A Prospective Study of Comparison of APACHE IV and SAPS III Scoring Systems and Calculation of Standardized Mortality Rate among Critically Ill Patients with Sepsis

OBJECTIVE: The study aims to compare the APACHE-IV and SAPS-III scores for critically ill sepsis patients in the ICU, determine the Standardized Mortality Rate (SMR) using both systems, and assess the effectiveness of the APACHE-IV score in predicting ICU length of stay. METHODS: An analytical prospective study was conducted over nine months at Apollo Hospitals, Hyderabad, involving critically ill patients aged 18 years or older admitted to the ICU with sepsis. Both APACHE-IV and SAPS-III scores were calculated within the first 24 hours of ICU admission based on physiological variables and comorbidities. Demographic and clinical data were collected at admission, and patients were followed until ICU discharge or death. Statistical analysis was performed using SPSS version 25.0, employing descriptive statistics, ROC curve analysis, and significance testing to compare the predictive capabilities of the scoring systems. Ethical approval was obtained, and informed consent was secured from all participants. RESULTS: The study analysed 150 critically ill patients, with pneumonia being the most prevalent infection. The APACHE IV scoring system was found to be more effective in predicting mortality than the SAPS III system. The APACHE IV system had a sensitivity of 83.3%, specificity of 95.9%, and a positive predictive value of 97.7%. The ROC curve analysis indicated a strong predictive capability for APACHE IV, compared to the SAPS III system's slightly lower performance. CONCLUSION: The APACHE IV scoring system demonstrated better predictive capability for mortality in critically ill patients compared to the SAPS III system. The observed mortality rates closely aligned with APACHE IV predictions, while SAPS III exhibited significant overestimation.