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Validation of four prognostic scores in patients with cancer admitted to Brazilian intensive care units: results from a prospective multicenter study

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Abstract

Objective

The aim of the present study was to validate the Simplified Acute Physiology Score II (SAPS II) and 3 (SAPS 3), the Mortality Probability Models III (MPM0-III), and the Cancer Mortality Model (CMM) in patients with cancer admitted to several intensive care units (ICU).

Design

Prospective multicenter cohort study.

Setting

Twenty-eight ICUs in Brazil.

Patients

Seven hundred and seventeen consecutive patients (solid tumors 93%; hematological malignancies 7%) included over a 2-month period.

Interventions

None.

Measurements and main results

Discrimination was assessed by area under receiver operating characteristic (AROC) curves and calibration by Hosmer–Lemeshow goodness-of-fit test. The main reasons for ICU admission were postoperative care (57%), sepsis (15%) and respiratory failure (10%). The ICU and hospital mortality rates were 21 and 30%, respectively. When all 717 patients were evaluated, discrimination was superior for both SAPS II (AROC = 0.84) and SAPS 3 (AROC = 0.84) scores compared to CMM (AROC = 0.79) and MPM0-III (AROC = 0.71) scores (P < 0.05 in all comparisons). Calibration was better using CMM and the customized equation of SAPS 3 score for South American countries (CSA). MPM0-III, SAPS II and standard SAPS 3 scores underestimated mortality (standardized mortality ratio, SMR > 1), while CMM tended to overestimation (SMR = 0.48). However, using the SAPS 3 for CSA resulted in more precise estimations of the probability of death [SMR = 1.02 (95% confidence interval = 0.87–1.19)]. Similar results were observed when scheduled surgical patients were excluded.

Conclusions

In this multicenter study, the customized equation of SAPS 3 score for CSA was found to be accurate in predicting outcomes in cancer patients requiring ICU admission.

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Acknowledgments

We are indebted to the Instituto Nacional de Câncer, especially the Department of Clinical Research, and CNPq, for all their support. This study was supported by Instituto Nacional de Câncer. Dr. Soares and Dr. Bozza are supported in part by individual research grants from CNPq.

Conflicts of interest statement

None.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Márcio Soares.

Additional information

On behalf of the Brazilian Research in Intensive Care Network, BRICNet.

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Appendix

Appendix

Participatingcentersandinvestigators.Bahia: Hospital Português (José Mário Meira Teles). Distrito Federal: Hospital Santa Luzia (Marcelo de Oliveira Maia). Espírito Santo: Vitória Apart Hospital (Cláudio Piras). Maranhão: Hospital São Domingos, São Luís (José Raimundo Araújo de Azevedo, Widlani Sousa Silva) Minas Gerais: Hospital Mater Dei, Belo Horizonte (Frederico Bruzzi Carvalho). Pará: Hospital Porto Dias, Belém (Leila Rezegue, Rômulo Nina Paes). Paraná: Hospital de Clínicas, UFPR (Álvaro Réa Neto, Nazah C M Youssef). Pernambuco: Hospital de Clínicas, UFPE (Michele Maria Gonçalves de Godoy, Cláudia Ângela Vilela de Almeida, Roberto Barreto Campello). Piauí: Hospital de Terapia Intensiva, Teresina (Patrícia M. Veiga de C. Mello, Lina Melo). Rio de Janeiro: Instituto Nacional de Câncer, Hospital do Câncer I (Márcio Soares, Jorge I. F. Salluh); Instituto Nacional de Câncer, Hospital do Câncer II (José Jorge Soares Netto, Alexandre de Marca; Rodrigo Hatum; Frederico Muller; Pedro Tibúrcio Nagles; Wlademir Gonzalez); Hospital de Clínicas de Niterói (Paulo César Pereira de Souza, Cláudio Monteiro, Darwin Prado, Moyzés Damasceno); Hospital Mario Lioni, Duque de Caxias (Paulo C. P. Souza, Pedro Paulo Galhardo, Guilherme Nossar); Hospital Pasteur (Bruno da Silva Ferreira, Vicente Cés de Souza Dantas); Hospital Samaritano (Aline Castro, Ricardo Lima); Hospital CardioTrauma (Marcos Freitas Knibel, Robson Dantas Santana); Clínica São Vicente (Arthur Vianna, Alessandra Alves); Hospital São Lucas (Marcos Freitas Knibel, Eduardo Xavier). Santa Catarina: Hospital São José, Criciúma (Felipe Dal-Pizzol, Cristiane Ritter). São Paulo: Hospital A. C. Camargo (Pedro Caruso, Valdelis Novis Okamoto, Lúcio Souza dos Santos); Fundação Pio XII, Hospital do Câncer de Barretos (Ulysses V. A. Silva, Rosana D. S. Almeida, Richard S. P. Silva); Hospital Sírio Libanês (Luciano C. Pontes de Azevedo, Guilherme P. Schettino); Hospital Israelita Albert Einstein (Eliezer Silva, Alexandre Biasi Cavalcante, Miquéias Martins Lima Silva); Hospital de Base, Faculdade Regional de Medicina de São José do Rio Preto (Suzana Margareth Ajeje Lobo); Hospital do Servidor Público Estadual (Ederlon Alves de Carvalho Rezende). Rio Grande do Norte: Hospital Unimed Natal (Érico de Lima Vale). Rio Grande do Sul: Santa Casa de Misericórdia de Porto Alegre, Pavilhão Central (Gilberto Friedman, Jorge Amilton Hoher); Santa Casa de Misericórdia de Porto Alegre, Hospital Santa Rita (André Peretty Torelly).

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Soares, M., Silva, U.V.A., Teles, J.M.M. et al. Validation of four prognostic scores in patients with cancer admitted to Brazilian intensive care units: results from a prospective multicenter study. Intensive Care Med 36, 1188–1195 (2010). https://doi.org/10.1007/s00134-010-1807-7

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