Validation of the SAPS 3 admission prognostic model in patients with cancer in need of intensive care
Validation of the SAPS 3 admission prognostic model in patients with cancer in need of intensive care
复制标题
DOI：
10.1007/s00134-006-0374-4
复制
发表时间：
2006-11-01
影响因子：
38.9
通讯作者：
Salluh, Jorge I. F.
中科院分区：
文献类型：
--
作者：
Soares, Marcio;Salluh, Jorge I. F.
目的：验证重症监护病房(ICU)癌症患者的SAPS 3入院预后模型。设计：队列研究。单位：内外科肿瘤ICU共10张床位。患者和参与者：在3年期间连续收治952名患者。干预：无。测量和结果：数据是在入住ICU时前瞻性收集的。计算SAPS II和SAPS 3评分及相应的估计死亡率。通过受试者工作特征(AUROC)曲线下面积和Hosmer-Lemesow拟合优度检验来评估辨别力。平均年龄为58.3岁+/-23.1岁，其中471例(49%)行手术治疗，348例(37%)内科治疗，133例(14%)急诊手术治疗。ICU死亡率为24.6%，住院死亡率为33.5%。SAPS 3和SAPS II评分分别为52.3±18.5分和35.3±20.7分。所有预后模型均显示良好的区分性(AUROC>；=0.8)。SAPS II的校准较差(p<；0.001)。然而，针对中美洲和南美洲(CSA)国家的标准SAPS 3及其定制方程的校准是适当的(p>；0.05)。SAPS II和标准SAPS 3预后模型在某种程度上倾向于低估观察到的死亡率(SMR>；1)。然而，使用定制方程时，估计死亡率更接近观察死亡率[SMR=0.95(95%CI=0.84-1.07)]。当排除预定手术患者时，也观察到类似的结果。结论：在ICU入院时SAPS 3入院预后模型，特别是其定制的CSA方程，在我们的癌症危重患者队列中是准确的。
Objectives: To validate the SAPS 3 admission prognostic model in patients with cancer admitted to the intensive care unit (ICU). Design: Cohort study. Setting: Ten-bed medical-surgical oncologic ICU. Patients and participants: Nine hundred and fifty-two consecutive patients admitted over a 3-year period. Interventions: None. Measurements and results: Data were prospectively collected at admission of ICU. SAPS II and SAPS 3 scores with respective estimated mortality rates were calculated. Discrimination was assessed by area under receiver operating characteristic (AUROC) curves and calibration by Hosmer-Lemeshow goodness-of-fit test. The mean age was 58.3 +/- 23.1 years; there were 471 (49%) scheduled surgical, 348 (37%) medical and 133 (14%) emergency surgical patients. ICU and hospital mortality rates were 24.6% and 33.5%, respectively. The mean SAPS 3 and SAPS II scores were 52.3 +/- 18.5 points and 35.3 +/- 20.7 points, respectively. All prognostic models showed excellent discrimination (AUROC >= 0.8). The calibration of SAPS II was poor (p < 0.001). However, the calibration of standard SAPS 3 and its customized equation for Central and South American (CSA) countries were appropriate (p > 0.05). SAPS II and standard SAPS 3 prognostic models tended somewhat to underestimate the observed mortality (SMR > 1). However, when the customized equation was used, the estimated mortality was closer to the observed mortality [SMR = 0.95 (95% CI = 0.84-1.07)]. Similar results were observed when scheduled surgical patients were excluded. Conclusions: The SAPS 3 admission prognostic model at ICU admission, in particular its customized equation for CSA, was accurate in our cohort of critically ill patients with cancer.