The Use of the Acute Physiology and Chronic Health Evaluation II (APACHE II) Score and C-reactive Protein/Albumin Ratio to Predict Morbidity and Mortality in Patients Undergoing Emergency Exploratory Laparotomy

TL;DR

This study compares the APACHE II score and CRP/albumin ratio to predict complications and death after emergency abdominal surgery.

Contribution

The CRP/albumin ratio showed slightly better predictive performance than the APACHE II score for post-operative complications.

Findings

APACHE II score ≥13 predicted major complications with 93% sensitivity and 81% specificity.

CRP/albumin ratio ≥5.1 predicted major complications with 95% sensitivity and 93% specificity.

CRP/albumin ratio had a higher AUC (0.97) than APACHE II (0.946) for predicting complications.

Abstract

Background

Exploratory laparotomy in emergency setting is associated with significant post-operative morbidity and mortality. Several prognostic indices have been developed to predict the outcomes. The present study investigated the APACHE II (Acute Physiology and Chronic Health Evaluation II) score and C-reactive protein (CRP)/albumin ratio as predictors of morbidity and mortality in patients who underwent emergency exploratory laparotomy at a tertiary-care hospital.

Methods

One hundred consecutive patients undergoing emergency laparotomy were enrolled. The APACHE II score and CRP/albumin ratio were calculated. Post-operatively, all complications (Clavien-Dindo classification) and deaths within 30 days of surgery were observed. Comparison of the receiver operating characteristic curve was performed to compare the area under the curve (AUC) of APACHE II and CRP/albumin ratio in predicting complications and mortality.

Results

The APACHE II score ≥13 predicted major complications with a sensitivity of 93% and a specificity of 81%. The CRP/albumin ratio ≥5.1 was found to predict major complications with a sensitivity and specificity of 95% and 93%, respectively. The AUC for the APACHE II Score and CRP/albumin ratio in predicting major complications was 0.946 and 0.97, respectively (p <0.001), thus demonstrating excellent diagnostic performance.

Conclusion

We found that the better parameter in terms of AUC is the CRP/albumin ratio, although statistically there was no significant difference in the diagnostic performance of the two parameters.

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