# Examining the Severity and Consequences of Patients Admitted With Acute Chest Pain via the Acute Physiology and Chronic Health Evaluation II Score and the Relevance of Adding High-Sensitivity Troponin Testing

## TL;DR

This study shows that combining APACHE II scores and high-sensitivity troponin testing improves predicting mortality in ICU patients with acute chest pain.

## Contribution

The study demonstrates the added prognostic value of high-sensitivity troponin when combined with APACHE II scores in ICU chest pain patients.

## Key findings

- Non-survivors had significantly higher APACHE II scores compared to survivors.
- High-sensitivity troponin positivity was strongly linked to higher mortality rates.
- The combined model showed excellent discrimination and good calibration for mortality prediction.

## Abstract

Background

Acute chest pain is a critical presentation in intensive care units (ICUs), demanding rapid and accurate risk stratification to guide timely intervention. While the Acute Physiology and Chronic Health Evaluation II (APACHE II) score quantifies physiological severity, high-sensitivity (HS) troponin offers a biochemical measure of myocardial stress. However, their combined prognostic potential in ICU chest pain populations remains underexplored.

Objective

This study aimed to evaluate the severity and outcomes of ICU patients admitted with acute chest pain using the APACHE II score and to determine the added prognostic relevance of HS troponin testing for mortality prediction.

Methods

A cross-sectional analytical study of 100 ICU patients was conducted at Hassan Ghazzawi Hospital (January-August 2025). Data on demographics, physiological variables, APACHE II scores, and HS troponin status were analysed using SPSS version 26.0 (IBM Corp., Armonk, NY).

Results

Non-survivors exhibited significantly higher APACHE II scores (19.0 ± 6.2 vs 11.1 ± 6.1, p < 0.001). HS troponin positivity was strongly associated with mortality (87% vs 20%, p < 0.001; OR = 27.8). Both APACHE II (OR = 1.18) and HS troponin (OR = 21.7) were independent mortality predictors. The model demonstrated excellent discrimination (AUC = 0.89) and good calibration (p = 0.65).

Conclusion

Both APACHE II score and HS troponin levels were evaluated as independent predictors of mortality using multivariate logistic regression analysis. Combined physiological and biochemical assessment enables superior risk stratification, optimising early intervention and improving clinical decision-making.