Is SAPS 3 better than APACHE II at predicting mortality in critically ill transplant patients?

Oliveira, Vanessa Martins de; Brauner, Janete Salles; Filho, Édison Moraes Rodrigues; Susin, Ruth Guimarães de Almeida; Draghetti, Viviani; Bolzan, Simone Tasqueto; Vieira, Sílvia Regina Rios

doi:10.6061/clinics/2013(02)oa06

Cited by 24 publications

(34 citation statements)

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“…However, validation studies of SAPS 3 were performed in specific subgroup of patients or in single-center studies involving a general ICU population [7–16]. In general, both the SAPS 3-SE and SAPS 3-CSA equations were evaluated in the studies.…”

Section: Discussionmentioning

confidence: 99%

“…In these previous studies, the SAPS 3-SE had a poor calibration and tended usually to underestimate mortality [7–10, 12]. The SAPS 3-SE tended to overestimate mortality in only two studies (one of them comprising patients with acute coronary syndromes), both with a relatively low mortality rate [11, 16].…”

Section: Discussionmentioning

confidence: 99%

“…However, to our knowledge, validation studies reported conflicting results and were mostly single centered, involving specific patient populations [7–13] and with relatively small sample sizes [14–16]. Moreover, as the calibration of severity-of-illness scores is expected to deteriorate overtime, the performance of such instruments should be reassessed on a regular basis [17].…”

Section: Introductionmentioning

confidence: 99%

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External validation of SAPS 3 and MPM0-III scores in 48,816 patients from 72 Brazilian ICUs

Moralez

Rabello

Lisboa³

et al. 2017

Ann. Intensive Care

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BackgroundThe performance of severity-of-illness scores varies in different scenarios and must be validated prior of being used in a specific settings and geographic regions. Moreover, models’ calibration may deteriorate overtime and performance of such instruments should be reassessed regularly. Therefore, we aimed at to validate the SAPS 3 in a large contemporary cohort of patients admitted to Brazilian ICUs. In addition, we also compared the performance of the SAPS 3 with the MPM0-III.MethodsThis is a retrospective cohort study in which 48,816 (medical admissions = 67.9%) adult patients are admitted to 72 Brazilian ICUs during 2013. We evaluated models’ discrimination using the area under the receiver operating characteristic curve (AUROC). We applied the calibration belt to evaluate the agreement between observed and expected mortality rates (calibration).ResultsMean SAPS 3 score was 44.3 ± 15.4 points. ICU and hospital mortality rates were 11.0 and 16.5%. We estimated predicted mortality using both standard (SE) and Central and South American (CSA) customized equations. Predicted mortality rates were 16.4 ± 19.3% (SAPS 3-SE), 21.7 ± 23.2% (SAPS 3-CSA) and 14.3 ± 14.0% (MPM0-III). Standardized mortality ratios (SMR) obtained for each model were: 1.00 (95% CI, 0.98–0.102) for the SAPS 3-SE, 0.75 (0.74–0.77) for the SAPS 3-CSA and 1.15 (1.13–1.18) for the MPM0-III. Discrimination was better for SAPS 3 models (AUROC = 0.85) than for MPM0-III (AUROC = 0.80) (p < 0.001). We applied the calibration belt to evaluate the agreement between observed and expected mortality rates (calibration): the SAPS 3-CSA overestimated mortality throughout all risk classes while the MPM0-III underestimated it uniformly. The SAPS 3-SE did not show relevant deviations from ideal calibration.ConclusionsIn a large contemporary database, the SAPS 3-SE was accurate in predicting outcomes, supporting its use for performance evaluation and benchmarking in Brazilian ICUs.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0276-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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External validation of SAPS 3 and MPM0-III scores in 48,816 patients from 72 Brazilian ICUs

Moralez

Rabello

Lisboa³

et al. 2017

Ann. Intensive Care

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“…En Brasil en al año 2009 se realizó un estudio de validación de la escala SAPS 3, los pacientes de estudio fueron ingresados en unidades de cuidados intensivos durante el periodo del 1 de marzo de 2008 al 1 de marzo 2009 y obteniendo los siguientes resultados: mortalidad real 10.8% y mortalidad prevista de 10.3%; la escala SAPS 3 mostró mejor sensibilidad (75%) y especificidad (86%) para la mortalidad hospitalaria que APACHE II, además al aplicar otro tipo de puntuación (APACHE II: Acute Physiology and Chronic Health Evaluation II) se mostraron resultados insuficientes para la predicción, baja discriminación y el inconveniente de no ser aplicable para todas las poblaciones, por lo cual actualmente es considerada obsoleta [7][8][9][10].…”

Section: Discussionunclassified

Validación de la Escala SAPS 3 como Modelo Predictor de Mortalidad en la Unidad de Cuidados Intensivos del Hospital Vicente Corral Moscoso. 2013.

et al. 2016

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ARTÍCULO ORIGINAL ACCESO ABIERTO©2016 Ordóñez et al.; Licencia Rev Med HJCA. Este es un artículo de acceso abierto distribuido bajo los términos de "Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License" (http://creativecommons.org/licenses/ by-nc-sa/4.0/), la cual permite copiar y redistribuir el material en cualquier medio o formato; mezclar, transformar y crear a partir del material, dando el crédito adecuado al propietario del trabajo original.El dominio público de transferencia de propiedad (http://creativecommons.org/publicdomain/ zero/1.0/) aplica a los datos recolectados y disponibles en este artículo, a no ser que exista otra disposición del autor. * Cada término de los Descriptores de Ciencias de la Salud (DeCS) reportados en este artículo ha sido verificado por el editor en la Biblioteca Virtual de Salud (BVS) de la edición actualizada a marzo de 2016, el cual incluye los términos MESH, MEDLINE y LILACS (http://decs.bvs.br/E/ homepagee.htm). TRABAJO ORIGINALREVISTA MÉDICA HJCA RESUMEN INTRODUCCIÓN: La estandarización de la mortalidad en las UCI ha sido un reto debido a la importante heterogeneidad de los pacientes ingresados. Este estudio tuvo como objetivo describir los resultados de la aplicación de la escala SAPS 3 en la UCI del HVCM para comparar la mortalidad real frente a la calculada mediante la escala. MÉTODO:Estudio basado en un diseño descriptivo-retrospectivo y de pruebas diagnós-ticas; se incluyeron 323 pacientes ingresados a UCI del HVCM en el año 2013. Se realizó una revisión de historias clínicas para la recopilación de la información; para el procesamiento de la información se utilizó Microsoft Excel® y la calculadora virtual de SAPS 3. Se estudiaron variables necesarias para el cálculo de la escala y los registros de mortalidad de los pacientes estudiados; además se utilizaron pruebas diagnósticas para determinar la utilidad de la escala en la población de estudio y correlacionar sus resultados con los hallazgos reales sobre mortalidad. RESULTADOS:Se incluyeron 323 pacientes: 42.72% menores de 40 años y un 45.2% transferidos directamente de quirófano. El 96.27% no utilizó drogas vasoactivas antes del ingreso y el 93.2% mantuvieron una tensión arterial sistólica mayor a 70mmHg, el 72% un pulso de hasta 120 latidos por minuto y el 53% ingresaron con un Glasgow de entre 7 y 12 puntos. Según la escala SAPS 3, el porcentaje promedio de mortalidad fue de 24±12% y el real de 21%; a nivel del 32% de mortalidad esperada se obtuvo una sensibilidad de 75% y una especificidad 82%. CONCLUSIONES:La escala SAPS 3 es un buen predictor de mortalidad en la UCI del HVCM debido al cálculo de sensibilidad y especificidad.

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“…APACHE II, SAPS II) remain 'gold standards' in prognostication among severely ill patients in individual ICUs worldwide. Both APACHE and SAPS performance in predicting in-hospital mortality has already been veri ed in patients with various diagnoses (8)(9)(10)(11)(12)(13)(14)(15)(16). However, their use in assessing post-discharge mortality in ICU survivors has not been studied (17)(18)(19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

Validation of APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed intensive care unit in Poland: a cohort study

Czajka

Ziębińska

Marczenko

et al. 2020

Preprint

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Background. There are several scores used for in-hospital mortality prediction in critical illness. Their application in a local scenario requires validation to ensure appropriate diagnostic accuracy. Moreover, their use in assessing post-discharge mortality in intensive care unit (ICU) survivors has not been extensively studied. We aimed to validate APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed adult ICU in Poland. APACHE II, APACHE III and SAPS II scores, with corresponding predicted mortality ratios, were calculated for 303 consecutive patients admitted to a 10-bed ICU in 2016. Short-term (in-hospital) and long-term (12-month post-discharge) mortality was assessed.Results. Median APACHE II, APACHE III and SAPS II scores were 19 (IQR 12-24), 67 (36.5-88) and 44 (27-56) points, with corresponding in-hospital mortality ratios of 25.8% (IQR 12.1-46.0), 18.5% (IQR 3.8-41.8) and 34.8% (IQR 7.9-59.8). Observed in-hospital mortality was 35.6%. Moreover, 12-month post-discharge mortality reached 17.4%. All the scores predicted in-hospital mortality (p<0.05): APACHE II (AUC=0.78; 95%CI 0.73-0.83), APACHE III (AUC=0.79; 95%CI 0.74-0.84) and SAPS II (AUC=0.79; 95%CI 0.74-0.84); as well as mortality after hospital discharge (p<0.05): APACHE II (AUC=0.71; 95%CI 0.64-0.78), APACHE III (AUC=0.72; 95%CI 0.65-0.78) and SAPS II (AUC=0.69; 95%CI 0.62-0.76), with no statistically significant difference between the scores (p>0.05). The calibration of the scores was good.Conclusions. All the scores are acceptable predictors of in-hospital mortality. In the case of post-discharge mortality, their diagnostic accuracy is lower and of borderline clinical relevance. Further studies are needed to create scores estimating the long-term prognosis of subjects successfully discharged from the ICU.

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Is SAPS 3 better than APACHE II at predicting mortality in critically ill transplant patients?

Cited by 24 publications

References 43 publications

External validation of SAPS 3 and MPM0-III scores in 48,816 patients from 72 Brazilian ICUs

External validation of SAPS 3 and MPM0-III scores in 48,816 patients from 72 Brazilian ICUs

Validación de la Escala SAPS 3 como Modelo Predictor de Mortalidad en la Unidad de Cuidados Intensivos del Hospital Vicente Corral Moscoso. 2013.

Validation of APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed intensive care unit in Poland: a cohort study

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