The Simplified Acute Physiology Score III Is Superior to the Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation II in Predicting Surgical and ICU Mortality in the “Oldest Old”

Abstract

Elderly patients in the USA account for 26–50% of all intensive care unit (ICU) admissions. The applicability of validated ICU scoring systems to predict outcomes in the “Oldest Old” is poorly documented. We evaluated the utility of three commonly used ICU scoring systems (SAPS II, SAPS III, and APACHE II) to predict clinical outcomes in patients > 90 years. 1,189 surgical procedures performed upon 951 patients > 90 years (between 2000 and 2010) were analyzed. SAPS II, SAPS III, and Acute APACHE II were calculated for all patients admitted to the SICU. Differences between survivors and nonsurvivors were analyzed using the Student's t-test and binary logistic regression analysis. A receiver operating characteristic (ROC) curve was constructed for each scoring system studied. The area under the ROC curve (aROC) for the SAPS III was 0.81 at a cut-off value of 57, whereas the aROC for SAPS II was 0.75 at a cut-off score of 44 and the aROC for APACHE II was 0.74 at a cut-off score of 13. The SAPS III ROC curve for prediction of hospital mortality exhibited the greatest sensitivity (84%) and specificity (66%) with a score of 57 for the “Oldest Old” population.

Validation of a prognostic score for mortality in elderly patients admitted to Intensive Care Unit

“…In geriatric patients, the performance of other prognostic models for hospital mortality has been evaluated, including previous versions of SAPS and APACHE II. [612131415161718]…”

“…[5] However, the performance of most recent models of mortality prediction has been evaluated specifically in the elderly population with special conditions, such as oldest surgical patients, with different results. [567] The performance of a prognostic score must be evaluated prior to being used in a particular group of patients. [4567] It has been suggested that the construction, validation, or adaptation of the existing instruments could incorporate factors specific to the geriatric patient.…”

“…[567] The performance of a prognostic score must be evaluated prior to being used in a particular group of patients. [4567] It has been suggested that the construction, validation, or adaptation of the existing instruments could incorporate factors specific to the geriatric patient. [6]…”

“…[4567] It has been suggested that the construction, validation, or adaptation of the existing instruments could incorporate factors specific to the geriatric patient. [6]…”

“…[8910] However, its specific performance in a population with particular characteristics, such as aged patients, is limited. [6] Therefore, the primary aim of the present study was to evaluate the SAPS 3 score predictive ability of hospital mortality in elderly patients admitted to medical-surgical ICU, a secondary aim was to compare with APACHE II predictive mortality model.…”