Prognostic performance and customization of the SAPS II: results of a multicenter Austrian study

Metnitz, Philipp; Valentin, Andreas; Vesely, H.; Alberti, Corinne; Lang, Thomas; Lenz, Kurt; Steltzer, H.; Hiesmayr, Michael

doi:10.1007/s001340050815

Cited by 75 publications

(62 citation statements)

References 11 publications

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“…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: 66%

“…Although more recent severity scores versions were developed in the nineties [2][3][4], the APACHE II remains, to date, the most widely used scoring system for ICUs assessment and for clinical trials conducted in the field of critical care medicine. Nevertheless, several studies showed a deterioration of both APACHE II and SAPS II scores performances [5][6][7][8]. The recently published SAPS 3 admission score [9] is a model built to predict hospital mortality from admission data (recorded within ±1 h).…”

Section: Introductionmentioning

confidence: 99%

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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: Discussioncontrasting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

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

et al. 2008

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“…There are many potential causes for suboptimal calibration. 33 It is infl uenced especially by case mix. …”

Section: Calibrationmentioning

confidence: 99%

Comparison of APACHE III, APACHE IV, SAPS 3, and MPM0III and Influence of Resuscitation Status on Model Performance

Keegan

Gajic

Afessa

2012

Chest

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The assessment of quality of care in the practice of medicine has become increasingly important. [1][2][3] The practice of critical care medicine has been especially scrutinized, at least in part because of the enormous costs of providing critical care services. 4,5 Aside from external pressures, monitoring and improvement of quality of care are important to clinicians. 6,7 Misuse of quality measures may occur and "[risks] stigmatizing an entire institution," 8 so it is imperative that any assessment of the quality of care delivered in the ICU involves a consideration of the severity of patient illness using a reliable measure. The Joint Commission 9 has proposed severity-adjusted mortality rate as a specifi c measure that should be recorded.Prognostic scoring systems have been developed by the critical care community in an effort to quantify the severity of illness of a given patient or group of patients. 10-12 Adjustment for severity of illness enables monitoring of the performance of an ICU over time and for comparison of ICUs in the same or different hospitals. It is imperative that such severity adjustments be as accurate as possible. 13 Many prognostic models exist, suggesting that the optimum model has not been established. The three most commonly used adult-ICU prognostic scoring systems are APACHE (Acute Physiology and Chronic Health Evaluation), the Simplified Acute Physiology Score (SAPS), and the Mortality Probability Conclusions: APACHE III and IV had similar discriminatory capability and both were better than SAPS 3, which was better than MPM 0 III. The calibrations of the models studied were poor. Overall, models with more predictor variables performed better than those with fewer. The addition of resuscitation status did not improve APACHE III or IV or SAPS 3 prediction. CHEST 2012; 142(4):851 -858Abbreviations: APACHE 5 Acute Physiology and Chronic Health Evaluation; AUC 5 area under the receiver operator characteristic curve; DNR 5 do not resuscitate; MPM 5 Mortality Probability Model; ROC 5 receiver operating characteristic; SAPS 5 Simplifi ed Acute Physiology Score

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“…Our results demonstrate much higher values on admission, for maxi mum score, and also in mortality, prob ably because the patients were suffering from CS complicating AMI. Mentnitz and colleagues [29] demonstrated that the SAPS II score was of good assistance in mortality evaluation in cardiac patients.…”

Section: Scoring In Cardiogenic Shockmentioning

confidence: 99%

Predictive value of outcome scores in patients suffering from cardiogenic shock complicating AMI

Kellner

Prondzinsky

Pallmann

et al. 2013

Med Klin Intensivmed Notfmed

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Acute myocardial infarction (AMI) is complicated by cardiogenic shock (CS) in 7-10% of cases and the mortality rate is about 60-70% [13,16]. Early revascula rization by percutaneous coronary inter vention (PCI) and intensive care includ ing positive inotropic agents, vasopres sors, and circulatory assist devices are routinely used to improve cardiac output and to prevent multiorgan failure [1,5,16]. Intraaortic balloon pump (IABP) is a commonly used mechanical support sys tem for patients with CS [25,33]. Despite intensive therapy, these patients often de velop a systemic inflammatory response syndrome (SIRS) progressing to multiple organ dysfunction syndrome (MODS) and subsequent death due to multiple or gan failure [6,39]. Identification of these patients in the ICU is clinically important [34]. Previous studies of patients with MODS or sepsis have shown the rele vance of several scoring systems such as the APACHE II [22,42,43] Originalien culation is more complex and laborious. However, a scoring system is only valid for a special group of patients when it has been validated on this group. The objec tive of the present study was to evaluate the predictive value of the APACHE II, APACHE III, Elebute-Stoner, SOFA, and SAPS II scores on mortality, determined on the day of diagnosis/admission of infarctionrelated CS patients and at the point of maximum value. Methods Inclusion and exclusion criteriaPatients treated with primary PCI for CS secondary to AMI, who required inotro pic and/or vasopressor support despite appropriate volume filling, were includ ed in the study. For the diagnosis of CS, the definitions of Hochman et al. [16] and Reynolds et al. [36] were used. The inclu sion and exclusion criteria are shown in . Tab. 1. Study designIn this prospective observational study, carried out in a medical intensive care unit of a university hospital from 2004 to 2005, we consecutively enrolled 45 pa tients in CS. Patients underwent regu lar clinical assessment, complete inva sive monitoring, and frequent blood sam pling for laboratory markers. Datasets for the APACHE II, APACHE III, ElebuteStoner, SOFA, and SAPS II scores and for the patient parameters were calcu lated. Written informed consent was ob tained from all patients or their relatives. The trial was approved by the local eth ics committee. Primary endpointsThe primary endpoint was the value of the initial and the maximum value of the APACHE II, APACHE III, ElebuteStoner, SOFA, and SAPS II scores in pre dicting mortality. Scores were collected at enrollment and then daily for 4 days. Demographic data, admission diagnosis, mechanical ventilation, IABP use, hemo dynamic parameters, survivors, and non survivors were recorded. The APACHE II, APACHE III, Elebute-Stoner, SOFA, and SAPS II scores were determined by the worst value found during the initial 24 h after ICU admission and also by the max imum value during the following 96 h.A flowchart of the study is shown in . Fig. 1. Coronary angiography and PCICoronary angiography and PCI were per formed using...

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Prognostic performance and customization of the SAPS II: results of a multicenter Austrian study

Cited by 75 publications

References 11 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

Comparison of APACHE III, APACHE IV, SAPS 3, and MPM0III and Influence of Resuscitation Status on Model Performance

Predictive value of outcome scores in patients suffering from cardiogenic shock complicating AMI

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