APACHE III outcome prediction in patients admitted to the intensive care unit after liver transplantation: a retrospective cohort studyReportar como inadecuado




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BMC Surgery

, 9:11

First Online: 29 July 2009Received: 20 March 2009Accepted: 29 July 2009

Abstract

BackgroundThe Acute Physiology and Chronic Health Evaluation APACHE III prognostic system has not been previously validated in patients admitted to the intensive care unit ICU after orthotopic liver transplantation OLT.
We hypothesized that APACHE III would perform satisfactorily in patients after OLT

MethodsA retrospective cohort study was performed.
Patients admitted to the ICU after OLT between July 1996 and May 2008 were identified.
Data were abstracted from the institutional APACHE III and liver transplantation databases and individual patient medical records.
Standardized mortality ratios with 95% confidence intervals were calculated by dividing the observed mortality rates by the rates predicted by APACHE III.
The area under the receiver operating characteristic curve AUC and the Hosmer-Lemeshow C statistic were used to assess, respectively, discrimination and calibration of APACHE III.

ResultsAPACHE III data were available for 918 admissions after OLT.
Mean standard deviation SD APACHE III APIII and Acute Physiology APS scores on the day of transplant were 60.5 25.8 and 50.8 23.6, respectively.
Mean SD predicted ICU and hospital mortality rates were 7.3% 15.4 and 10.6% 18.9, respectively.
The observed ICU and hospital mortality rates were 1.1% and 3.4%, respectively.
The standardized ICU and hospital mortality ratios with their 95% C.I.
were 0.15 0.07 to 0.27 and 0.32 0.22 to 0.45, respectively.

There were statistically significant differences in APS, APIII, predicted ICU and predicted hospital mortality between survivors and non-survivors.
In predicting mortality, the AUC of APACHE III prediction of hospital death was 0.65 95% CI, 0.62 to 0.68.
The Hosmer-Lemeshow C statistic was 5.288 with a p value of 0.871 10 degrees of freedom.

ConclusionAPACHE III discriminates poorly between survivors and non-survivors of patients admitted to the ICU after OLT.
Though APACHE III has been shown to be valid in heterogenous populations and in certain groups of patients with specific diagnoses, it should be used with caution – if used at all – in recipients of liver transplantation.

AbbreviationsICUIntensive Care Unit

APACHEAcute Physiology and Chronic Health Evaluation

SAPSSimplified Acute Physiology Score

MPMMortality Probability Model

OLTOrthotopic Liver Transplantation

MELDModel for End-Stage Liver Disease

SMRStandardized Mortality Ratio

SDStandard Deviation

AUCArea Under the Receiver Operating Characteristic Curve

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2482-9-11 contains supplementary material, which is available to authorized users.

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Autor: Mark T Keegan - Bhargavi Gali - James Y Findlay - Julie K Heimbach - David J Plevak - Bekele Afessa

Fuente: https://link.springer.com/article/10.1186/1471-2482-9-11



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