Simplified Acute Physiology Score II as Predictor of Mortality in Intensive Care Units: A Decision Curve Analysis

被引:33
作者
Allyn, Jerome [1 ]
Ferdynus, Cyril [2 ,3 ]
Bohrer, Michel [4 ]
Dalban, Cecile [2 ]
Valance, Dorothee [1 ]
Allou, Nicolas [1 ]
机构
[1] St Denis Univ Hosp, Intens Care Unit, St Denis, Reunion Isl, France
[2] St Denis Univ Hosp, Unite Soutien Methodol, St Denis, Reunion Isl, France
[3] INSERM, CIC 1410, St Denis, Reunion Isl, France
[4] St Denis Univ Hosp, Dept Med Informat, St Denis, Reunion Isl, France
关键词
LIFE-SUSTAINING TREATMENT; HEALTH EVALUATION II; DIAGNOSTIC-TESTS; SAPS-II; WITHDRAWAL; MODELS; VARIABILITY;
D O I
10.1371/journal.pone.0164828
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background End-of-life decision-making in Intensive care Units (ICUs) is difficult. The main problems encountered are the lack of a reliable prediction score for death and the fact that the opinion of patients is rarely taken into consideration. The Decision Curve Analysis (DCA) is a recent method developed to evaluate the prediction models and which takes into account the wishes of patients (or surrogates) to expose themselves to the risk of obtaining a false result. Our objective was to evaluate the clinical usefulness, with DCA, of the Simplified Acute Physiology Score II (SAPS II) to predict ICU mortality. Methods We conducted a retrospective cohort study from January 2011 to September 2015, in a medical-surgical 23-bed ICU at University Hospital. Performances of the SAPS II, a modified SAPS II (without AGE), and age to predict ICU mortality, were measured by a Receiver Operating Characteristic (ROC) analysis and DCA. Results Among the 4.370 patients admitted, 23.3% died in the ICU. Mean (standard deviation) age was 56.8 (16.7) years, and median (first-third quartile) SAPS II was 48 (34-65). Areas under ROC curves were 0.828 (0.813-0.843) for SAPS II, 0.814 (0.798-0.829) for modified SAPS II and of 0.627 (0.608-0.646) for age. DCA showed a net benefit whatever the probability threshold, especially under 0.5.
引用
收藏
页数:11
相关论文
共 31 条
[1]   Simplified Acute Physiology Score II/Acute Physiology and Chronic Health Evaluation II and Prediction of the Mortality and Later Development of Complications in Poisoned Patients Admitted to Intensive Care Unit [J].
Alizadeh, Afshin Mohammad ;
Hassanian-Moghaddam, Hossein ;
Shadnia, Shahin ;
Zamani, Nasim ;
Mehrpour, Omid .
BASIC & CLINICAL PHARMACOLOGY & TOXICOLOGY, 2014, 115 (03) :297-300
[2]   Value and role of intensive care unit outcome prediction models in end-of-life decision making [J].
Barnato, AE ;
Angus, DC .
CRITICAL CARE CLINICS, 2004, 20 (03) :345-+
[3]   Multicenter study of the multiple organ dysfunction syndrome in intensive care units:: the usefulness of Sequential Organ Failure Assessment scores in decision making [J].
Cabré, L ;
Mancebo, J ;
Solsona, JF ;
Saura, P ;
Gich, I ;
Blanch, L ;
Carrasco, G ;
Martín, MC .
INTENSIVE CARE MEDICINE, 2005, 31 (07) :927-933
[4]   Challenges in end-of-life care in the ICU - Statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003 [J].
Carlet, J ;
Thijs, LG ;
Antonelli, M ;
Cassell, J ;
Cox, P ;
Hill, N ;
Hinds, C ;
Pimentel, JM ;
Reinhart, K ;
Thompson, BT .
INTENSIVE CARE MEDICINE, 2004, 30 (05) :770-784
[5]   Dying with Dignity in the Intensive Care Unit [J].
Cook, Deborah ;
Rocker, Graeme .
NEW ENGLAND JOURNAL OF MEDICINE, 2014, 370 (26) :2506-2514
[6]   COMPARING THE AREAS UNDER 2 OR MORE CORRELATED RECEIVER OPERATING CHARACTERISTIC CURVES - A NONPARAMETRIC APPROACH [J].
DELONG, ER ;
DELONG, DM ;
CLARKEPEARSON, DI .
BIOMETRICS, 1988, 44 (03) :837-845
[7]   Decision Curve Analysis [J].
Fitzgerald, Mark ;
Saville, Benjamin R. ;
Lewis, Roger J. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2015, 313 (04) :409-410
[8]   Influence of the severity of illness measured by the simplified acute physiology score (SAPS) on occurrence of nosocomial infections in ICU patients [J].
Girou, E ;
Pinsard, M ;
Auriant, I ;
Canonne, M .
JOURNAL OF HOSPITAL INFECTION, 1996, 34 (02) :131-137
[9]   Defining Optimum Treatment of Patients With Pancreatic Adenocarcinoma Using Regret-Based Decision Curve Analysis [J].
Hernandez, Jonathan M. ;
Tsalatsanis, Athanasios ;
Humphries, Leigh Ann ;
Miladinovic, Branko ;
Djulbegovic, Benjamin ;
Velanovich, Vic .
ANNALS OF SURGERY, 2014, 259 (06) :1208-1214
[10]   Decisions to withhold or withdraw life-sustaining treatment in a Norwegian intensive care unit [J].
Hoel, H. ;
Skjaker, S. A. ;
Haagensen, R. ;
Stavem, K. .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 2014, 58 (03) :329-336