Research Journal of Medical Sciences
ISSN: Online 1993-6095ISSN: Print 1815-9346
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To Evaluate the Accuracy of APACHE IV Mortality Prediction of ICU Patients with Perforation Peritonitis Patients, Requiring Emergency Laparotomy
Ravi Pratap Singh, Ela Haider Rizvi, Atul Kumar Khare, Kuldip Pratap Patel and Dhananjay Majhi
Page: 267-275 | Received 18 Jun 2023, Accepted 27 Jun 2023, Published online: 02 Jul 2023
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Abstract
APACHE (Acute Physiology and Chronic Health Evaluation) score is one of the several intensive care units (ICU) scoring systems. The death rate of patients admitted to ICU’s is much higher than that of other areas. APACHE IV score is the youngest APACHE score was introduced in 2006 and used for estimating the risk of short‐term mortality from actual clinical data in the first day after admission as well as predicting the length of intensive care unit (ICU) stay. To evaluate the accuracy of APACHE IV mortality prediction of ICU patients with perforation peritonitis patients, requiring emergency laparotomy. This is a prospective cohort study done in tertiary care center in central India ‘’To evaluate the accuracy of APACHE IV mortality prediction of ICU patient with perforation peritonitis patients, requiring emergency laparotomy” was conducted in Department of Surgery in 50 patients, Surgical Abdominal Sepsis admitted in Surgical intensive care unit (SICU) during study period, for two years periods. Inclusion criteria. All patients belonging to >16 years of age who were admitted in SICU, as a result of perforation peritonitis, requiring exploratory laparotomy, Patients willing to participate in the study after written informed consent. Exclusion criteria‐ Age < 16 years, Sepsis secondary to trauma, Laparotomies for non‐septic indications. After obtaining Ethical clearance from Institute’s Ethical Committee, all the patients fulfilling the inclusion criteria were enrolled in the study. Written consent was obtained from all the study participants. The participants were divided in two groups i.e. survivors and non survivors based on their outcome. Data was compiled using MS excel and comparison of APACHE IV score was made between the two groups (survivors and nonsurvivors) and its predictive efficacy was analysed. Mean age of patients in present study was 36±16.14 years. In present study, 42 (84%) out of 50 patients were males while 8 (16%) were females. All 5 patients who died were males. Most common etiology of SABS was small intestine perforation (36%) followed by gastric perforation (26%). Mean Apache score was maximum in intra‐abdominal abscess (105) followed by ischemia (57) and gastric perforation and was minimum in large intestine perforation (29.3). Mean of MAP of 45 patients in survivor group was 82.55 mm Hg while the same in non‐survivors was 75 mm Hg. Mechanical ventilation was used in total of 3 patients, out of which 1 survived and 2 patients succumbed to death. The association of mechanical ventilation usage with mortality (chi square test) amongst survivors and non survivors was found to be statistically significant (p = 0.0008). Deranged Sodium was seen in 11 out of 45 survivors (24.4%) and 2 out of 5 (40%) non survivors. The survivors had a mean urine output of 1020 mL and non‐survivors had a mean urine output of 350 mL. In case of serum creatinine, mean of survivor group was 0.98 while in non‐survivors is 1.74. Mean albumin in survivor group was 3.09 mg dL-1 and in non‐survivors was 1.94. There was no mortality in 43 patients with APACHE Score <60. 60‐80 score group had 2 patients with no mortality and 5 patients belonged to score > 80 with 100% mortality. Test of significance (Fischer exact test) showed statistically significant association between mortality and Apache score (p<0.0001). Mean APACHE score of Survivor group was 39.0 while that of non‐survivor group was 86.20 and overall mean of all patients was 44.46. In present study, 12 patients had APS score less than 30 with no mortality. 1 out of 31 patients in 30‐60 score range died while 4 out of 7 died in case of score > 60. A receiver operating characteristic (ROC) curve, comparative analysis of the mortality predictions with APACHE IV is done and shows AUC = 0.911 and p<0.001. Thus, showing the high predictive efficacy of APACHE IV score. The mean observed length of stay of all patients was 6.65 days against an expected LOS (length of stay) of 4.6 days. Overall O:E Ratio was 1.44 against O:E of 1.21 in non‐survivors with observed and expected LOS of 10.2 and 8.42 days. The difference was statistically significant with p = 0.02. from this study we predict and evaluate the accuracy of APACHE IV mortality prediction of ICU patients with perforation peritonitis patients, requiring emergency laparotomy, which is essential for all healthcare workers.
How to cite this article:
Ravi Pratap Singh, Ela Haider Rizvi, Atul Kumar Khare, Kuldip Pratap Patel and Dhananjay Majhi. To Evaluate the Accuracy of APACHE IV Mortality Prediction of ICU Patients with Perforation Peritonitis Patients, Requiring Emergency Laparotomy.
DOI: https://doi.org/10.36478/10.59218/makrjms.2023.267.275
URL: https://www.makhillpublications.co/view-article/1815-9346/10.59218/makrjms.2023.267.275