SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 1: Objectives, methods and cohort description.
SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 1: Objectives, methods and cohort description.
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DOI：
10.1007/s00134-005-2762-6
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发表时间：
2005-10
影响因子：
38.9
通讯作者：
Le Gall, JR
中科院分区：
文献类型：
--
作者：
Metnitz, PGH;Moreno, RP;Almeida, E;Jordan, B;Bauer, P;Campos, RA;Iapichino, G;Edbrooke, D;Capuzzo, M;Le Gall, JR
目前使用的风险调整系统是十多年前开发的，缺乏预测能力。SAPS 3研究的目的是收集重症监护病房（ICU）患者异质队列的危险因素和结局数据，以建立一种新的、改进的风险调整模型。前瞻性多中心、多国队列研究。从2002年10月14日至12月15日，共有19,577名患者连续入住307个icu。数据收集于ICU入院时、第1、2、3天以及ICU住院的最后一天。数据包括社会人口统计学、慢性疾病、诊断信息、ICU入院时的生理紊乱、器官功能障碍的数量和严重程度、ICU和住院时间、ICU和出院时的生命体征。采用kappa统计和类内相关系数检验数据的信度，大多数变量的信度为>0.85。数据的完整性也令人满意，每位患者缺少1[0-3]个SAPS II参数。SAPS II的预后表现较差，在整个队列和四个（七个）确定区域的观察死亡率和预期死亡率之间存在显着差异，并且大多数测试亚组的校准较差。SAPS 3研究能够提供高质量的多国数据库，反映当前ICU病例组合和类型的异质性。SAPS II在该队列中的不良表现强调了为危重患者开发新的风险调整系统的必要性。电子补充材料包含在本文的在线全文版本中，授权用户可以访问：http://dx.doi.org/10.1007/s00134-005-2762-6
Risk adjustment systems now in use were developed more than a decade ago and lack prognostic performance. Objective of the SAPS 3 study was to collect data about risk factors and outcomes in a heterogeneous cohort of intensive care unit (ICU) patients, in order to develop a new, improved model for risk adjustment. Prospective multicentre, multinational cohort study. A total of 19,577 patients consecutively admitted to 307 ICUs from 14 October to 15 December 2002. Data were collected at ICU admission, on days 1, 2 and 3, and the last day of the ICU stay. Data included sociodemographics, chronic conditions, diagnostic information, physiological derangement at ICU admission, number and severity of organ dysfunctions, length of ICU and hospital stay, and vital status at ICU and hospital discharge. Data reliability was tested with use of kappa statistics and intraclass-correlation coefficients, which were >0.85 for the majority of variables. Completeness of the data was also satisfactory, with 1 [0–3] SAPS II parameter missing per patient. Prognostic performance of the SAPS II was poor, with significant differences between observed and expected mortality rates for the overall cohort and four (of seven) defined regions, and poor calibration for most tested subgroups. The SAPS 3 study was able to provide a high-quality multinational database, reflecting heterogeneity of current ICU case-mix and typology. The poor performance of SAPS II in this cohort underscores the need for development of a new risk adjustment system for critically ill patients. Electronic supplementary material is included in the online fulltext version of this article and accessible for authorised users: http://dx.doi.org/10.1007/s00134-005-2762-6
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