• Vanessa Stevens, Thomas P Lodise, Brian Tsuji, Meagan Stringham, Jill Butterfield, Elizabeth Dodds Ashley, Kristen Brown, Alan Forrest, and Jack Brown.
• Department of Pharmacy Practice, State University of New York School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA.
• Infect Control Hosp Epidemiol. 2012 Jun 1;33(6):558-64.

ObjectiveBloodstream infections due to methicillin-resistant Staphylococcus aureus (MRSA) have been associated with significant risk of in-hospital mortality. The acute physiology and chronic health evaluation (APACHE) II score was developed and validated for use among intensive care unit (ICU) patients, but its utility among non-ICU patients is unknown. The aim of this study was to determine the ability of APACHE II to predict death at multiple time points among ICU and non-ICU patients with MRSA bacteremia.DesignRetrospective cohort study.ParticipantsSecondary analysis of data from 200 patients with MRSA bacteremia at 2 hospitals.MethodsLogistic regression models were constructed to predict overall in-hospital mortality and mortality at 48 hours, 7 days, 14 days, and 30 days using APACHE II scores separately in ICU and non-ICU patients. The performance of APACHE II scores was compared with age adjustment alone among all patients. Discriminatory ability was assessed using the c-statistic and was compared at each time point using χ(2) tests. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test.ResultsAPACHE II was a significant predictor of death at all time points in both ICU and non-ICU patients. Discrimination was high in all models, with c-statistics ranging from 0.72 to 0.84, and was similar between ICU and non-ICU patients at all time points. APACHE II scores significantly improved the prediction of overall and 48-hour mortality compared with age adjustment alone.ConclusionsThe APACHE II score may be a valid tool to control for confounding or for the prediction of death among ICU and non-ICU patients with MRSA bacteremia.

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