A Modified APACHE II Score for Predicting Mortality of Variceal Bleeding

Abstract

Introduction: Prediction of outcome of based on personal experience is subjective. There is a need for a method of prediction to suit our current state of practice.
Objectives: To evaluate a modified APACHE II system in predicting mortality in acute variceal bleeding.
Patients and methods: Prospective study conducted from June 2005 through September 2006 in the Ibn Sina Hospital Bleeding Centre ICU. Clinical and laboratory data for 102 patients were allotted a modified APACHE II score, a child-Pugh class and fed to SPSS to calculate predicted mortality.
Results: The mean (±SD) age 49.2(± 16.1) years. Male were 79(77.5%). Patients with liver cirrhosis and periportal fibrosis were 75 (73.5%) and 27 (26.5%)) respectively. The mean predicted mortality was 22.8% while the actual mortality was 26.5% (27) patients. The mean modified APACHE II score among the deceased group was 19.04. Rate of
deaths among liver cirrhosis patients was 12 (44.4%) with mean predicted mortality of 27.3%. Deaths among periportal fibrosis occur at mean modified APACHE II score 17.7 and mean predicted mortality of 20%. Seventeen patients had
ICU stay L 4 days. Ten out of them died (58.8%).
Conclusion: Modified APACHE II score is effective in predicting outcome of patients with variceal bleeding. Score of L 15 points and long ICU stay are associated with high mortality.


Keywords: liver cirrhosis, periportal fibrosis, portal hypertension, schistosomiasis

udan Journal of Medical Sciences Vol. 2 (2) 2007: pp. 105-112