Assessment of performance and utility of mortality prediction models in a single Indian mixed tertiary intensive care unit

Abstract

Objectives:To assess the performance and utility of two mortality prediction models viz. Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in a single Indian mixed tertiary intensive care unit (ICU). Secondary objectives were bench-marking and setting a base line for research.Materials and Methods:In this observational cohort, data needed for calculation of both scores were prospectively collected for all consecutive admissions to 28-bedded ICU in the year 2011. After excluding readmissions, discharges within 24 h and age <18 years, the records of 1543 patients were analyzed using appropriate statistical methods.Results:Both models overpredicted mortality in this cohort [standardized mortality ratio (SMR) 0.88 ± 0.05 and 0.95 ± 0.06 using APACHE II and SAPS II respectively]. Patterns of predicted mortality had strong association with true mortality (R2 = 0.98 for APACHE II and R2 = 0.99 for SAPS II). Both models performed poorly in formal Hosmer-Lemeshow goodness-of-fit testing (Chi-square = 12.8 (P = 0.03) for APACHE II, Chi-square = 26.6 (P = 0.001) for SAPS II) but showed good discrimination (area under receiver operating characteristic curve 0.86 ± 0.013 SE (P < 0.001) and 0.83 ± 0.013 SE (P < 0.001) for APACHE II and SAPS II, respectively). There were wide variations in SMRs calculated for subgroups based on International Classification of Disease, 10th edition (standard deviation ± 0.27 for APACHE II and 0.30 for SAPS II).Interpretation and Conclusion:Lack of fit of data to the models and wide variation in SMRs in subgroups put a limitation on utility of these models as tools for assessing quality of care and comparing performances of different units without customization. Considering comparable performance and simplicity of use, efforts should be made to adapt SAPS II.

Clinical outcome and comparison of burn injury scoring systems in burn patient in Indonesia

“…Our findings suggested that abbreviated burn severity index (ABSI) demonstrated high accuracy compared to Ryan, Revised Baux Score, BOBI. This finding supports previous studies which showed good performance of ABSI [ [20] , [21] , [22] ]. The ABSI scoring system remains an accurate and valuable method for determining which is in line with other Swiss Burn Center results [ 22 ].…”

“…This finding supports previous studies which showed good performance of ABSI [ [20] , [21] , [22] ]. The ABSI scoring system remains an accurate and valuable method for determining which is in line with other Swiss Burn Center results [ 22 ]. Although Ryan, Revised Baux Score, BOBI also showed acceptable accuracy, in clinical practice, ABSI seems to be more easily implemented.…”

“…Discrepancies with earlier findings in this result could be due to the differences in demographic and quality of care in each area. It is therefore very crucial to analyse the internal or external validity of the prediction models before they are used in a new population or case mix [ 22 ].…”

Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study

“…In this context, several studies have reported that the Simplified Acute Physiology Score (SAPS) II is superior to APACHE II in predicting mortality [15][16][17][18]. Therefore, the purpose of this study was to propose a new mNUTRIC-S2 (S2 as a reference to SAPS II) scoring system to replace the outdated APACHE II with SAPS II and to compare the ICU mortality prediction ability of the mNUTRIC and mNUTRIC-S2 scores.…”