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

Abstract

Context:The performance of a prognostic score must be evaluated prior to being used. The aim of the present study was to evaluate the predictive ability of hospital mortality of Simplified Acute Physiology Score 3 (SAPS 3) score in elderly patients admitted to Intensive Care Units (ICUs).Aims:The aim of the present study was to evaluate the SAPS 3 score predictive ability of hospital mortality in elderly patients admitted to ICU.Settings and Design:This study was conducted as a prospective cohort, in two mixed ICUs.Patients and Methods:Two hundred and eleven elderly patients were included.Interventions:None. We compared the predictive accuracy of SAPS 3 measured at the first hour at ICU and Acute Physiology and Chronic Health Evaluation II (APACHE II) measured with the worst values in the first 24 h at ICU. The patients were followed until hospital discharge.Statistical Analysis Used:Evaluation of discrimination through area under curve receiver operating characteristic (aROC) and calibration by Hosmer-Lemeshow (HL) test.Results:The median age was 68 years. The hospital mortality rate was 35.54%. The mean value of SAPS 3 was 62.54 ± 12.51 and APACHE II was 17.46 ± 6.77. The mortality predicted by APACHE II was 24.98 ± 19.96 and for standard SAPS 3 equation 41.18 ± 22.34. The discrimination for SAPS 3 model was aROC = 0.68 (0.62–0.75) and to APACHE II aROC = 0.70 (0.63–0.78). Calibration: APACHE II with HL 10.127 P = 0.26, and standard SAPS 3 equation HL 7.204 P = 0.51.Conclusions:In this study, the prognostic model of SAPS 3 was not found to be accurate in predicting mortality in geriatric patients requiring ICU admission.

Are prognostic tools losing accuracy? Development and performance of a novel age-calibrated severity scoring system for critically ill patients

“…In the general population, SAPS3 demonstrated good accuracy in prediction of ICU mortality and it performed fairly in the very elderly subset of our critically ill cohort. Prior studies have demonstrated similar reductions in the accuracy of SAPS3 and other severity scores in elderly patients admitted to the ICU [ 9 ]. Notably, the novel ACIS tool outperformed the SAPS3 in our 80 years or older population and most other age strata.…”

“…Scoring systems, such as the Simplified Acute Physiology Score, have been validated and long used in ICUs around the world to assess the severity of illness. However, these scores did not include an aging population at time of validation, suggesting that their discriminatory capacity may diminish in the coming years with a complex very elderly population [7][8][9]. This study aims to determine the accuracy of the Simplified Acute Physiology Score (SAPS3) in patients admitted to a general ICU and identify variables associated with mortality to develop an alternative age calibrated scoring system.…”