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

Nassar, Antônio Paulo; Mocelin, Amílcar Oshiro; Andrade, Fabio Moreira; Brauer, Leonardo; Giannini, Fabio; Nunes, Andre Luiz Baptiston; Dias, Carolina

doi:10.1590/1516-3180.2013.1313474

Cited by 13 publications

(14 citation statements)

References 30 publications

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“…Although most studies aimed to validate SAPS III on a broad population in medical, surgical or mixed ICUs, nine studies (32.1%) applied SAPS III to patients with specific conditions such as cancer [ 15 , 20 ], elderly [ 17 ], acute kidney injury (AKI) [ 18 , 21 , 31 ], acute coronary syndromes [ 23 ], septic shock [ 30 ] and transplant patients [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

Evaluation of simplified acute physiology score 3 performance: a systematic review of external validation studies

2014

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IntroductionSimplified Acute Physiology Score 3 (SAPS 3) was the first critical care prognostic model developed from worldwide data. We aimed to systematically review studies that assessed the prognostic performance of SAPS 3 general and customized models for predicting hospital mortality in adult patients admitted to the ICU.MethodsMedline, Lilacs, Scielo and Google Scholar were searched to identify studies which assessed calibration and discrimination of general and customized SAPS 3 equations. Additionally, we decided to evaluate the correlation between trial size (number of included patients) and the Hosmer-Lemeshow (H-L) statistics value of the SAPS 3 models.ResultsA total of 28 studies were included. Of these, 11 studies (42.8%) did not find statistically significant mis-calibration for the SAPS 3 general equation. There was a positive correlation between number of included patients and higher H-L statistics, that is, a statistically significant mis-calibration of the model (r = 0.747, P <0.001). Customized equations for major geographic regions did not have statistically significant departures from perfect calibration in 9 of 19 studies. Five studies (17.9%) developed a regional customization and in all of them this new model was not statistically different from a perfect calibration for their populations. Discrimination was at least very good in 24 studies (85.7%).ConclusionsStatistically significant departure from perfect calibration for the SAPS 3 general equation was common in validation studies and was correlated with larger studies, as should be expected, since H-L statistics (both C and H) are strongly dependent on sample size This finding was also present when major geographic customized equations were evaluated. Local customizations, on the other hand, improved SAPS 3 calibration. Discrimination was almost always very good or excellent, which gives excellent perspectives for local customization when a precise local estimate is needed.

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Section: Resultsmentioning

confidence: 99%

Evaluation of simplified acute physiology score 3 performance: a systematic review of external validation studies

2014

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“…Few published studies are available to provide meaningful comparisons with the subgroup results from our study. Most describe smaller patient populations outside the U.S. (6,16,17,18). Previous use of APACHE IV to predict outcomes in patients with sepsis reported AUROCs ranging from 0.67 to 0.94 (6,16,19).…”

Section: Discussionmentioning

confidence: 99%

“…Our findings are important because although general severity scoring systems like APACHE IVa are not optimized for use in specific ICU patient subgroups, they are often used in this manner to make implications regarding quality of care (6,(16)(17)(18)(19)(21)(22)(23)(24)(25)(26). In addition to the subgroups discussed above, previous studies have employed general severity scoring system to predict outcomes in subgroups of patients with acute coronary syndrome (17), acute kidney failure (21), malignancy (22), organ transplantation (23), ECMO (24), cardiac surgery (25) and survivors of cardiac arrest (4,26). Many of these studies report AUROCs inferior to our 2VSS referent (6,19,20,(23)(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

The explained variance and discriminant accuracy of APACHE IVa severity scoring in specific subgroups of ICU patients

Raschke¹,

Gerkin²,

Ramos³

et al. 2018

Southwest J Pulm Crit Care

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“…Of previous studies comparing the APACHE IV and SAPS 3 prognostic models, two regarding general ICU patients showed that the APACHE IV model had better discriminatory capability than SAPS 3 [9,29], but other studies for acute kidney injury and acute coronary artery syndrome patients showed that the two models have similar discriminatory performance [10,11]. Additionally, one study reported that the discrimination and calibration of APACHE II are similar to those of SAPS 3 [26].…”

Section: Discussionmentioning

confidence: 99%

“…The APACHE IV model showed good discrimination and calibration in the United States where the model was developed [5]. Outside the United States, recent studies have demonstrated that the discriminatory performance of APACHE IV was good [8,9,10,11,12]. However, its performance has not yet been validated in Korea.…”

Section: Introductionmentioning

confidence: 99%

Validation of the APACHE IV model and its comparison with the APACHE II, SAPS 3, and Korean SAPS 3 models for the prediction of hospital mortality in a Korean surgical intensive care unit

Lee

Shon

Kim

et al. 2014

Korean J Anesthesiol

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BackgroundThe Acute Physiology and Chronic Health Evaluation (APACHE) IV model has not yet been validated in Korea. The aim of this study was to compare the ability of the APACHE IV with those of APACHE II, Simplified Acute Physiology Score (SAPS) 3, and Korean SAPS 3 in predicting hospital mortality in a surgical intensive care unit (SICU) population.MethodsWe retrospectively reviewed electronic medical records for patients admitted to the SICU from March 2011 to February 2012 in a university hospital. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow test, respectively. We calculated the standardized mortality ratio (SMR, actual mortality predicted mortality) for the four models.ResultsThe study included 1,314 patients. The hospital mortality rate was 3.3%. The discriminative powers of all models were similar and very reliable. The AUCs were 0.80 for APACHE IV, 0.85 for APACHE II, 0.86 for SAPS 3, and 0.86 for Korean SAPS 3. Hosmer and Lemeshow C and H statistics showed poor calibration for all of the models (P < 0.05). The SMRs of APACHE IV, APACHE II, SAPS 3, and Korean SAPS 3 were 0.21, 0.11 0.23, 0.34, and 0.25, respectively.ConclusionsThe APACHE IV revealed good discrimination but poor calibration. The overall discrimination and calibration of APACHE IV were similar to those of APACHE II, SAPS 3, and Korean SAPS 3 in this study. A high level of customization is required to improve calibration in this study setting.

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

Cited by 13 publications

References 30 publications

Evaluation of simplified acute physiology score 3 performance: a systematic review of external validation studies

Evaluation of simplified acute physiology score 3 performance: a systematic review of external validation studies

The explained variance and discriminant accuracy of APACHE IVa severity scoring in specific subgroups of ICU patients

Validation of the APACHE IV model and its comparison with the APACHE II, SAPS 3, and Korean SAPS 3 models for the prediction of hospital mortality in a Korean surgical intensive care unit

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