Scoring systems in cancer patients admitted for an acute complication in amedical intensive care unit

Objective: To validate and compare two severity scoring systems, the Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute P hysiology Score (SAPS) II and to determine their prognostic value for morta lity during the hospital stay and after discharge in a specific group of ca ncer patients admitted to intensive care unit (ICU) for an acute medical co mplication. Design: Prospective cohort study. Setting: The medical ICU of a European cancer hospital. Subjects: A total of 261 consecutive cancer patients admitted to ICU for an acute medical complication. Measurements: Variables included into the APACHE II and SAPS II scores, as well as characteristics of the cancer, were collected during the first 24 h rs of the ICU stay. Hospital and in-ICU mortalities, overall survival, and survival after day 30 were measured. Results: Observed hospital and ICU mortalities were 33% and 23%. Median sur vival time was 94 days and l-yr survival rate was 23%. The mean predicted r isk of death was 26.5% with APACHE II and 26.1% with SAPS II. Correlation b etween both systems was excellent. Calibration for mortality prediction abi lity of both scoring systems was similar. Discrimination between survivors and nonsurvivors was superior with SAPS II according to the area under the receiver operating characteristic curve but was better with APACHE II far s urvivors using thresholds minimizing the overall misclassification rates. M ultivariate prognostic analysis showed that the scoring systems were the on ly significant factors for hospital and in-ICU mortalities, whereas charact eristics related to the cancer (extent, phase) were the factors predicting survival after discharge. Conclusion: The prognosis of cancer patients admitted to ICU for a medical problem is first determined by the acute physiologic changes induced by the complication, as evaluated by the severity scores. There is no major diffe rence between the two assessed scoring systems. They are, however, not accu rate enough to be used in the routine management of these patients. After r ecovery from complications, characteristics related to the neoplastic disea se, however, retrieve their independent influence on the further survival. (Crit Care Med 2000; 28:2786-2792).