Comparison of the performance of SAPS II, SAPS 3, APACHE II, and their customized prognostic models in a surgical intensive care unit
Comparison of the performance of SAPS II, SAPS 3, APACHE II, and their customized prognostic models in a surgical intensive care unit
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DOI：
10.1093/bja/aen291
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发表时间：
2008-12-01
影响因子：
9.8
通讯作者：
Marx, G.
中科院分区：
文献类型：
--
作者：
Sakr, Y.;Krauss, C.;Marx, G.
简化急性生理评分（SAPS）3最近已开发，但尚未在外科重症监护室（ICU）患者中验证。我们比较了SAPS 3与SAPS II的性能以及外科ICU患者的急性生理学和慢性健康评估（APACHE）II评分，并对2004年8月至2005年12月期间所有入住德国大学医院术后ICU的患者的数据进行了分析。使用标准公式计算SAPS II、APACHE II、调整后的APACHE II（adj-APACHE II）、SAPS 3和欧洲定制的SAPS 3 [C-SAPS 3（Eu）]的ICU死亡概率。为了改善预后模型的校准，使用原始评分的逻辑回归进行一级定制，并计算定制评分（C-SAPS II，C-SAPS 3和C-APACHE II）的相应ICU死亡概率。住院死亡率为9%。Hosmer和Lemeshow统计显示，SAPS II、APACHE II、adj-APACHE II、SAPS 3和C-SAPS 3（Eu）的校准较差，但C-SAPS II、C-APACHE II和C-SAPS 3的校准良好。所有模型的辨别力一般都很好[受试者工作特征曲线下面积范围为0.78（C-APACHE II）至0.89（C-SAPS 3）]。C-SAPS 3评分似乎具有目视检查的最佳校准曲线。在这组外科ICU患者中，SAPS 3的性能与APACHE II和SAPS II相似。定制改进了所有预测模型的校准。
The Simplified Acute Physiology Score (SAPS) 3 has recently been developed, but not yet validated in surgical intensive care unit (ICU) patients. We compared the performance of SAPS 3 with SAPS II and the Acute Physiology and Chronic Health Evaluation (APACHE) II score in surgical ICU patients.Prospectively collected data from all patients admitted to a German university hospital postoperative ICU between August 2004 and December 2005 were analysed. The probability of ICU mortality was calculated for SAPS II, APACHE II, adjusted APACHE II (adj-APACHE II), SAPS 3, and SAPS 3 customized for Europe [C-SAPS3 (Eu)] using standard formulas. To improve calibration of the prognostic models, a first-level customization was performed, using logistic regression on the original scores, and the corresponding probability of ICU death was calculated for the customized scores (C-SAPS II, C-SAPS 3, and C-APACHE II).The study included 1851 patients. Hospital mortality was 9%. Hosmer and Lemeshow statistics showed poor calibration for SAPS II, APACHE II, adj-APACHE II, SAPS 3, and C-SAPS 3 (Eu), but good calibration for C-SAPS II, C-APACHE II, and C-SAPS 3. Discrimination was generally good for all models [area under the receiver operating characteristic curve ranged from 0.78 (C-APACHE II) to 0.89 (C-SAPS 3)]. The C-SAPS 3 score appeared to have the best calibration curve on visual inspection.In this group of surgical ICU patients, the performance of SAPS 3 was similar to that of APACHE II and SAPS II. Customization improved the calibration of all prognostic models.