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 [PMID: 36439324 DOI: 10.5492/wjccm.v11.i6.364]
Corresponding Author of This Article
Deven Juneja, DNB, FCCP, MBBS, Director, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket 1, Press Enclave Road, New Delhi 110017, India. devenjuneja@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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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%)
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
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
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
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%
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
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
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
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
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
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
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
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
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
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
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
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