Effectiveness of the sequential organ failure assessment, acute physiology and chronic health evaluation II, and simplified acute physiology score II prognostic scoring systems in paraquat-poisoned patients in the intensive care unit

• Published in: Human & experimental toxicology 2017-05, Vol.36 (5), p.431-437
• Main Authors: Lee, Jun Ho, Hwang, Seong Youn, Kim, Hye Ran, Kim, Yang Won, Kang, Mun Ju, Cho, Kwang Won, Lee, Dong Woo, Kim, Yong Hwan
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Aged, 80 and over; APACHE; Calibration; Death; Emergencies; Emergency medical services; Evaluation; Female; Herbicides - poisoning; Hospital Mortality; Humans; Intensive care; Intensive Care Units; Male; Mathematical analysis; Medical materials; Medical personnel; Medical records; Middle Aged; Mortality; Organ Dysfunction Scores; Paraquat; Paraquat - poisoning; Patients; Physicians; Physiology; Predictions; Prognosis; Republic of Korea - epidemiology; Retrospective Studies; Risk; ROC Curve; Simplified Acute Physiology Score; Studies; Young Adult
• ISSN: 0960-3271; 1477-0903
• DOI: 10.1177/0960327116657602

Objective: This study was conducted to assess the ability of the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II scoring systems, as well as the simplified acute physiology score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with paraquat. This will assist physicians with risk stratification. Material and methods: The medical records of 244 paraquat-poisoned patients admitted to the ICU from January 2010 to April 2015 were examined retrospectively. The SOFA, APACHE II, and SAPS II scores were calculated based on initial laboratory data in the emergency department and during the first 24 h of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II. The ability of the SOFA score, APACHE II score, and SAPS II method to predict group mortality was assessed using a receiver operating characteristic (ROC) curve and calibration analyses. Results: A total of 219 patients (mean age, 63 years) were enrolled. Sensitivities, specificities, and accuracies were 58.5%, 86.1%, and 64.0% for the SOFA, respectively; 75.1%, 86.1%, and 77.6% for the APACHE II scoring systems, respectively; and 76.1%, 79.1%, and 76.7% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.716, 0.850, and 0.835, respectively. Conclusion: The SOFA, APACHE II, and SAPS II had different capabilities to discriminate and estimate early in-hospital mortality of paraquat-poisoned patients. Our results show that although the SOFA and SAPS II are easier and more quickly calculated than APACHE II, the APACHE II is superior for predicting mortality. We recommend use of the APACHE II for outcome predictions and risk stratification in paraquat-poisoned patients in the ICU.