eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
Current issue Archive Manuscripts accepted About the journal Special issues Editorial board Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
vol. 14
Clinical research

Mortality of adult intensive care units in Turkey using the APACHE II and SOFA systems (outcome assessment in Turkish intensive care units)

Cetin Kaymak, Irfan Sencan, Seval Izdes, Aydin Sari, Hatice Yagmurdur, Derya Karadas, Derya Oztuna

Arch Med Sci 2018; 14, 3: 510–515
Online publish date: 2016/05/05
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
The aim of this study was to evaluate intensive care unit (ICU) performance using risk-adjusted ICU mortality rates nationally, assessing patients who died or had been discharged from the ICU. For this purpose, this study analyzed the Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) databases, containing detailed clinical and physiological information and mortality of mixed critically ill patients in a medical ICU at secondary and tertiary referral ICUs in Turkey.

Material and methods
A total of 690 adult intensive care units in Turkey were included in the study. Among 690 ICUs evaluated, 39.7% were secondary and 60.3% were tertiary ICUs. A total of 4188 patients were enrolled in this study. Intensive care units of ministry, university, and private hospitals were evaluated all over Turkey. During the study period, clinical data that were collected concurrently for each patient contained demographic details and the diagnostic category leading to ICU admission. APACHE II and SOFA scores following ICU admission were calculated and recorded. Patients were followed up for outcome data until death or ICU discharge.

The mean age of patients was 68.8 ±19 and 54% of them were male. The mean APACHE II score was 20 ±8.7. The ICUs’ mortality rate was 46.3%, and mean predicted mortality was 37.2% for APACHE II. The standardized mortality ratio was 1.28 (95% confidence interval: 1.21–1.31).

There was a wide difference in outcome for patients admitted to different ICUs and severity of illness using risk adjustment methods. The high mortality rate in patients could be related to comorbid diseases, high mechanical ventilation rates and older ages.


critical care, severity of illness, mortality, survival

Goldhill DR, Sumner A. Outcome of intensive care patients in a group of British Intensive Care Units. Crit Care Med 1998; 26: 1337-45.
Wunsch H, Brady AR, Rowan K. Impact of exclusion criteria on case mix, outcome, and length of stay for the severity of disease scoring methods in common use in critical care. J Crit Care 2004; 19: 67-74.
Higgins TL, McGee WT, Steingrub JS, Rapoport J, Lemeshow S, Teres D. Early indicators of prolonged intensive care unit stay: impact of illness severity, physician staffing, and pre-intensive care unit length of stay. Crit Care Med 2003; 31: 45-51.
Iapichino G, Gattinoni L, Radrizzani D, Simini B, Bertolini G, Ferla L. Volume of activity and occupancy rate in intensive care units. Association with mortality. Intensive Care Med 2004; 30: 290-7.
Kajdacsy-Balla Amaral A, Andrade F, Moreno R, Artigas A, Cantraine F, Vincent J. Use of the sequential organ failure assessment score as a severity score. Intensive Care Med 2005; 31: 243-9.
Vincent J, Ferreira F, Moreno R. Scoring systems for assessing organ dysfunction and survival. Crit Care Clin 2000; 16: 353-66.
Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-relate 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.
Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluations: a physiologically based classification system. Crit Care Med 1981; 9: 591-7.
Wenner JB, Norena M, Khan N, et al. Reliability of intensive care unit admitting and comorbid diagnoses, race, elements of Acute Physiology and Chronic Health Evaluation II score, and predicted probability of mortality in an electronic intensive care unit database. J Crit Care 2009; 24: 401-7.
Ho K. Combining sequential organ failure assessment (SOFA) score with acute physiology and chronic health evaluation (APACHE) II score to predict hospital mortality of critically ill patients. Anaesth Intensive Care 2007; 35: 515-21.
Levin PD, Sprung CL. The process of intensive care triage. Intensive Care Med 2001; 27: 1441-5.
Beck DH, Smith GB, Pappachan JV, Millar B. External validation of the SAPS II, APACHE II and APACHE III prognostic models in South England: a multicentre study. Intensive Care Med 2003; 29: 249-56.
Goldhill DR, Withington PS. The effect of case mix adjustment on mortality as predicted by APACHE II. Intensive Care Med 1996; 22: 415-9.
Markgraf R, Deutschinoff G, Pientka L, Scholten T, Lorenz C. Performance of the score systems Acute Physiology and Chronic Health Evaluation II and III at an interdisciplinary intensive care unit after customization. Crit Care 2001; 5: 31-6.
Pettilä V, Pettilä M, Sarna S, Voutilainen P, Takkunen O. Comparison of multiple organ dysfunction scores in the prediction of hospital mortality in the critically ill. Crit Care Med 2002; 30: 1705-11.
Ouanes I, Schwebel C, Français A, et al. A model to predict short-term death or readmission after intensive care unit discharge. J Crit Care 2012; 27: 422-6.
Kumar A, Aronow WS, Alexa M, et al. Prevalence of use of advance directives, health care proxy, legal guardian, and living will in 512 patients hospitalized in a cardiac care unit/intensive care unit in 2 community hospitals. Arch Med Sci 2010; 30: 188-91.
Hantke M, Holzer K, Thöne S, Schmandra T, Hanisch E. The SOFA score in evaluating septic illnesses. Correlations with the MOD and APACHE II score. Chirurg 2000; 71: 1270-6.
Metnitz PG, Lang T, Vesely H, Valetin A, Le Gal JR. Ratios of observed to expected mortality are affected by differences in case mix and quality of care. Intensive Care Med 2000; 26: 1466-72.
Harrison DA, Brady AR, Parry GJ, Carpenter JR, Rowan K. Recalibration of risk prediction models in a large multicenter cohort of admissions to adult, general critical care units in the United Kingdom. Crit Care Med 2006; 34: 1378-88.
Vincent JL, Marshall JC, Namendys-Silva SA, et al. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir Med 2014; 2: 380-6.
Guo Q, Li HY, Li YM, et al. Compliance with severe sepsis bundles and its effect on patient outcomes of severe community-acquired pneumonia in a limited resources country. Arch Med Sci 2014; 10: 970-8.
Colpan A, Akinci E, Erbay A, Balaban N, Bodur H. Evaluation of risk factors for mortality in intensive care units: a prospective study from a referral hospital in Turkey. Am J Infect Control 2005; 33: 42-7.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. An evaluation of outcome from intensive care in major medical centers. Ann Intern Med 1986; 104: 410-8.
Rocker G, Cook D, Sjokvist P, Weaver B, Finfer S, McDonald E. Clinician predictions of intensive care unit mortality. Crit Care Med 2004; 32: 1149-54.
Juneja D, Nasa P, Singh O, Javeri Y, Uniyal B, Dang R. Clinical profile, intensive care unit course, and outcome of patients admitted in intensive care unit with dengue. J Crit Care 2011; 26: 449-52.
Bastos PG, Knaus WA, Zimmerman JE. The importance of technology for achieving superior outcomes from intensive care. Intensive Care Med 1996; 22: 664-9.
Vincent JL, Carvalho F. Severity of illness. Semin Respir Crit Care Med 2010; 31: 31-8.
Khanagavi J, Gupta T, Aronow WS, et al. Hyperkalemia among hospitalized patients and association between duration of hyperkalemia and outcomes. Arch Med Sci 2014; 10: 251-7.
Williams TA, Ho KM, Dobb GJ, Finn JC, Knuiman M, Webb SA. Effect of length of stay in intensive care unit on hospital and long-term mortality of critically ill adult patients. Br J Anaesth 2010; 104: 459-64.
Piffaretti G, Mariscalco G, Riva F, Fontana F, Carrafiello G, Castelli P. Abdominal aortic aneurysm repair: long-term follow-up of endovascular versus open repair. Arch Med Sci 2014; 10: 273-82.
Paul E, Bailey M, Pilcher D. Risk prediction of hospital mortality for adult patients admitted to Australian and New Zealand intensive care units: development and validation of the Australian and New Zealand Risk of Death model. J Crit Care 2013; 28: 935-41.
Hogendorf P, Durczyński A, Kumor A, Strzelczyk J. Pancreatic head carcinoma and vascular endothelial growth factor (VEGF-A) concentration in portal blood: its association with cancer grade, tumor size and probably poor prognosis. Arch Med Sci 2014; 10: 288-93.
Thuluvath PJ, Wagennar RR, Verma S. Gender and ethnic differences in the post-liver transplant outcomes of patients with autoimmune hepatitis with acute liver failure at initial presentation: a case-control study. Arch Med Sci 2015; 11: 1227-35.
Sharma D, Newman TG, Aronow WS. Lung cancer screening: history, current perspectives, and future directions. Arch Med Sci 2015; 11: 1033-43.
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe