The Indian Journal of Chest Diseases and Allied Sciences

Register      Login

VOLUME 61 , ISSUE 2 ( April-June, 2019 ) > List of Articles

Original Article

Comparison of Performance of APACHE II and SOFA Scoring Systems in Critically Ill Patients Admitted to Intensive Care Unit

M.H. Rao, A. Venkatraman, R. Naga Divya, M. Madhusudhan, Alladi Mohan, A. Samantharay

Keywords : APACHE II, ICU, Mortality, SOFA, Mechanical ventilation, South India

Citation Information : Rao M, Venkatraman A, Divya RN, Madhusudhan M, Mohan A, Samantharay A. Comparison of Performance of APACHE II and SOFA Scoring Systems in Critically Ill Patients Admitted to Intensive Care Unit. Indian J Chest Dis Allied Sci 2019; 61 (2):69-74.

DOI: 10.5005/ijcdas-61-2-69

License: CC BY-NC 4.0

Published Online: 18-11-2022

Copyright Statement:  Copyright © 2019; The Author(s).


Background: Several disease scoring systems have evolved for predicting the mortality in intensive care unit (ICU) patients. We evaluated the performance of Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scoring systems in providing mortality risk estimates in critically ill patients. Methods: During March 2015 to March 2016, 160 critically ill patients requiring mechanical ventilation (MV) at our tertiary care teaching hospital in south India were prospectively studied. Results: Compared to survivors, non-survivors were significantly older (median [interquartile range, IQR] age [years] 42.5 (28-54.3) versus 33 [22–49.3] [p=0.025]); had higher median (IQR) APACHE II score (23 [18-29] versus 15 [11.8-19]); and SOFA score (9 [6-12] versus 5 [4-7] [p<0.001]); required MV for a longer duration (9 [6–13] versus 6 [4–9] days [p=0.048]) and had lesser duration of ICU stay (7 [4–12] versus 13.5 [8-21.3] days [p<0.001]) and hospital stay (9 [7–17.3] versus 16 [11.8-28] days [p<0.001]). APACHE II score (cut-off > 17, sensitivity 67.8%, specificity 80%) and SOFA score (cut-off > 7, sensitivity 78.9% and specificity 67.1%) performed similarly in predicting mortality (difference between areas under the curve 0.0180; standard error 0.0316; 95% confidence interval, -0.0440 to 0.0800; z statistic 0.569; p=0.569). Conclusion: Both APACHE II and SOFA scores appear to be useful tools in predicting mortality in critically ill patients requiring MV in the setting of an ICU in south India.

PDF Share
  1. Mohan A, Bollineni S. Predicting mortality in critically ill obstetric patients requiring intensive care unit admission in India. Indian J Med Sci 2007;61:175–7.
  2. Prayag S. ICUs worldwide: Critical care in India. Crit Care 2002;6:479–80.
  3. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–29.
  4. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A. The SOFA (Sepsis related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707–10.
  5. Aggarwal AN, Sarkar P, Gupta D, Jindal SK. Performance of standard severity scoring systems for outcome prediction in patients admitted to a respiratory intensive care unit in North India. Respirology 2006;11:196–204.
  6. Juneja D, Singh O, Nasa P, Dang R. Comparison of new scoring system with the conventional scoring systems in general intensive care population. Minerva Anestesiol 2012;78:194–200.
  7. Ahluwalia G, Pande JN, Sharma SK. Prognostic scoring for critically ill hospitalised patients. Indian J Chest Dis Allied Sci 1999;41:201–6.
  8. Gupta R, Arora VK. Performance evaluation of APACHE II score for an Indian patient with respiratory problems. Indian J Med Res 2004;119:273–82.
  9. Sam KG, Kondabolu K, Pati D, Kamath A, Pradeep Kumar G, Rao P. Poisoning severity score, APACHE II and GCS: effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning. J Forensic Leg Med 2009;16:239–47.
  10. Kulkarni SV, Naik AS, Subramanian N. APACHE-II scoring system in perforative peritonitis. Am J Surg 2007;194:549–52.
  11. Nimgaonkar A, Karnad DR, Sudarshan S, Ohno-Machado L, Kohane I. Prediction of mortality in an Indian intensive care unit: comparison between APACHE II and artificial neural networks. Intensive Care Med 2004;30:248–53.
  12. Sampath S, Fay MP, Pais P. Use of the logistic organ dysfunction system to study mortality in an Indian intensive care unit. Natl Med J India 1999;12:258–61.
  13. Markgraf R, Deutschinoff G, Pientka L, Scholten T. Comparison of acute physiology and chronic health evaluations II and III and simplified acute physiology score II: a prospective cohort study evaluating these methods to predict outcome in a German interdisciplinary intensive care unit. Crit Care Med 2000;28:26–33.
  14. Kalra D, Gupta S, Yadav BL, Tanwar P, Khan SA, Singh J, et al. Association of clinical outcome and APACHE II score in secondary peritonitis. Int J Health Sci Res 2016;6:107–13.
  15. Guler N, Unalp O, Guler A, Yaprak O, Dayangac M, Sozbilen M, et al. Glasgow Coma Scale and APACHE-II scores affect the liver transplantation outcomes in patients with acute liver failure. Hepatobiliary Pancreat Dis Int 2013;12:589–93.
  16. Madan HK, Singh R, Karnik ND. Value of SOFA scores in predicting prognosis in patients with ventilator associated pneumonia. Int J Anat Radiol Surg 2016;2137:1–6.
  17. Acharya SP, Pradhan B, Marhatta MN. Application of the Sequential Organ Failure Assessment score in predicting outcome in ICU patients with SIRS. Kathmandu Univ Med J 2007;5:475–83.
  18. Namendys-Silva SA, Silva–Medina GM, Vásquez-Barahona JA, Baltazar-Torres E, Rivero-Sigarroa JA, Fonseca-Lazcano, et al. Application of Sequential organ failure assessmen score to critically ill patients. Braz J Med Biol Res 2013;46:186–93.
  19. Devabhaktuni P, Samavedam S, Thota G, Pusala S, Velaga K, Bommakanti L, et al. Clinical profile and outcome of obstetric ICU patients. APACHE II, SOFA, SAPS II and MPM scoring systems for prediction of prognosis. Open J Obstetrics Gynecology 2013;3:41–50.
  20. Polderman KH, Girbes ARJ, Thijs LG, Strack van Schijndel RJ. Accuracy and reliability of APACHE II scoring in two intensive care units. Anaesthesia 2001;56:47–50.
  21. Okazaki H, Shikarbe A, Hata N, Yamamoto M, Kobayashi N, Shinada T, et al. New scoring system (APACHE-HF) for predicting adverse outcomes in patients with acute heart failure: evaluation of the APACHE II and Modified APACHE II scoring systems. J Cardiol 2014;64:441–9.
  22. Pietraszek-Grzywaczewska I, Bernas S, Lojko P, Piechota A, Piechota M. Predictive value of the APACHE II, SAPS II, SOFA and GCS scoring systems in patients with severe purulent bacterial meningitis. Anaesthesiol Intensive Ther 2016;48:175–9.
  23. Haidri FR, Rizvi N, Motiani B. Role of APACHE score in predicting mortality in chest ICU. J Pak Med Assoc 2011;61:589–92.
  24. Minoo A, Keyvan TK, Seyed DT, Abbas E. Estimation of the mortality rate using the APACHE II standard disease severity scoring system in intensive care unit patients. Iran J Crit Care Nurs 2012;4:209–14.
  25. Jones AE, Trzeciak S, Jeffrey AK. The sequential organ failure assessment scores for predicting outcome in patients with severe sepsis and evidence of hypo perfusion at the time of emergency department presentation. Crit Care Med 2009;37:1649–54.
  26. Oliveira-Neto A, Parpinelli MA, Cecatti JG, Souza JP, Sousa MH. Sequential Organ Failure Assessment score for evaluating organ failure and outcome of severe maternal morbidity in obstetric intensive care. Sci World J 2012;2012:172145.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.