Validation of SAPS 3 Admission Score and comparison with SAPS II

Capuzzo, Maurizia; Scaramuzza, A.; Vaccarini, B.; Gilli, Giuseppe; Zannoli, Silvia; Farabegoli, Lucia; Felisatti, G.; D'Avanzo, Ernesto; Alvisi, R

doi:10.1111/j.1399-6576.2009.01929.x

Cited by 22 publications

(22 citation statements)

References 18 publications

(18 reference statements)

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“…Although overestimation of mortality has been reported by others [10, 19–22], we show that this miscalibration does not affect all patients and all ICUs similarly. First, the miscalibration depended on the level of the predicted risk in each patient and on the specific items of the scores presented by the patients.…”

Section: Discussioncontrasting

confidence: 47%

Determinants of the calibration of SAPS II and SAPS 3 mortality scores in intensive care: a European multicenter study

et al. 2017

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BackgroundThe aim of the Simplified Acute Physiology Score (SAPS) II and SAPS 3 is to predict the mortality of patients admitted to intensive care units (ICUs). Previous studies have suggested that the calibration of these scores may vary across countries, centers, and/or characteristics of patients. In the present study, we aimed to assess determinants of the calibration of these scores.MethodsWe assessed the calibration of the SAPS II and SAPS 3 scores among 5266 patients admitted to ICUs during a 4-week period at 120 centers in 17 European countries. We obtained calibration curves, Brier scores, and standardized mortality ratios. Points attributed to SAPS items were reevaluated and compared with those of the original scores. Finally, we tested associations between the calibration and center characteristics.ResultsThe mortality was overestimated by both scores: The standardized mortality ratios were 0.75 (95% CI 0.71–0.79) for the SAPS II score and 0.91 (95% CI 0.86–0.96) for the SAPS 3 score. This overestimation was partially explained by changes in associations between some items of the scores and mortality, especially the heart rate, Glasgow Coma Scale score, and diagnosis of AIDS for SAPS II. The calibration of both scores was better in countries with low health expenditures. The between-center variability in calibration curves was much greater than expected by chance.ConclusionsBoth scores overestimate current mortality among European ICU patients. The magnitude of the miscalibration of SAPS II and SAPS 3 scores depends not only on patient characteristics but also on center characteristics. Furthermore, much between-center variability in calibration remains unexplained by these factors.Trial registrationClinicalTrials.gov identifier: NCT01422070. Registered 19 August 2011.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1673-6) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 47%

Determinants of the calibration of SAPS II and SAPS 3 mortality scores in intensive care: a European multicenter study

et al. 2017

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“…When compared with SAPS II, SAPS 3 has not been shown to perform markedly better [37–41], which may be why SAPS II is still widely used, despite its limitations.…”

Section: Discussionmentioning

confidence: 99%

Predictive Performance of the Simplified Acute Physiology Score (SAPS) II and the Initial Sequential Organ Failure Assessment (SOFA) Score in Acutely Ill Intensive Care Patients: Post-Hoc Analyses of the SUP-ICU Inception Cohort Study

et al. 2016

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PurposeSeverity scores including the Simplified Acute Physiology Score (SAPS) II and the Sequential Organ Failure Assessment (SOFA) score are used in intensive care units (ICUs) to assess disease severity, predict mortality and in research. We aimed to assess the predictive performance of SAPS II and the initial SOFA score for in-hospital and 90-day mortality in a contemporary international cohort.MethodsThis was a post-hoc study of the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) inception cohort study, which included acutely ill adults from ICUs across 11 countries (n = 1034). We compared the discrimination of SAPS II and initial SOFA scores, compared the discrimination of SAPS II in our cohort with the original cohort, assessed the calibration of SAPS II customised to our cohort, and compared the discrimination for 90-day mortality vs. in-hospital mortality for both scores. Discrimination was evaluated using areas under the receiver operating characteristics curves (AUROC). Calibration was evaluated using Hosmer-Lemeshow’s goodness-of-fit Ĉ-statistic.ResultsAUROC for in-hospital mortality was 0.80 (95% confidence interval (CI) 0.77–0.83) for SAPS II and 0.73 (95% CI 0.69–0.76) for initial SOFA score (P<0.001 for the comparison). Calibration of the customised SAPS II for predicting in-hospital mortality was adequate (P = 0.60). Discrimination of SAPS II was reduced compared with the original SAPS II validation sample (AUROC 0.80 vs. 0.86; P = 0.001). AUROC for 90-day mortality was 0.79 (95% CI 0.76–0.82; P = 0.74 for comparison with in-hospital mortality) for SAPS II and 0.71 (95% CI 0.68–0.75; P = 0.66 for comparison with in-hospital mortality) for the initial SOFA score.ConclusionsThe predictive performance of SAPS II was similar for in-hospital and 90-day mortality and superior to that of the initial SOFA score, but SAPS II’s performance has decreased over time. Use of a contemporary severity score with improved predictive performance may be of value.

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“…In a single-center Norwegian study on more than 2,000 patients SMRs were 0.82 (0.75-0.91) for SAPS II and 0.71 (0.65-0.78) for SAPS 3 [18]. In two more singlecenter studies and one multicenter study investigating cancer patients admitted to ICUs, SAPS 3 still predicted more deaths than SAPS II, but the degree of uncertainty was greater owing to the relatively small sample sizes [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Comparison between SAPS II and SAPS 3 in predicting hospital mortality in a cohort of 103 Italian ICUs. Is new always better?

Poole

Rossi²,

Latronico

et al. 2012

Intensive Care Med

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Validation of SAPS 3 Admission Score and comparison with SAPS II

Abstract: Each ICU should identify the SAPS 3 equation most suitable for its case mix. The SAPS II model tended to overestimate the mortality.

Cited by 22 publications

References 18 publications

Determinants of the calibration of SAPS II and SAPS 3 mortality scores in intensive care: a European multicenter study

Determinants of the calibration of SAPS II and SAPS 3 mortality scores in intensive care: a European multicenter study

Predictive Performance of the Simplified Acute Physiology Score (SAPS) II and the Initial Sequential Organ Failure Assessment (SOFA) Score in Acutely Ill Intensive Care Patients: Post-Hoc Analyses of the SUP-ICU Inception Cohort Study

Comparison between SAPS II and SAPS 3 in predicting hospital mortality in a cohort of 103 Italian ICUs. Is new always better?

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