External validation of SAPS 3 and MPM 0 -III scores in 48,816 patients from 72 Brazilian ICUs.

Autor: Moralez GM; Graduate Program in Translational Medicine, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil., Rabello LSCF; PPG Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.; ICU, Hospital Copa D'Or, Rio de Janeiro, Brazil., Lisboa TC; Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil., Lima MDFA; ICU, Hospital Esperança Recife, Recife, Brazil., Hatum RM; ICU, Hospital Total Cor, Rio de Janeiro, Brazil., De Marco FVC; ICU, Hospital viValle, São José dos Campos, Brazil., Alves A; ICU, Hospital Rios D'Or, Rio de Janeiro, Brazil., Pinto JEDSS; ICU, Hospital Norte D'Or, Rio de Janeiro, Brazil., de Araújo HBN; Hospital do Coração do Brasil, Brasília, Brazil., Ramos GV; Department of Critical Care, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil., Silva AR; Department of Critical Care, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil., Fernandes GC; ICU, Santa Casa de Misericórdia de Juiz de Fora, Juiz de Fora, Brazil., Faria GBA; ICU, Hospital Oeste D'Or, Rio de Janeiro, Brazil., Mendes CL; ICU, Hospital Universitário Lauro Wanderley, João Pessoa, Brazil., Ramos Filho RÁ; ICU, Hospital São Luiz - Unidade Jabaquara, São Paulo, Brazil., de Souza VP; Complexo Hospitalar de Niterói, Niterói, Brazil., do Brasil PEAA; Department of Critical Care, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil.; Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz-Fiocruz, Rio de Janeiro, Brazil., Bozza FA; Department of Critical Care, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil.; Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz-Fiocruz, Rio de Janeiro, Brazil., Salluh JIF; PPG Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.; Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil., Soares M; PPG Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. marciosoaresms@gmail.com.; Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil. marciosoaresms@gmail.com.; Department of Critical Care, D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30. Botafogo, Rio de Janeiro, 22281-100, Brazil. marciosoaresms@gmail.com.
Jazyk: angličtina
Zdroj: Annals of intensive care [Ann Intensive Care] 2017 Dec; Vol. 7 (1), pp. 53. Date of Electronic Publication: 2017 May 18.
DOI: 10.1186/s13613-017-0276-3
Abstrakt: Background: The performance of severity-of-illness scores varies in different scenarios and must be validated prior of being used in a specific settings and geographic regions. Moreover, models' calibration may deteriorate overtime and performance of such instruments should be reassessed regularly. Therefore, we aimed at to validate the SAPS 3 in a large contemporary cohort of patients admitted to Brazilian ICUs. In addition, we also compared the performance of the SAPS 3 with the MPM 0 -III.
Methods: This is a retrospective cohort study in which 48,816 (medical admissions = 67.9%) adult patients are admitted to 72 Brazilian ICUs during 2013. We evaluated models' discrimination using the area under the receiver operating characteristic curve (AUROC). We applied the calibration belt to evaluate the agreement between observed and expected mortality rates (calibration).
Results: Mean SAPS 3 score was 44.3 ± 15.4 points. ICU and hospital mortality rates were 11.0 and 16.5%. We estimated predicted mortality using both standard (SE) and Central and South American (CSA) customized equations. Predicted mortality rates were 16.4 ± 19.3% (SAPS 3-SE), 21.7 ± 23.2% (SAPS 3-CSA) and 14.3 ± 14.0% (MPM 0 -III). Standardized mortality ratios (SMR) obtained for each model were: 1.00 (95% CI, 0.98-0.102) for the SAPS 3-SE, 0.75 (0.74-0.77) for the SAPS 3-CSA and 1.15 (1.13-1.18) for the MPM 0 -III. Discrimination was better for SAPS 3 models (AUROC = 0.85) than for MPM 0 -III (AUROC = 0.80) (p < 0.001). We applied the calibration belt to evaluate the agreement between observed and expected mortality rates (calibration): the SAPS 3-CSA overestimated mortality throughout all risk classes while the MPM 0 -III underestimated it uniformly. The SAPS 3-SE did not show relevant deviations from ideal calibration.
Conclusions: In a large contemporary database, the SAPS 3-SE was accurate in predicting outcomes, supporting its use for performance evaluation and benchmarking in Brazilian ICUs.
Databáze: MEDLINE
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