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Validation of the SAPS 3 admission prognostic model in patients with cancer in need of intensive care

Intensive Care Medicine volume 32, pages 1839–1844 (2006)Cite this article

Abstract

Objectives

To validate the SAPS 3 admission prognostic model in patients with cancer admitted to the intensive care unit (ICU).

Design

Cohort study.

Setting

Ten-bed medical–surgical oncologic ICU.

Patients and participants

Nine hundred and fifty-two consecutive patients admitted over a 3-year period.

Interventions

None.

Measurements and results

Data were prospectively collected at admission of ICU. SAPS II and SAPS 3 scores with respective estimated mortality rates were calculated. Discrimination was assessed by area under receiver operating characteristic (AUROC) curves and calibration by Hosmer–Lemeshow goodness-of-fit test. The mean age was 58.3 ± 23.1 years; there were 471 (49%) scheduled surgical, 348 (37%) medical and 133 (14%) emergency surgical patients. ICU and hospital mortality rates were 24.6% and 33.5%, respectively. The mean SAPS 3 and SAPS II scores were 52.3 ± 18.5 points and 35.3 ± 20.7 points, respectively. All prognostic models showed excellent discrimination (AUROC ≥ 0.8). The calibration of SAPS II was poor (p < 0.001). However, the calibration of standard SAPS 3 and its customized equation for Central and South American (CSA) countries were appropriate (p > 0.05). SAPS II and standard SAPS 3 prognostic models tended somewhat to underestimate the observed mortality (SMR > 1). However, when the customized equation was used, the estimated mortality was closer to the observed mortality [SMR = 0.95 (95% CI = 0.84–1.07)]. Similar results were observed when scheduled surgical patients were excluded.

Conclusions

The SAPS 3 admission prognostic model at ICU admission, in particular its customized equation for CSA, was accurate in our cohort of critically ill patients with cancer.

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References

  1. Le Gall J-R, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963

    PubMed  Article  Google Scholar 

  2. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    PubMed  CAS  Google Scholar 

  3. Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J (1993) Mortality probability models (MPM II) based on an international cohort of intensive care unit patients. JAMA 270:2478–2486

    PubMed  CAS  Article  Google Scholar 

  4. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, Sirio CA, Murphy DJ, Lotring T, Damiano A, Harrel FE (1991) The APACHE III Prognostic System. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619–1636

    PubMed  CAS  Google Scholar 

  5. Soares M, Fontes F, Dantas J, Gadelha D, Cariello P, Nardes F, Amorim C, Toscano L, Rocco JR (2004) Performance of six severity-of-illness scores in cancer patients requiring admission to the intensive care unit: A prospective observational study. Crit Care 8:R194–R203

    PubMed  Article  Google Scholar 

  6. Groeger JS, Lemeshow S, Price K, Nierman DM, White P, Klar J, Granovsky S, Horak D, Kish SK (1998) Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model. J Clin Oncol 16:761–770

    PubMed  CAS  Google Scholar 

  7. Sculier J-P, Paesmans M, Markiewicz E, Berghmans T (2000) Scoring systems in cancer patients admitted for an acute complication in a medical intensive care unit. Crit Care Med 28:2786–2792

    PubMed  CAS  Article  Google Scholar 

  8. Schellongowski P, Benesch M, Lang T, Traunmüller F, Zauner C, Laczika K, Locker GJ, Frass M, Staudinger T (2004) Comparison of three severity scores for critically ill cancer patients. Intensive Care Med 30:430–436

    PubMed  Article  Google Scholar 

  9. den Boer S, de Keizer NF, de Jonge E (2005) Performance of prognostic models in critically ill cancer patients—a review. Crit Care 9:R458–R463

    Google Scholar 

  10. Berghmans T, Paesmans M, Sculier JP (2004) Is a specific oncological scoring system better at predicting the prognosis of cancer patients admitted for an acute medical complication in an intensive care unit than general gravity scores? Support Care Cancer 12:234–239

    PubMed  CAS  Article  Google Scholar 

  11. Metnitz PGH, Moreno RP, Almeida E, Jordan B, Bauer P, Campos RA, Iapichino G, Edbrooke D, Capuzzo M, Le Gall JR, SAPS 3 Investigators (2005) SAPS 3 – From evaluation of the patient to evaluation of the intensive care unit. Part 1: Objectives, methods and cohort description. Intensive Care Med 31:1336–1344

    PubMed  Article  Google Scholar 

  12. Moreno RP, Metnitz PGH, Almeida E, Jordan B, Bauer P, Campos RA, Iapichino G, Edbrooke D, Capuzzo M, Le Gall JR, SAPS 3 Investigators (2005) SAPS 3 – From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med 31:1345–1355

    PubMed  Article  Google Scholar 

  13. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710

    PubMed  CAS  Google Scholar 

  14. Hanley JA, McNeil BJ (1982) The meaning and use of the area under receiver operating characteristic (ROC) curve. Radiology 143:29–36

    PubMed  CAS  Google Scholar 

  15. Lemeshow S, Hosmer DW (1982) A review of goodness of fit statistics for use in the development of logistic regression model. Am J Epidemiol 115:92–106

    PubMed  CAS  Google Scholar 

  16. Thiery G, Azoulay E, Darmon M, Ciroldi M, De Miranda S, Levy V, Fieux F, Moreau D, Le Gall JR, Schlemmer B (2005) Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol 23:4406–4413

    PubMed  Article  Google Scholar 

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Author information

Affiliations

  1. Instituto Nacional de Câncer – INCA, Centro de Tratamento Intensivo, 10o Andar, Pça. Cruz Vermelha, 23, 20230–130, Rio de Janeiro, RJ, Brazil

    Márcio Soares & Jorge I. F. Salluh

  2. Intensive Care Unit, Hospital Barra D’Or, Rio de Janeiro, Brazil

    Jorge I. F. Salluh

Authors
  1. Márcio Soares
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  2. Jorge I. F. Salluh
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Corresponding author

Correspondence to Márcio Soares.

Additional information

This work was performed at the Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.

Financial support: institutional departmental funds.

Conflicts of interest: none.

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Soares, M., Salluh, J.I.F. Validation of the SAPS 3 admission prognostic model in patients with cancer in need of intensive care. Intensive Care Med 32, 1839–1844 (2006). https://doi.org/10.1007/s00134-006-0374-4

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  • DOI: https://doi.org/10.1007/s00134-006-0374-4

Keywords

  • SAPS 3
  • Intensive care unit
  • Cancer
  • Mortality
  • Outcome
  • Severity-of-illness scores