COMPARISON OF VALIDATION OF SAPS II AND APACHE

II SCORING SYSTEM ON MORTALITY OF PATIENTS IN

THE INTENSIVE CARE UNIT OF RSMH PALEMBANG

Idea Malik*1, Rose Mafiana2, Agustina Br Haloho3, Zen Hafy4

1 Department of Anesthesiology and Intensive Therapy Faculty of Medicine, Sriwijaya
University, Palembang
2 Department of Anesthesiology and Intensive Therapy Faculty of Medicine, Sriwijaya
University, Palembang
3 Department of Anesthesiology and Intensive Therapy Faculty of Medicine, Sriwijaya
University, Palembang
4 Department of Biomedical Faculty of Medicine, Sriwijaya University, Palembang
*08118009084, idea.malik.dr@gmail.com

Abstract

APACHE II is one of the most commonly used physiological scoring systems used in
RSMH to assess disease severity. However, this system is complex. Another simpler
scoring system is SAPS II because it combines the basic components of the APACHE
grading system with logistic regression analysis. Researchers are interested to conduct
research on the use of the SAPS II by comparing the two scoring systems. Compare
validation of the SAPS II and APACHE II scoring systems toward the mortality of patients
treated at ICU RSMH Palembang. Validation test with a retrospective cohort design was
undertaken during the 2018 period at the conducted on patients treated at ICU RSMH
Palembang. There were 295 patients obtained who met the inclusion and exclusion criteria.
The sensitivity and specificity measurements and the area under the receiving operator
(AUC) curve are then measured to determine the discrimination of the two scores. The
calibration is measured by Hosmer-Lemeshow goodness of fit test. Seventy three patients
died (24.7%). Discrimination The SAPS II score was categorized as well as APACHE II
(0.789 and 0.741, p = 0.000). The cut off value for the SAPS II score was 39.5 with a
sensitivity of 71.2% and a specificity of 71.6% while the APACHE II score was 14.5 with
a sensitivity of 68.5% and a specificity of 69.8%. However, calibration scores of SAPS II
(p = 0,000) and APACHE II (p = 0,000) were classified as inadequate (p < 0.05). The SAPS
II and APACHE II scores have equally validation.

Keywords: Acute Physiology and Chronic Health Evaluation II, Calibration,

Discrimination, Intensive Care Unit, Mortality rate, Simplified Acute Physiology Score II

References:

1. Moghaddam HH, Amiri H, Zamani N, Rahimi M, Shadnia S, and Taherkhani M. QT

dispersion and prognostication of the outcome in acute cardiotoxicities: a comparison
with SAPS II and APACHE II scoring systems. Cardiovascular Toxicology.
2014;2(14):129-133.
2. Feng Z, Wang T, Liu P, Chen S, Xiao H, Xia N, et al. Efficacy of various scoring system
for predicting the 28-day survival rate among patients with acute exacerbation of
chronic obstructive pulmonary disease requiring emergency intensive care. Canadian
Respiratory Journal. 2017;10(2017):1-9.
 PERBANDINGAN VALIDASI SKOR SAPS II DENGAN
APACHE II TERHADAP MORTALITAS PASIEN DI UNIT
PERAWATAN INTENSIF RSMH PALEMBANG
Idea Malik*1, Rose Mafiana 2, Agustina Br Haloho 3, Zen Hafy 4
1
Bagian Anestesiologi dan Terapi Intensif, Fakultas Kedokteran Universitas Sriwijaya,
Palembang, Indonesia
2
Bagian Anestesiologi dan Terapi Intensif, Fakultas Kedokteran Universitas Sriwijaya,
Palembang, Indonesia
3
Bagian Anestesiologi dan Terapi Intensif, Fakultas Kedokteran Universitas Sriwijaya,
Palembang, Indonesia
4
Bagian Biomedik, Fakultas Kedokteran Universitas Sriwijaya, Palembang, Indonesia
*08118009084, idea.malik.dr@gmail.com

Abstrak

Salah satu sistem skoring berdasarkan fisiologis yang dipakai di RSMH Palembang adalah
APACHE II yang merupakan sistem penilaian tingkat keparahan penyakit paling umum
digunakan. Namun, sistem ini sangat kompleks. SAPS II lebih sederhana karena
menggabungkan komponen dasar sistem penilaian APACHE dengan analisis regresi
logistik. Peneliti tertarik untuk melakukan penelitian tentang penggunaan sistem skoring
SAPS II. Membandingkan validitas sistem skoring SAPS II dan APACHE II terhadap
mortalitas pasien yang dirawat di UPI RSMH Palembang. Penelitian ini adalah uji validasi
dengan desain retrospektif kohort yang dilakukan pada pasien-pasien yang dirawat selama
periode tahun 2018. Didapatkan sampel sebanyak 295 pasien yang memenuhi kriteria
inklusi dan eksklusi. Selanjutnya dilakukan pengukuran sensitifitas dan spesifisitas serta
area di bawah kurva receiving operator (AUC) untuk menentukan diskriminasi.
Pengukuran kalibrasi digunakan uji Hosmer-Lemeshow goodness of fit. Didapatkan 73
pasien meninggal (24,7%). Diskriminasi Skor SAPS II dikategorikan sama baiknya dengan
APACHE II (0,789 dan 0,741, p = 0,000). Nilai cut off skor SAPS II dan APACHE II
adalah 39,5 dan 14,5 dengan sensitifitas 71,2% dan 68,5%, serta spesifisitas 71,6% dan
69,8%. Namun, kalibrasi skor SAPS II (p = 0,000) dan APACHE II (p = 0,000) tergolong
kategori kurang baik. Skor SAPS II memiliki validitas yang sebanding terhadap APACHE
II.

Kata Kunci: Acute Physiology and Chronic Health Evaluation II, angka mortalitas,
diskriminasi, kalibrasi , Simplified Acute Physiology Score II, Unit Perawatan Intensif.

References:

1. Moghaddam HH, Amiri H, Zamani N, Rahimi M, Shadnia S, and Taherkhani M. QT

dispersion and prognostication of the outcome in acute cardiotoxicities: a comparison
with SAPS II and APACHE II scoring systems. Cardiovascular Toxicology.
2014;2(14):129-133.
2. Feng Z, Wang T, Liu P, Chen S, Xiao H, Xia N, et al. Efficacy of various scoring system
for predicting the 28-day survival rate among patients with acute exacerbation of
chronic obstructive pulmonary disease requiring emergency intensive care. Canadian
Respiratory Journal. 2017;10(2017):1-9.