Module modified acute physiology and chronic health evaluation II: predicting the mortality of neuro-critical disease

Abstract

Objectives:

This study aimed to conduct and assess a module modified acute physiology and chronic health evaluation (MM-APACHE) II model, based on disease categories modified-acute physiology and chronic health evaluation (DCM-APACHE) II model, in predicting mortality more accurately in neuro-intensive care units (N-ICUs).

Methods:

In total, 1686 patients entered into this prospective study. Acute physiology and chronic health evaluation (APACHE) II scores of all patients on admission and worst 24-, 48-, 72-hour scores were obtained. Neurological diagnosis on admission was classified into five categories: cerebral infarction, intracranial hemorrhage, neurological infection, spinal neuromuscular (SNM) disease, and other neurological diseases. The APACHE II scores of cerebral infarction, intracranial hemorrhage, and neurological infection patients were used for building the MM-APACHE II model.

Results:

There were 1386 cases for cerebral infarction disease, intracranial hemorrhage disease, and neurological infection disease. The logistic linear regression showed that 72-hour APACHE II score (Wals  =  173·04, P < 0·001) and disease classification (Wals  =  12·51, P  =  0·02) were of importance in forecasting hospital mortality. Module modified acute physiology and chronic health evaluation II model, built on the variables of the 72-hour APACHE II score and disease category, had good discrimination (area under the receiver operating characteristic curve (AU-ROC  =  0·830)) and calibration (χ2  =  12·518, P  =  0·20), and was better than the Knaus APACHE II model (AU-ROC  =  0·778).

Discussion:

The APACHE II severity of disease classification system cannot provide accurate prognosis for all kinds of the diseases. A MM-APACHE II model can accurately predict hospital mortality for cerebral infarction, intracranial hemorrhage, and neurologic infection patients in N-ICU.

Keywords:

• Acute physiology and chronic health evaluation scoring system
• Mortality
• Neuro-critical disease
• Prognosis

Acknowledgements

The study was supported by Capital Clinical Characteristics of Practice, Science, and Technology Project of Beijing, China; National Key Department of Neurology funded by Chinese Health and Family Planning Committee; National Key Department of Critical-care Medicine funded by Chinese Health and Family Planning Committee.