Abstract

Objective: To evaluate the performance of the pneumonia severity index (PSI), acute physiology and chronic health evaluation II (APACHE II), and simplified acute physiology score III (SAPS III) in predicting mortality in patients with community-acquired pneumonia (CAP) who underwent invasive mechanical ventilation (IMV) in the emergency intensive care unit (EICU).

Methods: A retrospective study was performed using the clinical data of older patients with CAP (who underwent IMV in the EICU), analyzed using APACHE II, SAPS III, and PSI. Logistic regression was used to analyze independent risk factors for mortality in these patients. The predictive values of APACHE II, SAPS III, and PSI for mortality were evaluated by the receiver operating characteristic (ROC) curves.

Results: In total, 101 patients were enrolled. The logistic regression analysis showed that APACHE II was an independent risk factor for mortality in the older patients with CAP who underwent IMV (OR = 1.42, 95% confidence intervals (CI): 1.23-1.63, p < 0.001). The areas under the ROC curve (AUROC) corresponding to PSI, APACHE II, and SAPS III were 0.733, 0.837, and 0.700, respectively, and the AUROC of APACHE II was significantly higher than those of PSI and SAPS III (p < 0.05). The maximum Youden index of APACHE IIwas 0.548, and the corresponding scorewas 18.5. The sensitivity and specificity of APACHE II in predicting mortality were 88.1% and 66.7%, respectively.

Conclusion: Compared to PSI and SAPS III, APACHE II had an optimal effect on predicting mortality in older patients with CAP who underwent IMV.