Caution when using prognostic models: A prospective comparison of 3 recent prognostic models
Caution when using prognostic models: A prospective comparison of 3 recent prognostic models
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DOI：
10.1016/j.jcrc.2011.08.016
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发表时间：
2012-08-01
影响因子：
3.7
通讯作者：
Dias, Carlos Augusto
中科院分区：
文献类型：
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作者：
Nassar, Antonio Paulo, Jr.;Mocelin, Amilcar Oshiro;Dias, Carlos Augusto
目的：发展预后模型来估计死亡率并比较不同重症监护病房的预后。然而，这些模型在用于不同人群之前需要经过验证。在这项研究中，我们评估了最近开发的3种一般预后模型（急性生理和慢性健康评估[APACHE] IV，简化急性生理评分[SAPS] 3和死亡率概率模型III [MPM0-III]）在3个巴西内科外科重症监护病房的人群中的表现。材料和方法：对2008年7月至2009年12月入院的所有患者进行评估以纳入研究。计算所有模型的标准化死亡率。采用Hosmer-Lemeshow拟合优度检验评估校准。使用接收算子曲线下的面积来评估鉴别。结果：共纳入5780例患者。住院死亡率为9.1%。所有模型的判别性都很好（APACHE IV、SAPS 3和MPM0-III的接收算子曲线下面积分别为0.883、0.855和0.840）。APACHE IV比SAPS 3和MPM0-III具有更好的识别能力（P < 0.001）。所有模型的校准都很差，并且高估了医院死亡率（APACHE IV、MPM0-III和SAPS 3的Hosmer-Lemeshow统计值分别为53.7、134.2、226.6；所有模型的P < 0.001）。结论：在本研究中，所有的模型都显示出较差的校准，但所有模型的判别都很好。由于这在验证研究中是一个常见的发现，因此在使用预后模型进行基准测试时需要谨慎。(C) 2012爱思唯尔公司版权所有。
Purpose: Prognostic models have been developed to estimate mortality and to compare outcomes in different intensive care units. However, these models need to be validated before their use in different populations. In this study, we assessed the performance of 3 recently developed general prognostic models (Acute Physiologic and Chronic Health Evaluation [APACHE] IV, Simplified Acute Physiology Score [SAPS] 3 and Mortality Probability Model III [MPM0-III]) in a population admitted at 3 medical-surgical Brazilian intensive care units.Materials and Methods: All patients admitted from July 2008 to December 2009 were evaluated for inclusion in the study. Standardized mortality ratios were calculated for all models. Calibration was assessed by the Hosmer-Lemeshow goodness-of-fit test. Discrimination was evaluated using the area under the receiver operator curve.Results: A total of 5780 patients were included. Inhospital mortality was 9.1%. Discrimination was very good for all models (area under the receiver operator curve for APACHE IV, SAPS 3 and MPM0-III was 0.883, 0.855 and 0.840, respectively). APACHE IV showed better discrimination than SAPS 3 and MPM0-III (P < .001 for both comparisons). All models calibrated poorly and overestimated hospital mortality (Hosmer-Lemeshow statistic was 53.7, 134.2, 226.6 for APACHE IV, MPM0-III, and SAPS 3, respectively; P < .001 for all).Conclusions: In this study, all models showed poor calibration, while discrimination was very good for all of them. As this has been a common finding in validation studies, caution is warranted when using prognostic models for benchmarking. (C) 2012 Elsevier Inc. All rights reserved.