Outcome prediction in intensive care: results of a prospective, multicentre, Portuguese study

Moreno, Rui P.; Morais, Paloma Pereira

doi:10.1007/s001340050313

Cited by 150 publications

(92 citation statements)

References 42 publications

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“…In our patients' case mix, the APACHE II score suffered from both a lower discriminative power, as compared with the other assessed severity scores, and from a significant lack of calibration. These findings were previously described by several authors [5,17]. Nevertheless, other authors found acceptable calibration of the APACHE II score even in recent case mix population sample [18,19].…”

Section: Discussionsupporting

confidence: 87%

“…Several authors indeed showed that if the SAPS II model has a good discriminative power, its calibration is poor when applied to an independent case mix [8,17]. However, although it seemed to perform adequately in our patients' sample, we found, like other authors, that the SAPS II predictive model tended to overestimate the hospital mortality [8,17,18]. The present study has potential limitations.…”

Section: Discussioncontrasting

confidence: 65%

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SAPS 3 admission score: an external validation in a general intensive care population

et al. 2008

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Objectives: To validate the SAPS 3 admission score in an independent general intensive care case mix and to compare its performances with the APACHE II and the SAPS II scores. Design: Cohort observational study. Setting: A 26-bed general ICU from a Tertiary University Hospital. Patients and participants: Eight hundred and fifty-one consecutive patients admitted to the ICU over an 8-month period. Of these patients, 49 were readmissions, leaving 802 patients for further analysis. Intervention: None. Measurements and results: APACHE II, SAPS II and SAPS 3 variables were prospectively collected; scores and their derived probability of death were calculated according to their original manuscript description. The discriminative power was assessed using the area under the ROC curve (AUROC) and calibration was verified with the Hosmer-Lemeshow goodness-of-fit test. The AUROC of the APACHE II model (AUROC = 0.823) was significantly lower than those of the SAPS II (AUROC = 0.850) and SAPS 3 models (AUROC = 0.854) (P = 0.038). The calibration of the APACHE II model (P = 0.037) and of the SAPS 3 global model (P = 0.035) appeared unsatisfactory. On the contrary, both SAPS II model and SAPS 3 model customised for Central and Western Europe had a good calibration. However, in our study case mix, SAPS II model tended to overestimate the probability of death. Conclusion: In this study, the SAPS 3 admission score and its prediction model customised for Central and Western Europe was more discriminative and better calibrated than APACHE II, but it was not significantly better than the SAPS II.

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Section: Discussionsupporting

confidence: 87%

Section: Discussioncontrasting

confidence: 65%

SAPS 3 admission score: an external validation in a general intensive care population

et al. 2008

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“…Mortality risk stratification in severe sepsis and septic shock is commonly used in clinical trials and in practice, which helps to improve accuracy when evaluating new therapies [14]. By facilitating comparison of the actual with predicted mortalities, the use of such Scoring Systems can provide valuable information about the performance of individual ICUs in treating patients with sepsis.…”

Section: Identification Of the Underlying Causementioning

confidence: 99%

A Prospective Study of Comparison of APACHE- I V & SAPS- I I Scoring Systems and Calculation of Standardised Mortality Rate in Severe Sepsis and Septic Shock Patients

Dabhi¹,

Khedekar²,

Mehalingam

2014

JCDR

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“…2 Predictive models should be customized to fit the case-mix population where they will be used because the outcomes in the original databases and period from which the models were derived may be different from the databases of intensive care units (ICUs) using the models. 3,4 It is not clear whether calibration of the established models for local circumstances would enhance their accuracy in stratifying patients. 5 Although the methods have been reported to adapt well to different periods and case mixes, few studies have formally assessed the models' predictive accuracy when applied to new populations from other institutions or countries.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of transitioning from APACHE II to SAPS III as prognostic model in a Brazilian general intensive care unit. A retrospective study

et al. 2014

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CONTEXT AND OBJECTIVE: Prognostic models reflect the population characteristics of the countries from which they originate. Predictive models should be customized to fit the general population where they will be used. The aim here was to perform external validation on two predictive models and compare their performance in a mixed population of critically ill patients in Brazil. DESIGN AND SETTING: Retrospective study in a Brazilian general intensive care unit (ICU). METHODS:This was a retrospective review of all patients admitted to a 41-bed mixed ICU from August 2011 to September 2012. Calibration (assessed using the Hosmer-Lemeshow goodness-of-fit test) and discrimination (assessed using area under the curve) of APACHE II and SAPS III were compared. The standardized mortality ratio (SMR) was calculated by dividing the number of observed deaths by the number of expected deaths. RESULTS: A total of 3,333 ICU patients were enrolled. The Hosmer-Lemeshow goodness-of-fit test showed good calibration for all models in relation to hospital mortality. For in-hospital mortality there was a worse fit for APACHE II in clinical patients. Discrimination was better for SAPS III for in-ICU and in-hospital mortality (P = 0.042

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Outcome prediction in intensive care: results of a prospective, multicentre, Portuguese study

Abstract: SAPS II performed better than APACHE II in this independent database, but the results do not allow its use, at least without being customised, to analyse quality of care or performance among ICUs in the target population.

Cited by 150 publications

References 42 publications

SAPS 3 admission score: an external validation in a general intensive care population

SAPS 3 admission score: an external validation in a general intensive care population

A Prospective Study of Comparison of APACHE- I V & SAPS- I I Scoring Systems and Calculation of Standardised Mortality Rate in Severe Sepsis and Septic Shock Patients

Feasibility of transitioning from APACHE II to SAPS III as prognostic model in a Brazilian general intensive care unit. A retrospective study

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