Comparing the APACHE II score and IBM-10 score for predicting mortality in patients with ventilator-associated pneumonia


1 Department of Infectious and Tropical Medicine, Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Anesthesiology, Intensive Care Unit, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Infectious and Tropical Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Background: VAP is defined as pneumonia in patients who use ventilators. The acute physiology and chronic health evaluation (APACHE II) scoring system was originally developed for predicting mortality in patients who were admitted to the intensive care unit. Due to the complexity, a simpler score called IBMP-10 was developed. We designed the study to confirm and further investigate these two methods.
Materials and Methods: This cross-sectional and analysis-descriptive study was done at the moment of VAP diagnosis on 60 patients in intensive care units. APACHE II and the IBMP-10 scores were calculated. ROC curves were generated to compare the new prediction rule with the APACHE II score. Results were reported as adjusted odds ratios with 95% confidence intervals (CIs). Analyses were performed using SPSS, version 20 and P values of 0.05 were considered to be statistically significant.
Results: APACHE II Score means (P < 0.001) and IBMP-10 score (P < 0.001) means had significant increase in Non-survivor patient than in patients who survived. APACHE II can be used as a good prediction measure for mortality rate. In IBMP-10 method, specificity and PPV were greater than APACHE II, but in mc-nemar test, there was no significant difference between the two methods (P = 0.55). Both prediction rules had high NPV. In our study, survivors' prediction value in APACHE II was 46.7%, and in IBMP-10, it was 46.7%.
Conclusion: IBMP-10, compared to APACHE II, has greater sensitivity, specificity, and AUC to predict mortality. So the consequence of the use of IBMP-10 was better than APACHE II.


Torres A, Ewig S, Lode H, Carlet J, European HAP Working Group. Defining, treating and preventing hospital acquired pneumonia: European perspective. Intensive Care Med 2009;35:9-29.  Back to cited text no. 1
Rea-Neto A, Youssef NC, Tuche F, Brunkhorst F, Ranieri VM, Reinhart K, et al. Diagnosis of ventilator-associated pneumonia: A systematic review of the literature. Crit Care Med 2008;12:R56.  Back to cited text no. 2
Torres A, Ferrer M, Badia JR. Treatment guidelines and outcomes of hospital-acquired and ventilator-associated pneumonia. Clin Infect Dis 2010;51 Suppl 1:S48-53.  Back to cited text no. 3
Mirsaeidi M, Peyrani P, Ramirez JA, Improving Medicine through Pathway Assessment of Critical Therapy of Hospital-Acquired Pneumonia (IMPACT-HAP) Investigators. Predicting mortality in patients with ventilator-associated pneumonia: The APACHE II score versus the new IBMP-10 score. Clin Infect Dis 2009;49:72-7.  Back to cited text no. 4
Tejerina E, Frutos-Vivar F, Restrepo MI, Anzueto A, Abroug F, Palizas F, et al. Incidence, risk factors, and outcome of ventilator-associated pneumonia. J Crit Care 2006;21:56-65.  Back to cited text no. 5
Koenig SM, Truwit JD. Ventilator-associated pneumonia: Diagnosis, treatment, and prevention. Clin Microbiol Rev 2006;19:637-57.  Back to cited text no. 6
Bauer TT, Ewig S, Marre R, Suttorp N, Welte T; CAPNETZ Study Group CRB-65 predicts death from community-acquired pneumonia. J Intern Med 2006;260:93-101.  Back to cited text no. 7
Renaud B, Coma E, Labarere J, Hayon J, Roy PM, Boureaux H, et al. Routine use of the pneumonia severity index for guiding the site-of-treatment decision of patients with pneumonia in the emergency department: A multicenter, prospective, observational, controlled cohort study. Clin Infect Dis 2007;44:41-9.  Back to cited text no. 8
Charles PG, Wolfe R, Whitby M, Fine MJ, Fuller AJ, Stirling R, et al. SMART-COP: A tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis 2008;47:375-84.  Back to cited text no. 9
Gursel G, Demirtas S. Value of APACHE II, SOFA and CPIS scores in predicting prognosis in patients with ventilator-associated pneumonia. Respiration 2006;73:503-8.  Back to cited text no. 10
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.  Back to cited text no. 11
Beck DH, Taylor BL, Millar B, Smith GB. Prediction of outcome from intensive care: A prospective cohort study comparing acute physiology and chronic health evaluation II and III prognostic systems in a United Kingdom intensive care unit. Crit Care Med 1997;25:9-15.  Back to cited text no. 12
Wiskirchen DE, Kuti JL, Nicolau DP. Acute physiology and chronic health evaluation II score is a better predictor of mortality than IBMP-10 in patients with ventilator-associated pneumonia. Surg Infect (Larchmt) 2011;12:385-90.  Back to cited text no. 13