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EXTERNAL VALIDATION OF SAPS 3 AND MPM0-III SCORES IN 48,816 PATIENTS FROM 72 BRAZILIAN ICUS
Moralez, Giulliana Martines et al. | Date Issued: 2017
Author
Moralez, Giulliana Martines
Rabello, Ligia Sarmet Cunha Farah
Lisboa, Thiago Costa
Lima, Mariza da Fonte Andrade
Hatum, Rodrigo Marques
Marco, Fernando Vinicius Cesar de
Alves, Alessandra
Pinto, Jorge Eduardo da Silva Soares
Araújo, Hélia Beatriz Nunes de
Ramos, Grazielle Viana
Silva, Aline Reis
Fernandes, Guilherme Côrtes
Faria, Guilherme Brenande Alves
Mendes, Ciro Leite
Ramos Filho, Roberto Álvaro
Souza, Valdênia Pereira de
Brasil, Pedro Emmanuel Alvarenga Americano do
Bozza, Fernando A.
Salluh, Jorge Ibrain Figueira
Soares, Marcio
Affilliation
D’Or Institute for Research and Education. Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brasil.
Federal University of Rio de Janeiro. PPG Internal Medicine. Rio de Janeiro, RJ, Brazil / Hospital Copa D’Or. Rio de Janeiro, RJ, Brazil.
Santa Casa de Misericórdia de Porto Alegre. Complexo Hospitalar. Porto Alegre, RS, Brasil.
Hospital Esperança Recife. Recife, PE, Brasil.
Hospital Total Cor. Rio de Janeiro, RJ, Brasil.
Hospital viValle. São José dos Campos, SP, Brasil.
Hospital Rios D’Or. Rio de Janeiro, RJ, Brasil.
Hospital Norte D’Or. Rio de Janeiro, RJ, Brasil.
Hospital do Coração do Brasil. Brasília, DF, Brasil.
D’Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil.
D’Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil.
Santa Casa de Misericórdia de Juiz de Fora. Juiz de Fora, MG, Brasil.
Hospital Oeste D’Or. Rio de Janeiro, RJ, Brasil.
Hospital Universitário Lauro Wanderley. João Pessoa, PB, Brasil.
Hospital São Luiz. Unidade Jabaquara. São Paulo, SP, Brasil.
Complexo Hospitalar de Niterói. Niterói, RJ, Brasil.
D’Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
D’Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Federal University of Rio de Janeiro. PPG Internal Medicine. Rio de Janeiro, RJ, Brazil / D’Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. PPG Internal Medicine. Rio de Janeiro, RJ, Brazil / D’Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil / D’Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil.
Abstract
Background: The performance of severity-of-illness scores varies in diferent scenarios and must be validated prior of being used in a specifc 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 MPM0-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% (MPM0-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 MPM0-III. Discrimination was better for SAPS 3 models (AUROC = 0.85) than for MPM0-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 MPM0-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 itsuse for performance evaluation and benchmarking in Brazilian ICUs.
Keywords
Severity-of-illness scores
Validation
Intensive care units
Outcomes
Standardized mortality rate
 
Publisher
Springer
Citation
MORALES, Giulliana Martines et al. External validation of SAPS 3 and MPM0-III scores in 48,816 patients from 72 Brazilian ICUs. Annals of Intensive Care, v. 7, n. 1, p. 1-8, Dec. 2017.
DOI
10.1186/s13613-017-0276-3
ISSN
2110-5820
Notes
On Behalf of the ORCHESTRA Study Investigators.