부산대학교 도서관

Introduction: Developed in 1985, the APACHE Ⅱ scoring system was demonstrated to provide an accurate and reliable measure of the severity of illness and probabilities of mortality. This scoring system soon became the most widely used of the scoring systems. The APACHE Ⅱ scoring system has been used in estimate and in the quality assessment of intensive care units. Although recent studies have shown good discrimination and calibration for the APACHE Ⅱ scoring system, it still has limitations in the clinic. This study will discuss and demonstrate the limitations of APACHE Ⅱ in predicting mortality in severe sepsis patients. Methods: We collected the data of severe sepsis patients from January 2005 to December 2008. All APACHE Ⅱ scores on admission, age, and mortality results in the ICU were obtained from computer records. The patients were divided into five groups, based on the age points in the APACHE Ⅱ score. Their records were analyzed retrospectively, as well as the correlation between the APACHE Ⅱ score, age, and mortality. Results: Of the 884 patients with severe sepsis, 542 survived after critical care treatment. The mean APACHE Ⅱ scores of the survivors were higher than those of the non-survivors (P＜0.001), but the mean age of the survivors was older (P=0.004). The younger severe sepsis patients (age ＜ 54 years old) had 2.424-2.57 times the mortality risk of the older severe sepsis patients (age ＞= 75 years old). Discussion: Severity scoring systems play an important role in critical care. Our study revealed the limitations of the scoring system. The excessive age points of the APACHE Ⅱ scoring system may cause us to neglect the mortality risk of patients. Even through the severity scoring system demonstrated good agreement in describing patients in the aggregate, it did not perform as well for individual patients. Use of probabilities should not be employed for making clinical decisions regarding individual patients.