A Comparison of the Performance of Out-of-hospital Cardiac Arrest Score and Standard Severity Scores in Predicting Hospital Mortality and Neurological Consequence in Out-of-hospital Cardiac Arrest Patients
DOI:
https://doi.org/10.31584/jhsmr.2021821Keywords:
APACHE, SAPS, outcome, risk predictionAbstract
Objective: There is limited data to determine the performance of general and specific severity score in out-of-hospital cardiac arrest (OHCA) patients. Hence, we compared the performance of the OHCA score with Acute Physiology and Chronic Health Evaluation (APACHE) and Simplified Acute Physiology Score (SAPS) to predict outcome in OHCA patients.
Material and Methods: A retrospective study was conducted in a mixed intensive care unit of a tertiary hospital. The primary outcome was in-hospital mortality. The secondary outcome was poor neurological outcome.
Results: A total of 190 OHCA patients were enrolled. The OHCA score had moderate discrimination with an area under the receiver operating characteristic curve (AUC) 0.77 (95% CI 0.7-0.837) whereas discrimination of APACHE II-IV, SAPS II, and SAPS 3 were good with an AUC more than 0.8. The actual hospital mortality rate was 64.7%. The OHCA score predicted hospital mortality of 95.3 8.4, which significantly overestimated the mortality with standardized mortality ratio 0.68 (95% CI 0.56-0.81). However, all severity scores revealed poor calibration. Additionally, overall performance of APACHE II-IV, SAPS II and SAPS 3 were better than the OHCA score. For secondary outcome, discrimination of the OHCA score was moderate with an AUC 0.790 (95% CI 0.700-0.878) whereas other severity scores demonstrated good discrimination with AUC more than 0.8.
Conclusion: APACHE II-IV, SAPS II, and SAPS 3 indicated superior overall performance and demonstrated good discrimination for predicting hospital mortality and unfavorable neurological consequence better than the OHCA score. However, all severity scores attested poor calibration, therefore, specific scores for OHCA patients should be modified.
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