Effectiveness of Medical Care Provided in ICUs According to Acute Physiology and Chronic Health Evaluation II (APACHE ) Score Requirements

Abstract

Objective: The present study was conducted to assess the quality of medical care delivered in ICUs of IMAM Hussein Medical City, Karbala, Iraq, using the APACHE II scoring system.

Study Design: Cross-sectional study Place and Duration of Study: This study was conducted at the Imam Al-Hussein Medical City in Karbala, Iraq from October–December 2023.

Methods: This study of 131 ICU patients (≥18 years) conducted at Imam Al-Hussein Medical City in Karbala, Iraq across emergency, medical, and surgical units. Demographic, clinical, and cardiovascular data were used to compute APACHE II scores and accurately predict mortality.

Results: Majority of the patients were males, 62.6%, and above 60 years of age, 38.2%. Pathological admission caused 61.8% into the ICU. The general mortality rate was 52.7% whereas 73.3% of patients were on mechanical 
ventilation. The statistical analysis done revealed that the APACHE II scores had a significant relation to the patient outcome mainly in the surgical and medical ICUs. Higher APACHE II scores were associated with an increased 
mortality and mainly so in the emergency ICU since the patients were admitted with more acute illnesses, with their mean APACHE II score standing at 21.77. The surgical ICU remarkably recorded an actual outcome significantly different from the APACHE II predicted mortality with a p-value less than 0.001.

Conclusion: APACHE II predicts ICU mortality, notably in surgical units (scores ≥30–34: 100% fatality; p<0.001). Age, comorbidities (DM/HTN), and pathological admissions elevate scores (medical: r=0.553; surgical: r=0.384; p≤0.002). Males exhibit lower scores (p≤0.05). Emergency ICUs show highest mortality (69.2%) despite comparable scores. Mechanical ventilation correlates with medical ICU scores (p=0.009). APACHE II’s 
clinical/metabolic focus (no MAP/HR link) supports risk stratification. Future research needs biomarkers and gender-specific protocols.