External validation of SAPS 3 and MPM0-III scores in 48,816 patients from 72 Brazilian ICUs

被引：18

作者：

Moralez, Giulliana Martines ^{[1
]}

Cunha Farah Rabello, Ligia Sarmet ^{[2
,3
]}

Lisboa, Thiago Costa ^{[4
]}

Andrade Lima, Mariza da Fonte ^{[5
]}

Hatum, Rodrigo Marques ^{[6
]}

Cesar De Marco, Fernando Vinicius ^{[7
]}

Alves, Alessandra ^{[8
]}

da Silva Soares Pinto, Jorge Eduardo ^{[9
]}

Nunes de Araujo, Helia Beatriz ^{[10
]}

Ramos, Grazielle Viana ^{[11
]}

Silva, Aline Reis ^{[11
]}

Fernandes, Guilherme Cortes ^{[12
]}

Alves Faria, Guilherme Brenande ^{[13
]}

Mendes, Ciro Leite ^{[14
]}

Ramos Filho, Roberto Alvaro ^{[15
]}

de Souza, Valdenia Pereira ^{[16
]}

Alvarenga Americano do Brasil, Pedro Emmanuel ^{[11
,17
]}

Bozza, Fernando Augusto ^{[11
,17
]}

Figueira Salluh, Jorge Ibrain ^{[2
,18
,19
]}

Soares, Marcio ^{[2
,18
,19
,20
]}

机构：

[1] DOr Inst Res & Educ IDOR, Grad Program Translat Med, Rio De Janeiro, Brazil

[2] Univ Fed Rio de Janeiro, PPG Internal Med, Rio De Janeiro, Brazil

[3] Hosp Copa DOr, ICU, Rio De Janeiro, Brazil

[4] Santa Casa de Misericordia Porto Alegre, Complexo Hosp, Porto Alegre, RS, Brazil

[5] Hosp Esperanca Recife, ICU, Recife, PE, Brazil

[6] Hosp Total Cor, ICU, Rio De Janeiro, Brazil

[7] Hosp viValle, ICU, Sao Jose Dos Campos, Brazil

[8] Hosp Rios DOr, ICU, Rio De Janeiro, Brazil

[9] Hosp Norte DOr, ICU, Rio De Janeiro, Brazil

[10] Hosp Coracao Brasil, Brasilia, DF, Brazil

[11] DOr Inst Res & Educ IDOR, Dept Crit Care, Rio De Janeiro, Brazil

[12] Santa Casa Misericordia Juiz de Fora, ICU, Juiz De Fora, Brazil

[13] Hosp Oeste DOr, ICU, Rio De Janeiro, Brazil

[14] Hosp Univ Lauro Wanderley, ICU, Joao Pessoa, Paraiba, Brazil

[15] Hosp Sao Luiz, ICU, Unidade Jabaquara, Sao Paulo, Brazil

[16] Complexo Hosp Niteroi, Niteroi, RJ, Brazil

[17] Fundacao Oswaldo Cruz Fiocruz, Inst Nacl Infectol Evandro Chagas, Rio De Janeiro, Brazil

[18] DOr Inst Res & Educ IDOR, Dept Crit Care, Rio De Janeiro, Brazil

[19] DOr Inst Res & Educ IDOR, Grad Program Translat Med, Rio De Janeiro, Brazil

[20] DOr Inst Res & Educ, Dept Crit Care, Rua Diniz Cordeiro 30, BR-22281100 Rio De Janeiro, Brazil

来源：

ANNALS OF INTENSIVE CARE | 2017年 / 7卷

关键词：

Severity-of-illness scores; Validation; Intensive care units; Outcomes; Standardized mortality rate; INTENSIVE-CARE-UNIT; HOSPITAL MORTALITY; APACHE IV; PROGNOSTIC MODEL; ACUTE PHYSIOLOGY; PERFORMANCE; SEVERITY; COHORT;

D O I：

10.1186/s13613-017-0276-3

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: The performance of severity-of-illness scores varies in different scenarios and must be validated prior of being used in a specific settings and geographic regions. Moreover, models' calibration may deteriorate overtime and performance of such instruments should be reassessed regularly. Therefore, we aimed at to validate the SAPS 3 in a large contemporary cohort of patients admitted to Brazilian ICUs. In addition, we also compared the performance of the SAPS 3 with the MPM0-III. Methods: This is a retrospective cohort study in which 48,816 (medical admissions = 67.9%) adult patients are admitted to 72 Brazilian ICUs during 2013. We evaluated models' discrimination using the area under the receiver operating characteristic curve (AUROC). We applied the calibration belt to evaluate the agreement between observed and expected mortality rates (calibration). Results: Mean SAPS 3 score was 44.3 +/- 15.4 points. ICU and hospital mortality rates were 11.0 and 16.5%. We estimated predicted mortality using both standard (SE) and Central and South American (CSA) customized equations. Predicted mortality rates were 16.4 +/- 19.3% (SAPS 3-SE), 21.7 +/- 23.2% (SAPS 3-CSA) and 14.3 +/- 14.0% (MPM0-III). Standardized mortality ratios (SMR) obtained for each model were: 1.00 (95% CI, 0.98-0.102) for the SAPS 3-SE, 0.75 (0.74-0.77) for the SAPS 3-CSA and 1.15 (1.13-1.18) for the MPM0-III. Discrimination was better for SAPS 3 models (AUROC = 0.85) than for MPM0-III (AUROC = 0.80) (p < 0.001). We applied the calibration belt to evaluate the agreement between observed and expected mortality rates (calibration): the SAPS 3-CSA overestimated mortality throughout all risk classes while the MPM0-III underestimated it uniformly. The SAPS 3-SE did not show relevant deviations from ideal calibration. Conclusions: In a large contemporary database, the SAPS 3-SE was accurate in predicting outcomes, supporting its use for performance evaluation and benchmarking in Brazilian ICUs.

引用

页数：8

共 27 条

[11] Maccariello Elizabeth R., 2008, Rev. bras. ter. intensiva, V20, P115, DOI 10.1590/S0103-507X2008000200001
[12] SAPS 3 - From evaluation of the patient to evaluation of the intensive care unit. Part 1: Objectives, methods and cohort description
Metnitz, PGH
Moreno, RP
Almeida, E
Jordan, B
Bauer, P
Campos, RA
Iapichino, G
Edbrooke, D
Capuzzo, M
Le Gall, JR
[J]. INTENSIVE CARE MEDICINE, 2005, 31 (10) : 1336 - 1344
[13] SAPS 3 - From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission
Moreno, RP
Metnitz, PGH
Almeida, E
Jordan, B
Bauer, P
Campos, RA
Iapichino, G
Edbrooke, D
Capuzzo, M
Le Gall, JR
[J]. INTENSIVE CARE MEDICINE, 2005, 31 (10) : 1345 - 1355
[14] Caution when using prognostic models: A prospective comparison of 3 recent prognostic models
Nassar, Antonio Paulo, Jr.
Mocelin, Amilcar Oshiro
Baptiston Nunes, Andre Luiz
Giannini, Fabio Poianas
Brauer, Leonardo
Andrade, Fabio Moreira
Dias, Carlos Augusto
[J]. JOURNAL OF CRITICAL CARE, 2012, 27 (04) : 423.e1 - 423.e7
[15] SAPS 3, APACHE IV or GRACE: which score to choose for acute coronary syndrome patients in intensive care units?
Nassar Junior, Antonio Paulo
Mocelin, Amilcar Oshiro
Andrade, Fabio Moreira
Brauer, Leonardo
Giannini, Fabio Poianas
Baptiston Nunes, Andre Luiz
Dias, Carlos Augusto
[J]. SAO PAULO MEDICAL JOURNAL, 2013, 131 (03): : 173 - 178
[16] TOXICITY AND RESPONSE CRITERIA OF THE EASTERN-COOPERATIVE-ONCOLOGY-GROUP
OKEN, MM
CREECH, RH
TORMEY, DC
HORTON, J
DAVIS, TE
MCFADDEN, ET
CARBONE, PP
[J]. AMERICAN JOURNAL OF CLINICAL ONCOLOGY-CANCER CLINICAL TRIALS, 1982, 5 (06): : 649 - 655
[17] External validation of prognostic models for critically ill patients required substantial sample sizes
Peek, N.
Arts, D. G. T.
Bosman, R. J.
van der Voort, P. H. J.
de Keizer, N. F.
[J]. JOURNAL OF CLINICAL EPIDEMIOLOGY, 2007, 60 (05) : 491 - 501
[18] Comparison between SAPS II and SAPS 3 in predicting hospital mortality in a cohort of 103 Italian ICUs. Is new always better?
Poole, Daniele
Rossi, Carlotta
Latronico, Nicola
Rossi, Giancarlo
Finazzi, Stefano
Bertolini, Guido
[J]. INTENSIVE CARE MEDICINE, 2012, 38 (08) : 1280 - 1288
[19] Hospital Factors Associated With Discharge Bias in ICU Performance Measurement
Reineck, Lora A.
Pike, Francis
Le, Tri Q.
Cicero, Brandon D.
Iwashyna, Theodore J.
Kahn, Jeremy M.
[J]. CRITICAL CARE MEDICINE, 2014, 42 (05) : 1055 - 1064
[20] ICU severity of illness scores: APACHE, SAPS and MPM
Salluh, Jorge I. F.
Soares, Marcio
[J]. CURRENT OPINION IN CRITICAL CARE, 2014, 20 (05) : 557 - 565

← 1 2 3 →