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The Utility of Acute Physiology and Chronic Health Evaluation II Scores for Prediction of Mortality among Intensive Care Unit (ICU) and Non-ICU Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia

Vanessa Stevens PhD, Thomas P. Lodise PharmD, Brian Tsuji PharmD, Meagan Stringham PharmD(cand), Jill Butterfield PharmD, Elizabeth Dodds Ashley PharmD MHS, Kristen Brown MSN, Alan Forrest PharmD and Jack Brown PharmD MS
Infection Control and Hospital Epidemiology
Vol. 33, No. 6 (June 2012), pp. 558-564
DOI: 10.1086/665731
Stable URL: http://www.jstor.org/stable/10.1086/665731
Page Count: 7
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The Utility of Acute Physiology and Chronic Health Evaluation II Scores for Prediction of Mortality among Intensive Care Unit (ICU) and Non-ICU Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia
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Abstract

Objective. Bloodstream infections due to methicillin-resistant Staphylococcus aureus (MRSA) have been associated with significant risk of in-hospital mortality. The acute physiology and chronic health evaluation (APACHE) II score was developed and validated for use among intensive care unit (ICU) patients, but its utility among non-ICU patients is unknown. The aim of this study was to determine the ability of APACHE II to predict death at multiple time points among ICU and non-ICU patients with MRSA bacteremia.Design. Retrospective cohort study.Participants. Secondary analysis of data from 200 patients with MRSA bacteremia at 2 hospitals.Methods. Logistic regression models were constructed to predict overall in-hospital mortality and mortality at 48 hours, 7 days, 14 days, and 30 days using APACHE II scores separately in ICU and non-ICU patients. The performance of APACHE II scores was compared with age adjustment alone among all patients. Discriminatory ability was assessed using the c-statistic and was compared at each time point using χ2 tests. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test.Results. APACHE II was a significant predictor of death at all time points in both ICU and non-ICU patients. Discrimination was high in all models, with c-statistics ranging from 0.72 to 0.84, and was similar between ICU and non-ICU patients at all time points. APACHE II scores significantly improved the prediction of overall and 48-hour mortality compared with age adjustment alone.Conclusions. The APACHE II score may be a valid tool to control for confounding or for the prediction of death among ICU and non-ICU patients with MRSA bacteremia.

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