Comparison of Severity of Illness Scoring Systems in the Prediction of Mortality among Patients with Severe Sepsis and Septic Shock - A Prospective Observational Study

Background: Sepsis, which can progress to severe sepsis and septic shock, is becoming a major healthcare problem and affects millions of people around the world each year. Sepsis and septic shock result in mortality rates of one in three and one in six affected patients, respectively. Early identification and appropriate management improve outcomes. It is equally essential to compare various scoring systems to determine which combination of parameters best predicts the outcome of the patient. Aim: To determine which among APACHE II and MEDS is better in predicting in-hospital mortality among patients with severe sepsis and septic shock. Objectives: 1) To compare APACHE II and MEDS score in the prediction of hospital mortality among patients with severe septic and septic shock treated with MEGDT. 2) To assess the ability of APACHE II and MEDS score to predict mortality among patients with severe sepsis and septic shock treated with Modified Early Goal Directed Therapy. Design, Setting, and participants: A prospective observational study was conducted at KIMSHEALTH Thiruvananthapuram from December 2020 to June 2022, involving 116 sepsis patients over 18 years. Method: APACHE II and MEDS scoring were done for the study population, and results were compared to determine sensitivity and specificity. Results: Measurement of MEDS score and APACHE II score on 1st day of admission for scoring severity of illness had good predictive capability for mortality. While MEDS and APACHE II scores exhibited equal specificity, the sensitivity of APACHE II was 100 % compared to 97.6 % for MEDS. Conclusion: Measurement of both MEDS score and APACHE II score on the day of ED admission is a very useful tool in predicting the outcome among sepsis and septic shock patients. The APACHE II score demonstrated the largest AUC of the studied scoring systems and showed slightly better sensitivity, PPV, NPV and accuracy than MEDS score, although both shared equal specificity.