APACHE II score and mortality in respiratory failure due to cardiogenic pulmonary edema

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Abstract
We reviewed retrospectively 88 patients to assess whether the APACHE II severity of disease classification system can predict mortality in patients with respiratory failure due to cardiac pulmonary edema. Mean score for survivors was higher than for nonsurvivors (24.5 ± 6.7 vs. 20.7 ± 5.7, p < .01), and increasing APACHE II scores were not associated with increasing mortality. Mortality was 54% for APACHE II scores ± 18,43% for scores >18 and 24 and p < .001. The presence of myocardial infarction (MI) was associated with a high mortality. Mortality in the 51 MI patients was 52.9% vs. 13.5% in the 37 patients without MI (p < .001), but APACHE II scores were similar (22.6 ± 6.6 and 23.7 ± 6.4, respectively). The relationship between APACHE II scores and mortality did not improve if patients with and without MI are analyzed separately. For patients with MI, mortality was 78.6% for scores between 12 and 17, 56.2% for scores between 18 and 23,33.3% for scores between 24 and 29, and 33.3% for scores >29. For patients without MI, mortality was 0% for scores between 12 and 17, 30.7% for scores between 18 and 23, 9.1% for scores between 24 and 29, and 0% for scores >29. Patients with MI had lower initial mean arterial pressure than those without MI (86 ± 31 vs. 120 ± 25 mm Hg, p < .001), and more frequently required vasoactive medication (63% vs. 5.5%, p < .001), suggesting that significant myocardial injury from infarction is related to the higher mortality observed. These results suggest the APACHE II scores might not provide accurate prognostic information in an ICU population with a large proportion of patients with cardiogenic pulmonary edema, and confirm the APACHE II authors' warning that the index should be assessed critically in disease states in which it has not been previously validated

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