Comparison of Four Severity Assessment Scoring Systems in Critically Ill Patients for Predicting Patient Outcomes: A Prospective Observational Study From a Single Tertiary Center in Central India

Background and aim A variety of scoring systems are employed in intensive care units (ICUs) with the objective of predicting patient morbidity and mortality. The present study aimed to compare four different severity assessment scoring systems, namely, Acute Physiology and Chronic Health Evaluation II (APACHE II), Rapid Emergency Medicine Score (REMS), Sequential Organ Failure Assessment (SOFA), and Simplified Acute Physiologic Score II (SAPS II) to predict prognosis of all patients admitted to a mixed medical ICU of a tertiary care teaching hospital in central India. Methods The prospective observational study included 1136 patients aged 18 years or more, admitted to the mixed medical ICU. All patients underwent severity assessment using the four scoring systems, namely APACHE II, SOFA, REMS, and SAPS II, after admission. Predicted mortality was calculated from each of the scores and actual patient outcomes were noted. Receiver operating curve analysis was undertaken to identify the cut-off value of individual scoring systems for predicting mortality with optimum sensitivity and specificity. Calibration and discrimination were employed to ascertain the validity of each scoring model. Bivariate and multivariable logistic regression analyses among the study participants were conducted to identify the best scoring system, after adjusting for potential confounders. Results Final analysis was done on 957 study participants (mean (±SD) age-58.4 (±12.9) years; males-62.2%). The mortality rate was 14.7%. APACHE II, SOFA, SAPS II, and REMS scores were significantly higher among the non-survivors as compared to the survivors (p