APACHE IV, SAPS III, and SOFA scores for outcome prediction in a surgical/trauma critical care unit: an analytical cross-sectional study

Abstract

Patients’ outcomes in surgical/trauma intensive care units (ICUs) are still challenging to predict. There has been a lack of consensus over the efficacy of Acute Physiology and Chronic Health Evaluation IV (APACHE IV), Simplified Acute Physiology Score III (SAPS III), and Sequential Organ Failure Assessment (SOFA) scores in predicting patient outcomes. This analytical cross-sectional study was designed to determine how well APACHE IV, SAPS III, and SOFA scores predict ICU mortality and the length of stay in a surgical ICU. APACHE IV, SAPS III, and SOFA scores were calculated on admission. The effectiveness of these scores in predicting mortality was determined using logistic regression models. The accuracy of these discriminative abilities was measured using the area under the receiver operating characteristic curve (AUC). The Hosmer and Lemeshow calibration test was calculated to test the model fit. The agreement between APACHE IV, SAPS III, and SOFA scores in the prediction of mortality was examined using the Bland–Altman curve. A total of 148 patients met the study criteria. APACHE IV was the only significant predictor of mortality, with a 1-point increase in the APACHE IV score resulting in a 5% increase in death probability (AOR = 1.049, 95% CI 1.028–1.069) (P-value < 0.001). The APACHE IV score was superior to the SAPS III and SOFA scores regarding accuracy, with an AUC of 0.766 (95% CI, 0.670–0.862) (P-value < 0.001). Furthermore, there was a significant positive correlation between APACHE IV score and ICU length of stay (r = 0.22, P = 0.004). APACHE IV outperformed SAPS III and SOFA scores in predicting mortality in a surgical/trauma critical care unit and showed a significant positive correlation with the ICU length of stay.