APACHE IV Versus PPI for Predicting Community Hospital ICU Mortality

Background: Both the Acute Physiology and Chronic Health Evaluation (APACHE) IV and Palliative Performance Index (PPI) are scales used to estimate intensive care unit (ICU) prognosis and mortality. Objective: To Compare the diagnostic utility of the PPI and APACHE IV and their subsequent implications in predicting ICU mortality at a community hospital. Design: This was a Prospective Cohort Study. Setting: The study was conducted at the Community hospital ICU. Patients: Participants were 211 patients admitted from December 24, 2008 to June I I, 2009. Measurements: An observer gathered appropriate data and performed the APACHE IV and PPI scales within 24 hours of admission. Results were then analyzed using standard formulae. Results: The study included 211 participants in total with 211 participants in the PPI group (n=211) and 162 in the APACHE IV group (n=162). The APACHE score and PPI were found to be significant for predicting ICU mortality (P value of P<.002 and 99% CI of 13.74 to 20.32, P value of P<.001 and 99% CI of 3.70 to 4.61, respectively). APACHE IV demonstrated a sensitivity of 84.6%, specificity of 96.0%, PPV of 64.7%, and NPV of 98.6%. In contrast, the PPI possessed a sensitivity of 69.2%, specificity of 96.0%, PPV of 64.7%, and NPV of 97.8%. Limitations: Limitations may have occurred with the subjective nature of the PPI and Glasgow Coma Scale (GCS), along with meeting criterion for the APACHE IV. Conclusion: This prospective cohort study in the ICU of a community hospital demonstrated that both the APACHE IV and PPI were significant tools for predicting ICU mortality. When contrasting the 2 scales, the APACHE IV could more accurately rule in mortality when mortality occurred and rule out mortality when survival occurred.