UTILITY OF APACHEII, SAPS II AND SOFA SCORES AS INDICATORS OF SEVERITY OF SEPSIS AND PREDICTORS OF MORTALITY IN A TERTIARY CARE HOSPITAL UTILITY OF APACHEII, SAPS II AND SOFA SCORES AS INDICATORS OF SEVERITY OF SEPSIS AND PREDICTORS OF MORTALITY IN A TERTIARY CARE HOSPITAL

Abstract

Background: The load of sepsis on our health care delivery system is huge, with approximately 750,000 cases per year in the United States, 215,000 consequential deaths, and annual costs of $16.7 billion nationally. Objectives: Objective of this study is to predict the outcome and mortality of patients with sepsis in a tertiary care hospital by using defined scores like APACHE II, SAPS II, SOFA scores. Methodology: This prospective observational study was carried out in ICU setup of multispecialty hospital in Western Maharashtra. Sample size was 90 patients with sepsis who were admitted to ICU (surgical) directly or indirectly, during the duration of one and half month. The study was approved by the Institutional ethical committee and written informed consent from all the patients or their guardians/legal representatives. The detailed history, clinical examination and all the relevant laboratory investigations were done including blood culture. The parameters as mentioned in APACHEII, SAPS II and SOFA scores were recorded daily. For statistical analysis, Chi-Square test, Fisher's Exact test, Mann-Whitney Test and Binary Logistic Regression were used. SPSS software was used for analysis. Results: Out of these 90 patients, 64 (71.1%) were males, and 26 (28.8%) were females. Mean age of the study population was 61.86 years. Mean duration of stay in the ICU was found out to be 3.33 days. Culture positivity was found in 53 cases (58.8%). Gram negative organisms were responsible for 37 (69.8%) cases while gram positive organisms were responsible for 16 (30.1%) cases. Statistics of various variables among cases and other detailed results were studied. SOFA score (p-0.046) & APACHE II score (p-0.00042) have been found to be statistically significant predictors of 'Death'; higher the SOFA score & APACHE II score-more probability of patient dying. However, mortality as per SAPS II (p-0.202) was not found to be statistically significant predictor of death. Conclusions: APACHE II, SAPS II and SOFA scores can be used for prediction of mortality by using appropriate statistical tests. People of older age, male gender, and preexisting chronic health conditions are chiefly prone to develop severe sepsis, hence prevention strategies should be targeted at these susceptible populations. The epidemiology of severe sepsis in developing countries warrants greater attention in future studies.