APACHE II score does not predict multiple organ failure or mortality in postoperative surgical patients
F. B. Cerra, F. Negro and J. Abrams
Department of Surgery, University of Minnesota, Minneapolis 55455.
A clinical study was undertaken to evaluate the ability of the APACHE
(acute physiology and chronic health care) II system to predict the
development of multiple organ failure syndrome and subsequent mortality.
The study was conducted in a university general surgery intensive care unit
using the admission APACHE II score. Over a 1-year period, 92 patients
qualified for the study, 24 of whom survived, 69 of whom suffered multiple
organ failure syndrome, and 68 of whom died. The APACHE II score did not
predict the development of multiple organ failure syndrome or mortality
with clinical utility and significantly underestimated the potential for
the development of multiple organ failure syndrome. Factors that did
predict the development of multiple organ failure syndrome and mortality
were the time-dependent changes in the PaO2-to-fraction of inspired oxygen
ratio and serum lactate, creatinine, and bilirubin levels. Better markers
of cell injury are needed for use in decision making and quality assurance
analysis in surgical patients.
