Assessment of the Prognosis of Coronary Patients

Sarmiento, X.; Rué, Montserrat; Toboso, J. M.; Solèr, M.; Artigas, A.

doi:10.1378/chest.111.6.1666

Cited by 11 publications

(2 citation statements)

References 17 publications

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“…However, except for APACHE III, 20 the older versions of the scores were not developed in cohorts with ACS patients, although they were validated in this group of patients afterwards. 2 , 21 , 22 ACS patients were included in developing the newest versions (APACHE IV and SAPS 3), but these still have not been validated in an external ACS population.…”

Section: Discussionmentioning

confidence: 99%

“… 2 Subsequently, a comparison between APACHE II, SAPS II and MPM-II (mortality probability models) showed that all of these scores presented appropriate calibration and good discrimination for AMI patients. 22 Recently, the same group found that a prognostic model that included the Killip classification and APACHE II showed good accuracy. 24 …”

Section: Discussionmentioning

confidence: 99%

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SAPS 3, APACHE IV or GRACE: which score to choose for acute coronary syndrome patients in intensive care units?

et al. 2013

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CONTEXT AND OBJECTIVE: Acute coronary syndromes (ACS) are a common cause of intensive care unit (ICU) admission. Specific prognostic scores have been developed and validated for ACS patients and, among them, GRACE (Global Registry of Acute Coronary Events) has had the best performance. However, intensive care clinicians generally use prognostic scores developed from heterogeneous populations of critically ill patients, such as APACHE IV (Acute Physiologic and Chronic Health Evaluation IV) and SAPS 3 (Simplified Acute Physiology Score 3). The aim of this study was to evaluate and compare the performance of these three scores in a non-selected population of ACS cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

SAPS 3, APACHE IV or GRACE: which score to choose for acute coronary syndrome patients in intensive care units?

et al. 2013

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When to customize a severity model

Teres¹,

Lemeshow

1999

Intensive Care Med

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General intensive care unit (ICU) severity models are remarkably popular, as judged by the number of peer review publications that contain a severity system as a key component of the study. A MEDLINE search of articles published between January 1993 and December 1997 revealed that there were 552 articles published, with two-thirds of these studies using the Acute Physiology and Chronic Health Evaluation (APACHE), mortality probability models (MPMs), or the Simplified Acute Physiology Score (SAPS) (S. Weitzen, T. Higgins, D. Teres, unpublished data). Studies using pediatric or neonatal models were next in frequency (15 %), with a much smaller number of articles focused on cardiac surgery models, multiple organ failure models, or trauma scores. In more than half of these studies the severity score was used for risk stratification or as a clinical descriptor of patient populations. Surprisingly, 30 % of the articles focused on the development, validation, or performance of severity systems or comparisons of models. Other studies (10 %) used models as part of economic analyses and in only 4 % of studies was the primary goal comparison of quality of care in ICUs.In this issue of Intensive Care Medicine, Metnitz et al. [1] report, in a small but detailed study, on the performance of SAPS II in nine Austrian ICUs. The results are not surprising; SAPS II did not fit well in the new set of patients 6 years after the original publication of SAPS II [2]. To date, there have been no studies that have shown that severity models are stable over time, in a new setting, and with different case mixes [3±7]. APACHE III did not demonstrate external validation using a large number of hospitals in the United States [8,9]. If we believe in medical progress and in the advancement of science, then we would not expect the models to show good calibration over time. We would expect the observed mortality to be lower than the mean predicted hospital mortality, particularly for middle severity patients. If there were severe resource constraints and reduction in staffing and we had good benchmark data, we might expect to find higher observed than predicted hospital mortality. What about the introduction of a new disease now more frequently treated in the ICU but not previously included in severity model development? AIDS was considered a fatal disease and was only minimally included in APACHE, MPM, and SAPS databases [2, 10±12]. Now AIDS is a more chronic disease with more patients being admitted to the ICU with AIDS as a background condition or as a major component of the acute process. What about new technology? Non-invasive positive pressure ventilation is now being more commonly used. For a patient with acute exacerbation of chronic respiratory failure who is placed on nocturnal nasal ventilation on admission to the ICU, how do we apply the definitions of respiratory failure including intubation and mechanical ventilation as described in models that are now several years old? For all of the above reasons, there is a rationale for consider...

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