The analysis of two scoring methods for acute stroke patients ICU mortality prediction

DONG Lin-lin; JIANG Li-jie; LIU Ying; LIU Tie-hong; QIU Bing; ZHANG Yan

doi:10.3969/j.issn.1002-1949.2016.06.013

Abstract：Objective To compare the accuracy of acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ) and simplified acute physiology score Ⅱ ( SAPS Ⅱ) in predicting hemorrhagic or ischemic stroke in ICU. Methods We studied the applicability of the APACHEⅡand SAPS Ⅱ in patients admitted to the ICU with acute stroke and compared the results with the Glasgow coma scale ( GCS) , national institutes of health stroke scale ( NIHSS) , the European stroke scale( ESS) and modified Edinburgh - Scandinavia stroke scale score ( MESSS ) . Ischemic or hemorrhagic stroke patients admitted to the ICU between 2013 January and 2015 June were included in the study. Overall 249 patients were included in this study. APACHEⅡ and SAPSⅡ predicted mortalities were compared using a calibration curve, the Hosmer -Lemeshow goodness -of -fit test, and the receiver operating characteristic ( ROC) curve, and the results were compared with the GCS, NIHSS, ESS and MESSS. Results The observed mortality was 26. 5%, whereas APACHEⅡ and SAPSⅡ-predicted mortalities were 34. 01% and 34. 23%, respectively. The mean GCS, NIHSS, ESS and MESSS scores were 9. 32, <br> 21. 52, 52. 20 and 17. 53, respectively. The calibration curve was close to the line of perfect prediction. The ROC curve showed a slightly better prediction of mortality for APACHEⅡ in hemorrhagic stroke patients(AUC=0. 805) and SAPSⅡ in ischemic stroke patients(AUC=0. 834). The GCS, NIHSS, ESS and MESSS were inferior in predicting mortality in both patient groups. Conclusion The accuracy of APACHEⅡ in hemorrhagic stroke patients and SAPS Ⅱ in ischemic stroke patients was superior.