Evaluation of mortality with scoring systems in the hematological oncology patients who followed-up in the intensive care unit

The intensive care units require multidisciplinary approach because of the variability in the patients that are followed-up. Various scoring systems have been developed to determine prognosis in the patients to follow-up from the beginning, to regulate their treatment and to group patients for the clinical trials. Acute Physiology and Chronic Health Evaluation (APACHE) is the first developed scoring system to predict the prognosis of the patients. In the following years, other scoring systems such as Simplified Acute Physiology Score (SAPS), Sequential Organ Failure Assessment (SOFA), Mortality Probability Models (MPM) have been presented for use. Admission of haematological oncology patients to the intensive care units frequently requires use of extensive technological and physical resources. Therefore; admission of haematological oncology patients to the intensive care units lead to ethical dilemmas for oncologists and anaesthesists. The prediction of prognosis becomes important with respect to regulation of patient therapy and informing the patients and their relatives about mortality and morbidity. As though, some of the studies have shown that scoring systems include valuable prognostic factors in predicting mortality, nevertheless, significant results have not been obtained in some studies. In our study, we aimed to evaluate the capability of the acute physiology and organ insufficiency scores with respect to prediction of mortality in the hematological oncology patients who were transplanted or nontransplanted bone-marrow and followed-up in the intensive care unit. The scores APACHE II, III, IV, SAPS III and SOFA were evaluated and their predictive capabilities were compared.The patient files of the patients who were transplanted (Group 1, n=25) or nontransplanted (Group 2, n=25) bone-marrow and followed-up in the intensive care unit of the Yeditepe University Hospital between the years 2005 to 2010 have been reviewed retrospectively. The scores of the patients were recorded on a daily basis or in the first 24 hours following admission to intensive care unit depending on their specifications and their predictive capabilities with respect to mortality have been evaluated statistically. The SPSS 17.0 (SPSS Inc. Chicago, Ill, USA) software was used in the statistical evaluation.It has been detected that SOFA 1st day value (p < 0,05), SOFA 3rd day value (P < 0,01), vasopressor requirement (p < 0,05), aPTT value (p < 0,05), presence of reproduction in the blood culture (p < 0,05) of the Group I patients and APACHE III value (p < 0,05), SOFA 3rd day value (p < 0,05), vasopressor requirement (p < 0,001) and creatinin value (p < 0,05) of the Group II patients shown correlation with exitus in the intensive care unit.Key words: APACHE II, APACHE III, APACHE IV, SAPS III, SOFA, haematological oncology patients