INTEGRATION OF APACHE II AND III SCORING SYSTEMS IN EXTREMELY HIGH RISK PATIENTS WITH ACUTE RENAL FAILURE TREATED BY DIALYSIS

Figures & data

Table 1. Patient Characteristics

	Survivors	Non-survivors	p-Value
Outcome	29	71
Age	59.4 ± 20.3	58.3 ± 20.0	0.806
Gender (M : F)	18 : 11	47 : 24	0.167
Duration of ICU stay (days)	39.6 ± 40.5	21.9 ± 20.3	0.032
Admission days	81.2 ± 61.7	27.3 ± 24.5	< 0.001
Interval from ICU admission to the start of H/D (days)	10.8 ± 20.5	10.2 ± 14.9	0.891
IHD : CRRT	27 : 2	63 : 8	0.509
APACHE II scores	17.72 ± 4.74	23.79 ± 6.92	< 0.001
APACHE III scores	71.72 ± 14.08	100.44 ± 29.26	< 0.001

M, male; F, female; ICU, intensive care unit; H/D, hemodialysis; IHD, intermittent hemodialysis; CRRT, continuous renal replacement therapy.

Table 2. Presumptive Causes of Acute Renal Failure

	n	Survivors	Survival Rates (%)
Acute tubular necrosis, associated with
Sepsis syndrome	69	17	24.64
Cardiogenic shock or cardiac arrest	15	2	13.33
Hypovolemic shock	46	9	19.57
Nephrotoxin exposure	24	4	16.67
Acute pancreatitis	6	4	66.67
Rhabdomyolysis	6	4	66.67
Hepatorenal syndrome	5	0	0.00
Obstructive uropathy	3	2	66.67
Uncertain	2	1	50.00

Figure 1. Correlations of APACHE II and III scores. The APACHE III scores correlated significantly (p<0.001) with APACHE II scores for the entire group, the group of survivors, and the non-surviving patients.

Figure 2. Calibration curves for APACHE II and III. The diagonal line represents the line of ideal prediction (predicted mortality = observed mortality) for APACHE II (open diamonds) and APACHE III (solid squares). Calibration curves above the diagonal indicate that actual mortality was greater than predicted (i.e., underestimation by the predictive model).

Figure 3. Receiver operating characteristic curves for APACHE II (solid, curved line) and APACHE III (bold, curved line). Diagonal line, line of chance performance.

Table 3. Hosmer–Lemeshow Goodness-of-Fit Statistics for APACHE II and III

Predicted Deciles of Mortality (%)	No.	APACHE II				No.	APACHE III
		Survived		Died			Survived		Died
		Observed	Expected	Observed	Expected		Observed	Expected	Observed	Expected
0–10	9	0	0.531	9	8.469	10	0	0.062	10	9.938
>10–20	10	0	0.897	10	9.103	10	0	0.282	10	9.718
>20–30	12	1	1.572	11	10.428	11	0	0.958	11	10.042
>30–40	8	1	1.356	7	6.644	10	3	1.535	7	8.465
>40–50	9	2	1.899	7	7.101	9	0	1.912	9	7.088
>50–60	9	4	2.440	5	6.560	10	5	2.965	5	7.035
>60–70	8	5	2.625	3	5.375	12	7	5.112	5	6.888
>70–80	12	5	4.760	7	7.240	11	6	5.263	5	5.737
>80–90	10	5	4.731	5	5.269	10	4	5.723	6	4.277
>90–100	13	6	8.188	7	4.812	7	4	5.187	3	1.813
Σ(E−O)^2/E		χ^2 = 8.102, df = 8, p = 0.424					χ^2 = 11.140, df = 8, p = 0.194

No., total number of patients per decile; E, expected number of deaths; O, observed number of deaths; df, degrees of freedom.

Table 4. Survivors in the Very High Risks Group (APACHE II score>23)

	Case 1	Case 2	Case 3
Age	19	69	90
Gender	female	male	female
Duration of ICU stay (days)	20	26	1
Admission days	21	143	19
Interval from ICU admission to the start of H/D (days)	2	3	0
APACHE II scores	24	27	26
APACHE III scores	80	73	70

ICU, intensive care unit; H/D, hemodialysis.