Scoring systems in critically ill: Which one to use in cancer patients?

doi:10.5492/wjccm.v11.i6.364

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World Journal of Critical Care Medicine

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Retrospective Study

World J Crit Care Med. Nov 9, 2022; 11(6): 364-374
Published online Nov 9, 2022. doi: 10.5492/wjccm.v11.i6.364

Table 1 Comparison of baseline variables among survivors and non-survivors

Parameters	Survivors, n = 169	Non-survivors, n = 231	Total, n = 400	P value
Age in yr	62.85 ± 12.49	61.45 ± 14.82	62.04 ± 13.88	0.527
Male	98 (58.0%)	142 (61.5%)	240 (60.0%)	0.48
Female	71 (42.0%)	89 (38.5%)	160 (40.0%)	0.48
DM	56 (33.1%)	62 (26.8%)	118 (29.5%)	0.17
Hypertension	61 (36.1%)	63 (27.3%)	124 (31.0%)	0.06
Reason for ICU admission
Sepsis	42 (24.9%)	68 (29.4%)	110 (27.5%)	0.31
Respiratory distress/failure	76 (45.0%)	93 (40.3%)	169 (42.2%)	0.34
Cardiac arrest	1 (0.6%)	8 (3.5%)	9 (2.2%)	0.08
Gastrointestinal bleed	15 (8.9%)	14 (6.1%)	29 (7.2%)	0.33
Altered sensorium	33 (19.5%)	45 (19.5%)	78 (19.5%)	1
Acute kidney injury	2 (1.2%)	3 (1.3%)	5 (1.2%)	1
Type of malignancy
Solid organ	135 (79.9%)	187 (81.0%)	322 (80.5%)	0.78
Hematological	34 (20.1%)	44 (19.0%)	78 (19.5%)
Metastasis	80 (59.3%)	145 (77.5%)	225 (69.9%)	0.001
Previous history of surgery for CA
Yes	72 (42.6%)	74 (32.0%)	146 (36.5%)	0.03
No	97 (57.4%)	157 (68.0%)	254 (63.5%)
ICU stay	5 (3-8)	4 (2-10)	5 (3-9)	0.58
Hospital stay	14 (8-21)	11 (5-22)	12 (7-21)	0.006
Use of MV	24 (14.2%)	130 (56.3%)	154 (38.5%)	< 0.001
Days of MV	5 (3-7.75)	3 (2-6)	3 (2-7)	0.002
Use of renal support	7 (4.1%)	29 (12.6%)	36 (9.0%)	0.004
Days of renal support	2.14 ± 0.90	2.48 ± 2.06	2.42 ± 1.88	0.786
Use of vasopressor support	26 (15.4%)	174 (75.3%)	200 (50.0%)	< 0.001
Days of vasopressor support	3 (2-4)	2 (1.75-4.0)	2 (2-4)	0.276

ICU: Intensive care unit; MV: Mechanical ventilation.

Table 2 Comparison between survivors and non-survivors for various scores

Scoring system	Survivors, n = 169	Non-survivors, n = 231	Total, n = 400	P value
APACHE II	17.66 ± 4.96	22.82 ± 8.34	20.64 ± 7.55	< 0.001
APACHE II PDR	28.10 ± 17.74	44.04 ± 25.88	37.30 ± 24.10	< 0.001
APACHE III	59.01 ± 16.95	81.36 ± 31.37	71.92 ± 28.46	< 0.001
APACHE III PDR	17.59 ± 15.80	37.59 ± 28.51	29.14 ± 25.91	< 0.001
APACHE IV	58.80 ± 16.98	80.45 ± 31.70	71.30 ± 28.55	< 0.001
APACHE IV PDR	20.45 ± 14.99	40.45 ± 27.91	32.00 ± 25.33	< 0.001
SAPS II	34.67 ± 11.83	49.20 ± 19.87	43.06 ± 18.39	< 0.001
SAPS II PDR	19.81 ± 16.97	42.83 ± 30.51	33.10 ± 28.06	< 0.001
SAPS III PDR	18.12 ± 16.95	34.66 ± 24.12	27.67 ± 22.88	< 0.001
SOFA Score	5.76 ± 2.80	9.02 ± 4.58	7.64 ± 4.24	< 0.001
MPM II₀ PDR	33.39 ± 15.08	52.16 ± 26.63	44.23 ± 24.31	< 0.001

APACHE: Acute Physiology and Chronic Health Evaluation; SAPS: Simplified Acute Physiology Score; SOFA: Sequential Organ Failure Assessment; MPM: Mortality Probability Model; PDR: Predicted death rate.

Table 3 Comparison of the actual and predicted mortality rates for the various scoring systems

Scoring system	Actual mortality	Predicted mortality	SMR	95%CI
APACHE II	0.577	0.373	1.547	1.423-1.678
APACHE III	0.577	0.291	1.982	1.824-2.151
APACHE IV	0.577	0.320	1.803	1.659-1.956
SAPS II	0.577	0.331	1.743	1.604-1.891
SAPS III	0.577	0.277	2.083	1.917-2.26
MPM II₀ PDR	0.577	0.442	1.305	1.201-1.416

SMR: Standardized mortality rate; CI: Confidence interval; APACHE: Acute Physiology and Chronic Health Evaluation; SAPS: Simplified Acute Physiology Score; MPM: Mortality Probability Model; PDR: Predicted death rate.

Table 4 Lemeshow-Hosmer goodness-of-fit tests for evaluating the calibration of the scoring systems

Scoring system	Chi square value	P value
APACHE II	9.366	0.312
APACHE II PDR	12.159	0.144
APACHE III	4.707	0.788
APACHE III PDR	6.471	0.595
APACHE IV	9.331	0.315
APACHE IV PDR	10.763	0.216
SAPS II	9.479	0.304
SAPS II PDR	10.410	0.237
SAPS III PDR	10.787	0.214
SOFA Score	15.966	0.025
MPM II₀ PDR	11.265	0.187

Table 5 Area under curve for predicting hospital mortality for various scoring system

Scoring system	AUC	P value	95%CI	Cut off	Sensitivity	Specificity
APACHE II	0.688	< 0.001	0.637-0.739	> 18.5	67.5%	62.7%
APACHE III	0.720	< 0.001	0.672-0.769	> 78.5	46.8%	87.6%
APACHE IV	0.708	< 0.001	0.659-0.758	> 72.5	53.7%	79.3%
SAPS II	0.734	< 0.001	0.685-0.782	> 34.5	76.2%	60.4%
SAPS III PDR	0.762	< 0.001	0.715-0.808	39.0	44.3%	92.0%
SOFA Score	0.715	< 0.001	0.665-0.764	> 7.5	58.0%	79.3%
MPM II₀ PDR	0.762	< 0.001	0.714-0.810	36.45	71.3%	69.9%

AUC: Area under the curve; CI: Confidence interval; APACHE: Acute Physiology and Chronic Health Evaluation; SAPS: Simplified Acute Physiology Score; SOFA: Sequential Organ Failure Assessment; MPM: Mortality Probability Model; PDR: Predicted death rate.

Table 6 Correlation of different scoring system with each other

Scoring system		APACHE II Score	A2 PDR	APACHE III Score	A3 PDR	APACHE IV Score	A4 PDR	SAPS II Score	SAPS2 PDR	SAPS 3 PDR	SOFA score
APACHE II Score	r value		0.898	0.892	0.836	0.883	0.826	0.820	0.812	0.748	0.679
APACHE II Score	P value		0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000
A2 PDR	r value	0.898		0.824	0.832	0.814	0.805	0.751	0.752	0.716	0.635
A2 PDR	P value	0.000		0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000
APACHE III Score	r value	0.892	0.824		0.929	0.966	0.895	0.910	0.902	0.820	0.753
APACHE III Score	P value	0.000	0.000		0.000	0.000	0.000	0.000	0.000	0.000	0.000
A3 PDR	r value	0.836	0.832	0.929		0.897	0.895	0.851	0.852	0.763	0.711
A3 PDR	P value	0.000	0.000	0.000		0.000	0.000	0.000	0.000	0.000	0.000
APACHE IV Score	r value	0.883	0.814	0.966	0.897		0.915	0.890	0.877	0.821	0.762
APACHE IV Score	P value	0.000	0.000	0.000	0.000		0.000	0.000	0.000	0.000	0.000
A4 PDR	r value	0.826	0.805	0.895	0.895	0.915		0.836	0.839	0.782	0.727
A4 PDR	P value	0.000	0.000	0.000	0.000	0.000		0.000	0.000	0.000	0.000
SAPS II Score	r value	0.820	0.751	0.910	0.851	0.890	0.836		0.972	0.814	0.756
SAPS II Score	P value	0.000	0.000	0.000	0.000	0.000	0.000		0.000	0.000	0.000
SAPS 2 PDR	r value	0.812	0.752	0.902	0.852	0.877	0.839	0.972		0.813	0.773
SAPS 2 PDR	P value	0.000	0.000	0.000	0.000	0.000	0.000	0.000		0.000	0.000
SAPS 3 PDR	r value	0.748	0.716	0.820	0.763	0.821	0.782	0.814	0.813		0.684
SAPS 3 PDR	P value	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000		0.000
SOFA score	r value	0.679	0.635	0.753	0.711	0.762	0.727	0.756	0.773	0.684
SOFA score	P value	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000
MPM II₀ PDR	r value	0.704	0.653	0.777	0.729	0.759	0.734	0.790	0.805	0.714	0.700
MPM II₀ PDR	P value	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000

Citation: Beniwal A, Juneja D, Singh O, Goel A, Singh A, Beniwal HK. Scoring systems in critically ill: Which one to use in cancer patients? World J Crit Care Med 2022; 11(6): 364-374
URL: https://www.wjgnet.com/2220-3141/full/v11/i6/364.htm
DOI: https://dx.doi.org/10.5492/wjccm.v11.i6.364