Clinical Outcomes of Intensive Care Units’ Patients according to the APACHE II Score at Ghazi Al Hariri Hospital for Surgical Specialties

Authors

DOI:

https://doi.org/10.32007/jfacmedbaghdad3273

Keywords:

APACHE II, Critically ill patients, Intensive Care Units, Mortality Rates, Prognosis

Abstract

Background: APACHE II is an abbreviation for the Acute Physiology and Chronic Health Evaluation scoring system that is frequently used to study the possibility of disease progression and predict the mortality risk in patients with critical illness.
Objectives: To analyze the outcomes of the Intensive Care Unit (ICU) at Ghazi Hariri Hospital for Surgical Specialties using the APACHE II scoring system.
Methods: From May 28 to August 28, 2025, a prospective cohort study took place. Included were (100) patients (≥18 years old) who remained for at least 24 hours at the ICU of Ghazi Hariri Hospital, Baghdad. The APACHE II scoring system was calculated for each patient within a period not exceeding 24 hours. Statistical analyses were performed using SPSS, which included a Chi-square test used to analyze the associations between the APACHE II scores, demographic variables, and patient outcomes, and the two-way ANOVA to test the differences between each group.
Results: The mean age was 54.1 ± 20.43 years, with 53 males and 47 females. Mortality increased significantly in patients with higher APACHE II values. The observed mortality was lower than predicted, particularly among patients with APACHE II scores ≥ 30. The outcome had a significant effect on the APACHE II score (p < 0.001), while the diagnosis type didn't show significant results. Mortality rates were higher for medically admitted patients (51%) compared to surgical patients (30.6%). Elderly people were associated with poor outcomes.
Conclusion: The most important findings are that APACHE II scores and age served as a powerful prognostic tool in estimating patients' outcomes in the ICU. However, sex showed a result of no effect on mortality rates. The study also pointed to the role of ICU staff, which has a great impact on improving patients' outcomes.

References

1. Quintairos A, Pilcher D, Salluh JI. ICU scoring systems. Intensive Care Medicine. 2023 Feb;49(2):223-5. https://doi.org/10.1007/s00134-022-06914-8.

2. Lee OP, Kanesan N, Leow EH, et al. Survival benefits of therapeutic plasma exchange in severe sepsis and septic shock: a systematic review and meta-analysis. J. Intensive Care. 2023 Jul;38(7):598-611. https://doi.org/10.1177/08850666231170775

3. Afessa B, Gajic O, Keegan MT. Severity of illness and organ failure assessment in adult intensive care units. Critical Care Clinics. 2007 Jul 1;23(3):639-58. https://doi.org/10.1016/j.ccc.2007.05.004.

4. Chang YC, Invernizzi J, Mcizana T. Validation of the APACHE II scoring system in critically ill patients diagnosed with COVID-19 and admitted at a regional-level hospital intensive care unit: A retrospective study. Southern African Journal of Critical Care. 2025 Sep 23;41(2):e1522. https://doi.org/10.7196/SAJCC.2025.v412.1522.

5. Fernandes S, Sérvio R, Patrício P, et al. Validation of the acute physiology and chronic health evaluation (APACHE) II score in COVID-19 patients admitted to the intensive care unit in times of resource scarcity. Cureus. 2023 Feb 7;15(2). https://doi.org/10.7759/cureus.34721

6. Mumtaz H, Ejaz MK, Tayyab M, et al. APACHE scoring as an indicator of mortality rate in ICU patients: a cohort study. Ann. Med. Surg. 2023 Mar 1;85(3):416 https://doi.org/10.1097/MS9.0000000000000264.

7. Ali AH, Harun SN, Othman N, et al. Discriminatory performance of APACHE II score and the prediction of mortality within the ICU in patients with sepsis admitted to the ICU. Materia Socio-Medica. 2025;37(2):153-158. https://doi.org/10.5455/msm.2025.37.153-158.

8. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit. Care Med. 1985 Oct 1;13(10):818-29. https://doi.org/10.1097/00003246-198510000-00009.

9. Sarkar R, Martin C, Mattie H, et al. Performance of intensive care unit severity scoring systems across different ethnicities in the USA: a retrospective observational study. Lancet Digit Health. 2021 Apr;3(4):e241-e249. https://doi.org/10.1016/S2589-7500(21)00022-4.

10. Sadaka F, Cytron MA, Fowler K, et al. A model for identifying patients who may not need neurologic intensive care unit admission: resource utilization study. J. Intensive Care. 2016 Mar;31(3):193-7. https://doi.org/10.1177/0885066614530952.

11. Yelamanchi R. The APACHE II scoring systems and the ICU. InBiomarkers in Trauma, Injury and Critical Care 2022 Jul 27 (pp. 1-14). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-87302-8_52-1.

12. Tian Y, Yao Y, Zhou J, et al. Dynamic APACHE II score to predict the outcome of intensive care unit patients. Front Med. 2021; 8:744907. https://doi.org/10.3389/fmed.2021.744907.

13. Deniz M, Ayvat P. Factors affecting the outcome of older adults followed in the intensive care unit according to age stages: Mortality in older adults in ICU. JOSAM. 2023 Sep 22;7(9):602-6. https://doi.org/10.28982/josam.7925.

14. Farajzadeh M, Nasrollahi E, Bahramvand Y, et al. The use of APACHE II Scoring System for predicting clinical outcome of patients admitted to the intensive care unit: a report from a resource-limited center. Shiraz E-Med J. 2021; 22(5):e102858. https://doi.org/10.5812/semj.102858.

15. Nuttall D, Parkin D, Devlin N. Inter-provider comparison of patient-reported outcomes: developing an adjustment to account for differences in patient case mix. Health economics. 2015 Jan;24(1):41-54. https://doi.org/10.1002/hec.2999.

16. Ismail AJ, Hassan WM, Nor MB, et al. The impact of age on mortality in the intensive care unit: a retrospective cohort study in Malaysia. Acute and Critical Care. 2024 Aug 12;39(3):390-9. https://doi.org/10.4266/acc.2024.00640.

17. Khan IA, Ullah MK, Mahmood S, et al. Predictive accuracy of APACHE II score in predicting mortality in poly Trauma patients. TPMJ. 2021 Nov 30;28(12):1752-7. https://doi.org/10.29309/TPMJ/2021.28.12.6852.

18. Kim JY, Lim SY, Jeon K, et al. External validation of the Acute Physiology and Chronic Health Evaluation II in Korean intensive care units. Yonsei Medical Journal. 2013 Jan 22;54(2):425. https://doi.org/10.3349/ymj.2013.54.2.425.

19. Shadvar K, Nader-Djalal N, Vahed N, et al. Comparison of lactate/albumin ratio to lactate and lactate clearance for predicting outcomes in patients with septic shock admitted to intensive care unit: an observational study. Scientific Reports. 2022 Jul 29;12(1):13047. https://doi.org/10.1038/s41598-022-14764-z.

20. Silakhori S, Dadpour B, Khadem RM, et al. Comparing APACHE II, APACHE IV, SAPS II, and SOFA predictive power in poisoned patients admitted to the intensive care unit. Int. J. Med. Toxicol. Forensic Med. 2020; 10(2):28814. https://doi.org/10.32598/ijmtfm.v10i2.28814

Downloads

Issue

Section

Articles

Categories

How to Cite

1.
Ali WI, Alkhalidy T, Al Janabi E, El Helfi J, EL-Baage T. Clinical Outcomes of Intensive Care Units’ Patients according to the APACHE II Score at Ghazi Al Hariri Hospital for Surgical Specialties. J Fac Med Baghdad [Internet]. [cited 2026 Aug. 18];. Available from: https://iqjmc.uobaghdad.edu.iq/index.php/19JFacMedBaghdad36/article/view/3273