Prognostic performance and customization of the SAPS II: results of a multicenter Austrian study
Prognostic performance and customization of the SAPS II: results of a multicenter Austrian study
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DOI：
10.1007/s001340050815
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发表时间：
1999-02-01
影响因子：
38.9
通讯作者：
Hiesmayr, M
中科院分区：
文献类型：
--
作者：
Metnitz, PGH;Valentin, A;Hiesmayr, M
目的：评估原始的简化急性生理评分（SAPS） II在奥地利重症监护患者中的预后表现，并评估定制的影响。设计：多中心研究的数据库分析环境：奥地利的9个成人内科、外科和混合重症监护病房（ICUs）。患者：共有1733例患者连续入住icu。测量和结果：数据库包括入院数据、SAPS II、住院时间和住院死亡率。SAPS II的Hosmer-Lemeshow拟合优度检验显示拟合不均匀性（H = 89.1, 10 df, p < 0.0001; = 91.8, 10 elf, p < 0.0001）。亚组分析显示，以心血管（内科和外科）疾病为主要入院原因的患者表现良好。利用逻辑回归方法推导了一个新的预测方程。定制模型（SAPS IIAM）的拟合优度很好（H = 11.2, 9 df, p = 0.33, C = 11.6, 9 elf, p = 0.24）。标准化死亡率（SMR）从0.81 +/- 0.26变化到0.93 +/- 0.29。结论：应用于所有患者时，SAPS II并没有很好地校准。然而，它在以心血管疾病为主要入院原因的患者中表现良好，因此可以应用于这些患者。从没有已知校准的评分系统计算出的标准化死亡率必须持怀疑态度。
Objectives:To evaluate the prognostic performance of the original Simplified Acute Physiology Score (SAPS) II in Austrian intensive care patients and to evaluate the impact of customization.Design: Analysis of the database of a multicenter studySetting: Nine adult medical, surgical, and mixed intensive care units (ICUs) in Austria.Patients: A total of 1733 patients consecutively admitted to the ICUs.Measurements ann results: The database included admission data, SAPS II, length of stay, and hospital mortality. The Hosmer-Lemeshow goodness-of-fit test for the SAPS II showed a lack of uniformity of fit (H = 89.1, 10 df, p < 0.0001: = 91.8, 10 elf, p < 0.0001). Subgroup analysis showed good performance in patients with cardiovascular (medical and surgical) diseases as the primary reasons for admission. A new predictive equation was derived by means of the logistic regression. Goodness-of-fit was excellent for the customized model (SAPS IIAM) (H = 11.2, 9 df, p = 0.33, C = 11.6, 9 elf, p = 0.24). The mean standardized mortality ratio (SMR) changed from 0.81 +/- 0.26 to 0.93 +/- 0.29 with customization.Conclusions: SAPS II was not well calibrated when applied to all patients. However, it performed well for patients with cardiovascular dis-eases as the primary reason for admission and may thus be applied to these patients. Standardized mortality ratios that are calculated from scoring systems without known calibration must be viewed with skepticism.