac surgery. The mean of APACHE II Score was 9.9 (standard deviations 4). The prevalence of in-hospital death was 6.1%. The best prognostic cut-off value for the primary endpoint was 12, with a ROC curve of 0.92. Patients with an APACHE II score >= 12 had significantly higher mortality, higher incidence of LCO, stroke, surgical bleeding, and dialysis requirement. In a multivariate logistic regression model, the APACHE II score was independently associated with higher in-hospital death (odds ratio, 1.14; 95 confidence interval %, 1.08-1.21; p < 0.0001). Conclusions: The APACHE II Score proved to be an independent predictor of in-hospital death in patients undergoing post-operative cardiac surgery, with a high capacity for discrimination.