Is SAPS 3 better than APACHE II at predicting mortality in critically ill transplant patients?

Authors

  • Vanessa M. de Oliveira Hospital Dom Vicente Scherer; Intensive Care Unit
  • Janete S. Brauner Hospital N. Senhora da Conceicao; Internal Medicine Unit
  • Edison Rodrigues Filho Hospital Dom Vicente Scherer; Intensive Care Unit
  • Ruth G. A. Susin Hospital Dom Vicente Scherer; Intensive Care Unit
  • Viviane Draghetti Hospital Dom Vicente Scherer; Intensive Care Unit
  • Simone T. Bolzan Hospital Dom Vicente Scherer; Intensive Care Unit
  • Silvia R. R. Vieira Universidade Federal do Rio Grande do Sul

DOI:

https://doi.org/10.6061/CLINICS/2013(02)OA06

Keywords:

APACHE, SAPS, Kidney Transplantation, Liver Transplantation, Lung Transplantation, Critical Care Patients

Abstract

OBJECTIVES: This study compared the accuracy of the Simplified Acute Physiology Score 3 with that of Acute Physiology and Chronic Health Evaluation II at predicting hospital mortality in patients from a transplant intensive care unit. METHOD: A total of 501 patients were enrolled in the study (152 liver transplants, 271 kidney transplants, 54 lung transplants, 24 kidney-pancreas transplants) between May 2006 and January 2007. The Simplified Acute Physiology Score 3 was calculated using the global equation (customized for South America) and the Acute Physiology and Chronic Health Evaluation II score; the scores were calculated within 24 hours of admission. A receiver-operating characteristic curve was generated, and the area under the receiver-operating characteristic curve was calculated to identify the patients at the greatest risk of death according to Simplified Acute Physiology Score 3 and Acute Physiology and Chronic Health Evaluation II scores. The Hosmer-Lemeshow goodness-of-fit test was used for statistically significant results and indicated a difference in performance over deciles. The standardized mortality ratio was used to estimate the overall model performance. RESULTS: The ability of both scores to predict hospital mortality was poor in the liver and renal transplant groups and average in the lung transplant group (area under the receiver-operating characteristic curve = 0.696 for Simplified Acute Physiology Score 3 and 0.670 for Acute Physiology and Chronic Health Evaluation II). The calibration of both scores was poor, even after customizing the Simplified Acute Physiology Score 3 score for South America. CONCLUSIONS: The low predictive accuracy of the Simplified Acute Physiology Score 3 and Acute Physiology and Chronic Health Evaluation II scores does not warrant the use of these scores in critically ill transplant patients.

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Published

2013-01-01

Issue

Section

Clinical Sciences

How to Cite

Oliveira, V. M. de, Brauner, J. S., Rodrigues Filho, E., Susin, R. G. A., Draghetti, V., Bolzan, S. T., & Vieira, S. R. R. (2013). Is SAPS 3 better than APACHE II at predicting mortality in critically ill transplant patients? . Clinics, 68(2), 153-158. https://doi.org/10.6061/CLINICS/2013(02)OA06