Supplemental Digital Content
Supplemental Digital Content 1. All potential determinants including definitions,
data measurement scales, levels of measurement and presence of determinants in
the APACHE-IV model
Present in
Potential Measurement Range or levels of APACHE-IV
Definition
determinant scale measurement modela
Age Age in years on ICU admission Categorical <45; 45-59; 60-64; Yes
65-69; 70-74; 75-
84; ≥85
Sex Genotypic sex of ICU patients Categorical Male - Female Yes
Acute APS within APACHE III structure Continuous 0-252 Yes
Physiology
Score (APS)
APS without APS within APACHE III structure Continuous 0-204 Indirect as
point assigned minus the assigned points for GCS part of APSb
for GCS score on ICU admission
GCS score Glasgow Coma Scale; lowest score Categorical High (13-15); Only indirect
(lowest score during the first 24 hours of ICU Moderate (9-12); via APSb
during first 24h admission; sedative effects were not Low (3-8);
of ICU scored (in that case the last Not available
admission) observed GCS was used); GCS<15
was only scored if a real lowered
consciousness level was objectfied
Specialized Hospitals that are assigned to Categorical Yes - No No
neurosurgical provide specialised intracranial
centre neurosurgical care and in which
post-operative care can be continued
in the hospital’s ICU
Type of Medical or surgical (whether elective Categorical Medical - Surgical Yes
admissionc or emergency) reason for ICU
admission
Time of Time of ICU admission, whether this Categorical 8:00-18:00h (day- No
admissionc is during day-time hours of shift time); 18:00h-
hours 8:00h (shift-time)
Type of All national hospitals are categorised Categorical Academic – No
hospitalc into (1) academic (university medical Teaching -
centres, 8 in total), (2) teaching General
hospitals (large hospitals providing
highly specialised medical care and
collaborating in cooperation STZ
(“Samenwerkende Topklinische
opleidingsZiekenhuizen”), which is
based on medical specialist training
programmes) and (3) general
hospitals
Calendar yearc Year of ICU admission Categorical 2010-2019 No
(table continues)
Present in
Potential Measurement Range or levels APACHE-IV
Definition
determinant scale of measurement modela
COMORBIDITIES
Chronic Chronic restrictive or obstructive lung Categorical Yes - No No
respiratory disease resulting in severe functional
insufficiency or disability
COPD OR
Registered chronic hypoxia or severe
pulmonary hypertension (systolic
PAP>40 mmHg) or oxygen
dependency
OR
Diagnosis of COPD more than 6
months ago with use of
bronchodilators or steroids prescribed
for chronic pulmonary disease
NYHA class IV Inability to carry on any physical Categorical Yes - No No
activity without discomfort. Symptoms
of heart failure at rest.
Diabetes Diagnosis of diabetes before ICU Categorical Yes - No Yes
admission and treated with oral anti-
diabetics or insulin
Chronic renal Raised serum creatinine larger than Categorical Yes - No Yes; only
insufficiency or 2.0 mg per 100 ml or 177umol/l dialysis
dialysis combined with diagnosis of chronic dependency
dependency renal failure before current hospital
admission
OR
Dialysis dependency (haemodialysis
or peritoneal dialysis) before current
hospital admission
Immunologic Prolonged use of immunosuppressive Categorical Yes - No Yes; AIDS
deficiency or therapy separately
compromised OR
status Use of oral or intravenous
corticosteroids (more than 5 days
1mg/kg prednisone or more than 20
days 0.1mg/kg prednisone or
equivalent)
OR
Active chemotherapy or radiotherapy
within the last year
OR
Documented humoral or cellular
immunodeficiency
Malignancies Current solid tumour proven by Categorical Yes - No Yes
radiological examination or
pathological report
OR
Stadium IV neoplasm
OR
Hematologic malignancy as malign
lymphoma, acute leukaemia or
multiple myeloma
(table continues)
Present in
Potential Measurement Range or levels APACHE-IV
Definition
determinant scale of measurement modela
COMPLICATIONS AND ICU TREATMENTS
Mechanical Use of invasive or non-invasive Categorical Yes - No Yesb
ventilation mechanical ventilator during first 24
hours of ICU admission
Use of Continuous intravenous medication Categorical Yes - No No
intravenous during at least 1 hours during first 24
vasoactive hours of ICU admission of one of the
medication following groups:
- positive inotropes
- vasopressors
- phosphodiesterase inhibitor
Acute renal Use of renal replacement therapy Categorical Yes - No Only indirect
failure during first 24 hours of ICU admission via APSb
OR
serum creatinine larger than 1.5 mg
per 100 ml or 133umol/l combined
with oliguria (defined as diuresis of
150 ml or less in 8 hours in a row)
Confirmed Confirmed infection using cultures and Categorical Yes - No No
infection gram stains
OR
Combination of perioperative or
radiographic observation with clinical
findings and laboratory results
APACHE, Acute Physiology and Chronic Health Evaluation; ICU, intensive care unit; COPD, chronic obstructive
pulmonary disease; NYHA, New York Heart Association; GCS, Glasgow Coma Scale
a
Additional covariates in the APACHE-IV model are hepatic cirrhosis and admission origin.
b
In the APACHE-IV model, the determinants ‘Mechanical ventilation’ and ‘Acute renal failure’ are used in the
APACHE-III APS, to choose between two parameters to assign APS points for. The GCS score on admission is
used as a parameter in the APACHE-III APS as well (see also Supplemental Digital Content 2), although
excluded from the APS in the models derived in this study to separate acute physiologic derangement and
impaired level of consciousness as explicated in the Methods section.
c
Used to adjust for in descriptive models only
