To the Editor.—The recent paper by Cerra et al1 presents the results of a clinical study using the APACHE II (acute physiology and chronic health evaluation) score to predict the development of and mortality associated with multiple organ failure syndrome. The authors conclude that the APACHE II score is an insensitive predictor of this disease. We would like to highlight several shortcomings in this study's methods.
The APACHE II risk prediction equation was designed to stratify the risk of unselected patients in 13 US medical and surgical intensive care units. In the retrospective study by Cerra et al, significantly different and more stringent selection criteria were used. Eligible patients all experienced precipitating events such as septic shock and subsequent surgical interventions within 24 hours of admission to the intensive care unit. In addition, eligible patients had to develop pulmonary failure, require mechanical ventilation,