Evaluation of the Severity of Patients Admitted to ICU in Japan

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The purpose of this study is to establish a scoring system by which we can evaluate the severity of ICU patients in Japan.First, we used the APACHE-II scoring system which has been widely used in many foreign countries for evaluating the severity of ICU patients and for predicting their subsequent prognosis. The subjects of the study were patients admitted to our ICUs. Their severity and predicted mortality were evaluated by using the APACEH-II scoring system. As a whole, APACHE-II scores were proportionally correlated with actual observed mortality (OM), and the overall calculated predicted mortality (PM) also fit with the OM. However, discrepancies were found between the APACHE-II scores and the OM and between the PM and the OM especially in septic patients with multiple organ failure (MOF). The reason why the discrepancies were found in septic patients was considered that the APACHE-II scoring system does not have scores evaluating liver dysfunction which was frequently observed in septic patients and was an important cause of death of the patients.Next, we modified the APACHE-II scoring system and designed the APACHE-HEPATIC scoring system (APACHE-H), which included the scores to evaluate the liver function by using an arterial blood ketone body ratio (AKBR), an osmolality gap, a prothrombin time and a hepaplastin time. The accuracy and predictive power of the APACHE-H were superior to the APACHE-II in MOF patients. However, because the added items such as AKBR were not always easy to examine, the APACHE-H was considered necessary to be improved its simplicity.In conclusion, the APACHE-II scoring system seemed to be a useful index to classify the severity of ICU patients except for some subgroups of patients such as septic ones with MOF. The APACHE-H scoring system was superior to the APACHE-II for evaluating the severity of MOF patients.