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The Utility of Acute Physiology and Chronic Health Evaluation II Scores for Prediction of Mortality among Intensive Care Unit (ICU) and Non-ICU Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia.
Stevens, Vanessa PhD 1,2; Lodise, Thomas P. PharmD 3; Tsuji, Brian PharmD 1; Stringham, Meagan PharmD (cand) 1; Butterfield, Jill PharmD 3; Ashley, Elizabeth Dodds PharmD, MHS 2; Brown, Kristen MSN 2; Forrest, Alan PharmD 1,4; Brown, Jack PharmD, MS 1,2
[Article] Infection Control & Hospital Epidemiology. 33(6):558-564, June 2012.

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OBJECTIVE: Bloodstream infections due to methicillin-resistant Staphylococcus aureus (MRSA) have been associated with significant risk of in-hospital mortality. The acute physiology and chronic health evaluation (APACHE) II score was developed and validated for use among intensive care unit (ICU) patients, but its utility among non-ICU patients is unknown. The aim of this study was to determine the ability of APACHE II to predict death at multiple time points among ICU and non-ICU patients with MRSA bacteremia.

DESIGN: Retrospective cohort study.

PARTICIPANTS: Secondary analysis of data from 200 patients with MRSA bacteremia at 2 hospitals.

METHODS: Logistic regression models were constructed to predict overall in-hospital mortality and mortality at 48 hours, 7 days, 14 days, and 30 days using APACHE II scores separately in ICU and non-ICU patients. The performance of APACHE II scores was compared with age adjustment alone among all patients. Discriminatory ability was assessed using the c-statistic and was compared at each time point using [chi]2 tests. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test.

RESULTS: APACHE II was a significant predictor of death at all time points in both ICU and non-ICU patients. Discrimination was high in all models, with c-statistics ranging from 0.72 to 0.84, and was similar between ICU and non-ICU patients at all time points. APACHE II scores significantly improved the prediction of overall and 48-hour mortality compared with age adjustment alone.

CONCLUSIONS: The APACHE II score may be a valid tool to control for confounding or for the prediction of death among ICU and non-ICU patients with MRSA bacteremia.