The utility of acute physiology and chronic health evaluation II scores for prediction of mortality among intensive care unit (ICU) and non-ICU patients with methicillin-resistant Staphylococcus aureus bacteremia

Infect Control Hosp Epidemiol. 2012 Jun;33(6):558-64. doi: 10.1086/665731. Epub 2012 Apr 13.


Objective: Bloodstream infections due to methicillin-resistant Staphylococcus aureus (MRSA) have been associated with significant risk of in-hospital mortality. The acute physiology and chronic health evaluation (APACHE) II score was developed and validated for use among intensive care unit (ICU) patients, but its utility among non-ICU patients is unknown. The aim of this study was to determine the ability of APACHE II to predict death at multiple time points among ICU and non-ICU patients with MRSA bacteremia.

Design: Retrospective cohort study.

Participants: Secondary analysis of data from 200 patients with MRSA bacteremia at 2 hospitals.

Methods: Logistic regression models were constructed to predict overall in-hospital mortality and mortality at 48 hours, 7 days, 14 days, and 30 days using APACHE II scores separately in ICU and non-ICU patients. The performance of APACHE II scores was compared with age adjustment alone among all patients. Discriminatory ability was assessed using the c-statistic and was compared at each time point using χ(2) tests. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test.

Results: APACHE II was a significant predictor of death at all time points in both ICU and non-ICU patients. Discrimination was high in all models, with c-statistics ranging from 0.72 to 0.84, and was similar between ICU and non-ICU patients at all time points. APACHE II scores significantly improved the prediction of overall and 48-hour mortality compared with age adjustment alone.

Conclusions: The APACHE II score may be a valid tool to control for confounding or for the prediction of death among ICU and non-ICU patients with MRSA bacteremia.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bacteremia / mortality*
  • Cohort Studies
  • Cross Infection / mortality*
  • Decision Support Techniques*
  • Female
  • Humans
  • Intensive Care Units
  • Logistic Models
  • Male
  • Methicillin-Resistant Staphylococcus aureus*
  • Middle Aged
  • Prognosis
  • ROC Curve
  • Retrospective Studies
  • Staphylococcal Infections / mortality*