Application of acute physiology and chronic health evaluation ii and sequential organ failure assessment score in the prognostication of patients in systemic inflammatory response syndrome

Introduction: Various scoring systems like the Acute physiology and Chronic Health Evaluation (APACHE) II and III, Simplified Acute Physiological Score (SAPS) II, Logistic Organ Dysfunction (LOD) and Sequential Organ Failure Assessment (SOFA) scores have been used to prognosticate the patients. One of the most commonly used, is the APACHE but in view of the multiple variables, bedside application becomes difficult. Aim of the study was to prognosticate the patients by using SOFA and APACHE scoring and to determine the better scoring parameter in determining outcome. Methods: It was a prospective observational study. 45 cases in SIRS were included in the study. The APACHE score was measured at admission and the SOFA score was calculated at 0, 48 and 96 hrs. A comparison between the two scoring systems was done in order to determine the better parameter. Result: 32% of the subjects were females. The APACHE scoring at admission correlated best with SOFA scoring at admission (p value -0.003) but a higher predictability of mortality was seen with SOFA scoring at 96 hrs (p value – 0.017). At the end of 96 hrs, death was recorded in 19 subjects (47% of the cases). Conclusion: The Sequential Organ failure Assessment is a more reliable predictor of mortality in comparison to APACHE II of which the score taken at 96 hrs was best in favour. The highest SOFA score also was an equally reliable parameter. The limitation of the study was the shorter study duration.