The SAPS 3 score as a predictor of hospital mortality in a South African tertiary intensive care unit: A prospective cohort study.

Autor: van der Merwe E; Adult Critical Care Unit, Livingstone Tertiary Hospital, Port Elizabeth, South Africa.; Walter Sisulu University, Mthatha, South Africa., Kapp J; Adult Critical Care Unit, Livingstone Tertiary Hospital, Port Elizabeth, South Africa.; Walter Sisulu University, Mthatha, South Africa., Pazi S; Department of Statistics, Nelson Mandela University, Port Elizabeth, South Africa., Aylward R; Adult Critical Care Unit, Livingstone Tertiary Hospital, Port Elizabeth, South Africa., Van Niekerk M; Adult Critical Care Unit, Livingstone Tertiary Hospital, Port Elizabeth, South Africa., Mrara B; Walter Sisulu University, Mthatha, South Africa., Freercks R; Division of Nephrology and Hypertension, Livingstone Hospital, Port Elizabeth, South Africa.; Division Nephrology and Hypertension, Department of Medicine, University of Cape Town, Cape Town, South Africa.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 May 21; Vol. 15 (5), pp. e0233317. Date of Electronic Publication: 2020 May 21 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0233317
Abstrakt: Background: No African countries were included in the development of the Simplified Acute Physiology Score 3 (SAPS 3). This study aimed to assess the performance of the SAPS 3 as a predictor of hospital mortality in patients admitted to a multi-disciplinary tertiary intensive care unit (ICU) in South Africa.
Methods: A prospective cohort study was undertaken in a tertiary single-centre closed multidisciplinary ICU with 16 beds over 12 months in 2017. First time admissions 12 years and over were included. Exclusions were patients who died within six hours of admission, incomplete data sets and unknown outcome after ICU discharge. Demographic data, clinical admission data and co-morbidities were recorded. The SAPS 3 score was calculated within the first hour of ICU admission. The highest Sequential Organ Failure Assessment score, vasopressor use, mechanical ventilation requirements and details of acute kidney injury, if present, were recorded. Discrimination of the model was evaluated using an area under the receiver operating characteristic curve (AUROC) and calibration by the Hosmer-Lemeshow (HL) Goodness of Fit Test (Ĉ and Ĥ statistic). The observed versus the SAPS 3 model predicted mortality ratios were compared and the standardized mortality ratio (SMR) was calculated.
Results: A total of 829 admissions with a mean SAPS 3 (SD) of 48.1 (16) were included. Of patients with a known human immunodeficiency virus (HIV) status, 32,4% were positive. The ICU and hospital mortality rates were 13.3% and 21.4% respectively. The SAPS 3 model had a AUROC of 0.796 and HL Ĉ and Ĥ statistics were 12.1 and 11.8 (p-values 0.15 and 0.16). The SMR for the model was 1.002 (95%CI: 0.91-1.10). The mortality of 41% for the subgroup with sepsis/septic shock was higher than predicted with a SMR of 1.24 (95% CI 1.11-1.37).
Conclusions: The SAPS 3 model showed good calibration and fair discrimination when applied to the cohort. The SAPS 3 model can be used to describe the case mix in this African ICU with a high incidence of HIV. Ongoing efforts should be made to improve outcomes of septic patients.
Competing Interests: Roche South Africa provided an unrestricted research grant that was used to fund data capturing, analysis, presentation and publication of the study. Roche SA was not involved in the design or writing of this research. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
Databáze: MEDLINE
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