Comparison Of Validity Apache Ii, Sofa And Customized Sequential Organ Failure Assessment (Csofa) For Predicting Non-Surgical Patient

ABSTRACT Background : Application of Sistem Jaminan Kesehatan Nasional (SJKN) in intensive care unit (ICU) service encourages ICU services for being more effective and efficient. Prediction of mortality is important either for administration or clinical in ICU management. Even non-surgical patient population is not large, but it has high mortality rate. Objective : To gain good and easy to used scoring system, we assessed missing value, and discrimination for all scoring system. Methods :This research enrolled 184 non-surgical patients in ICU of Sanglah Hospital restrospectively started from 1 st january to 31 st december 2014. All patient assessed by APACHE II, SOFA, and CSOFA. Analytic logistic regression test is used to determine each sub variabel correlation with mortality, and then to gain cut off point of ROC analytical curve to get sensitivity and specificity. Result : Area under Receiver Operating Characteristic (AuROC) for APACHE, SOFA, and CSOFA is 0,892, 0,919, and 0,9172 consecutively. The missing value for SOFA, APACHE II, and CSOFA is 84,23%, 8,15%, dan 1,65%, which is dominated by bilirubin parameter. Logistic regression analysis shows sub variabel neurology, cardiovascular, and respiration gave significant correlation with mortality with OR 4,58, 2,24, and 1,47. Other significant subvariable are AKI, sepsis, and chronic illness with OR 8,14, 3,89 dan 2,42. Conclusion : CSOFA scoring system is more valid than APACHE II and SOFA to predict mortality, because it had better discrimination value and less missing value.