Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Nov 9, 2022; 11(6): 364-374
Published online Nov 9, 2022. doi: 10.5492/wjccm.v11.i6.364
Scoring systems in critically ill: Which one to use in cancer patients?
Anisha Beniwal, Deven Juneja, Omender Singh, Amit Goel, Akhilesh Singh, Hemant Kumar Beniwal
Anisha Beniwal, Deven Juneja, Omender Singh, Amit Goel, Akhilesh Singh, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
Hemant Kumar Beniwal, Department of Neurosurgery, Dr SNMC Hospital, Jodhpur 342001, India
Author contributions: Beniwal A and Juneja D designed the study; Beniwal A, Juneja D and Beniwal HK collected the data, analyzed the results, performed the majority of the writing and prepared the tables; Singh O, Goel A and Singh A provided critical input in writing the paper and reviewed the manuscript.
Institutional review board statement: Approved by Institutional Scientific Committee of Max Super Speciality Hospital, No. 1944105991.
Informed consent statement: As this was a retrospective study, the need for consent was waived off by the institute’s ethical committee.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deven Juneja, DNB, FCCP, MBBS, Director, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket 1, Press Enclave Road, New Delhi 110017, India. devenjuneja@gmail.com
Received: April 26, 2022
Peer-review started: April 26, 2022
First decision: June 8, 2022
Revised: June 12, 2022
Accepted: September 9, 2022
Article in press: September 9, 2022
Published online: November 9, 2022
Processing time: 191 Days and 9.6 Hours
Abstract
BACKGROUND

Scoring systems have not been evaluated in oncology patients. We aimed to assess the performance of Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, APACHE IV, Simplified Acute Physiology Score (SAPS) II, SAPS III, Mortality Probability Model (MPM) II0 and Sequential Organ Failure Assessment (SOFA) score in critically ill oncology patients.

AIM

To compare the efficacy of seven commonly employed scoring systems to predict outcomes of critically ill cancer patients.

METHODS

We conducted a retrospective analysis of 400 consecutive cancer patients admitted in the medical intensive care unit over a two-year period. Primary outcome was hospital mortality and the secondary outcome measure was comparison of various scoring systems in predicting hospital mortality.

RESULTS

In our study, the overall intensive care unit and hospital mortality was 43.5% and 57.8%, respectively. All of the seven tested scores underestimated mortality. The mortality as predicted by MPM II0 predicted death rate (PDR) was nearest to the actual mortality followed by that predicted by APACHE II, with a standardized mortality rate (SMR) of 1.305 and 1.547, respectively. The best calibration was shown by the APACHE III score (χ2 = 4.704, P = 0.788). On the other hand, SOFA score (χ2 = 15.966, P = 0.025) had the worst calibration, although the difference was not statistically significant. All of the seven scores had acceptable discrimination with good efficacy however, SAPS III PDR and MPM II0 PDR (AUROC = 0.762), had a better performance as compared to others. The correlation between the different scoring systems was significant (P < 0.001).

CONCLUSION

All the severity scores were tested under-predicted mortality in the present study. As the difference in efficacy and performance was not statistically significant, the choice of scoring system used may depend on the ease of use and local preferences.

Keywords: APACHE score; Intensive care unit; Medical oncology; SOFA score; Scoring systems; Severity of illness index

Core Tip: Scoring systems are important for patient triaging, benchmarking intensive care unit (ICU) performance, comparing different ICUs and may also help in patient prognostication, selecting treatment options and resource utilization. However, validity and utility of these scores may be questionable in the patient population apart from where they were developed. Hence, these scores need to be tested and validated in different patient populations, in different geographical areas and over different time periods. There is a lack of an ideal score for prognostication of critically ill cancer patients. In our retrospective study, analyzing data from 400 patients and comparing seven commonly employed critical illness scores, we observed that all the scores had similar efficacy and under-predicted mortality. Therefore, the selection of severity of illness score should depend on the ease of use and local preferences.