Comparison of Acute Physiology, Age and Chronic Health Evaluation II score and Peradeniya Organophosphorus Poisoning Scale in predicting clinical outcomes and mortality in organophosphorus poisoning.

Abstract

Background: Organophosphorus poisoning is a major health hazard in developing countries. We conducted a study to compare the Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) scoring system and Peradeniya Organophosphorus Poisoning Scale in predicting the complications, ventilator requirement and mortality in patients of Acute Organophosphorus Poisoning.

Methodology: A prospective observational study was done on 100 patients above 18 years of age, presenting with alleged history of consumption of organophosphorus compounds. The patients were evaluated for the required details to calculate the APACHE II score and Peradeniya Organophosphorus Poisoning Scale and were followed up till discharge or mortality to identify the complications, ventilator requirement and mortality. This data was tabulated using Excel and analyzed using SPSS software to look for correlation between the scores and the outcome.

Results: The mean age of our patients was 33.64 ± 12.99 years. The APACHE II cutoff score for complications, ventilator requirement and mortality was ≥ 7 (sensitivity 94.3%, specificity 96.9%, Area under Receiver Operator Characteristic (ROC) 0.99, p < 0.01), ≥9 (sensitivity 86.7%, specificity 82.4%, Area under ROC 0.91, p < 0.01) and ≥16 (sensitivity 85.7, specificity 96.8%, Area under ROC 0.98, p < 0.01) respectively. Similarly, the Peradeniya Organophosphorus Poisoning Scale cutoff was for complications, ventilator requirement and mortality was ≥ 3 (sensitivity 80%, specificity 92.3%, Area under ROC 0.90, p < 0.01), ≥3 (sensitivity 80%, specificity 75.3%, Area under ROC 0.85, p < 0.01) and ≥7 (sensitivity 85.7%, specificity 97.8%, Area under ROC 0.99, p < 0.01) respectively.

Conclusion: Both APACHE II and POPS demonstrated good predictive performance for adverse outcomes in acute organophosphorus poisoning. Both scores showed excellent discrimination for mortality, with no statistically significant difference between their AUCs.