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The prognostic accuracy evaluation of SAPS 3, SOFA and APACHE II scores for mortality prediction in the surgical ICU: an external validation study and decision-making analysis

BACKGROUND: The early postoperative period is critical for surgical patients. SOFA, SAPS 3 and APACHE II are prognostic scores widely used to predict mortality in ICU patients. This study aimed to evaluate these index tests for their prognostic accuracy for intra-ICU and in-hospital mortalities as t...

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Autores principales: Falcão, Antônio Luis Eiras, Barros, Alexandre Guimarães de Almeida, Bezerra, Angela Alcântara Magnani, Ferreira, Natália Lopes, Logato, Claudinéia Muterle, Silva, Filipa Pais, do Monte, Ana Beatriz Francioso Oliveira, Tonella, Rodrigo Marques, de Figueiredo, Luciana Castilho, Moreno, Rui, Dragosavac, Desanka, Andreollo, Nelson Adami
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353976/
https://www.ncbi.nlm.nih.gov/pubmed/30701392
http://dx.doi.org/10.1186/s13613-019-0488-9
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author Falcão, Antônio Luis Eiras
Barros, Alexandre Guimarães de Almeida
Bezerra, Angela Alcântara Magnani
Ferreira, Natália Lopes
Logato, Claudinéia Muterle
Silva, Filipa Pais
do Monte, Ana Beatriz Francioso Oliveira
Tonella, Rodrigo Marques
de Figueiredo, Luciana Castilho
Moreno, Rui
Dragosavac, Desanka
Andreollo, Nelson Adami
author_facet Falcão, Antônio Luis Eiras
Barros, Alexandre Guimarães de Almeida
Bezerra, Angela Alcântara Magnani
Ferreira, Natália Lopes
Logato, Claudinéia Muterle
Silva, Filipa Pais
do Monte, Ana Beatriz Francioso Oliveira
Tonella, Rodrigo Marques
de Figueiredo, Luciana Castilho
Moreno, Rui
Dragosavac, Desanka
Andreollo, Nelson Adami
author_sort Falcão, Antônio Luis Eiras
collection PubMed
description BACKGROUND: The early postoperative period is critical for surgical patients. SOFA, SAPS 3 and APACHE II are prognostic scores widely used to predict mortality in ICU patients. This study aimed to evaluate these index tests for their prognostic accuracy for intra-ICU and in-hospital mortalities as target conditions in patients admitted to ICU after urgent or elective surgeries and to test whether they aid in decision-making. The process comprised the assessment of discrimination through analysis of the areas under the receiver operating characteristic curves and calibration of the prognostic models for the target conditions. After, the clinical relevance of applying them was evaluated through the measurement of the net benefit of their use in the clinical decision. RESULTS: Index tests were found to discriminate regular for both target conditions with a poor calibration (C statistics—intra-ICU mortality AUROCs: APACHE II 0.808, SAPS 3 0.821 and SOFA 0.797/in-hospital mortality AUROCs: APACHE II 0.772, SAPS 3 0.790 and SOFA 0.742). Calibration assessment revealed a weak correlation between the observed and expected number of cases in several thresholds of risk, calculated by each model, for both tested outcomes. The net benefit analysis showed that all score’s aggregate value in the clinical decision when the calculated probabilities of death ranged between 10 and 40%. CONCLUSIONS: In this study, we observed that the tested ICU prognostic scores are fair tools for intra-ICU and in-hospital mortality prediction in a cohort of postoperative surgical patients. Also, they may have some potential to be used as ancillary data to support decision-making by physicians and families regarding the level of therapeutic investment and palliative care. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13613-019-0488-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-63539762019-02-24 The prognostic accuracy evaluation of SAPS 3, SOFA and APACHE II scores for mortality prediction in the surgical ICU: an external validation study and decision-making analysis Falcão, Antônio Luis Eiras Barros, Alexandre Guimarães de Almeida Bezerra, Angela Alcântara Magnani Ferreira, Natália Lopes Logato, Claudinéia Muterle Silva, Filipa Pais do Monte, Ana Beatriz Francioso Oliveira Tonella, Rodrigo Marques de Figueiredo, Luciana Castilho Moreno, Rui Dragosavac, Desanka Andreollo, Nelson Adami Ann Intensive Care Research BACKGROUND: The early postoperative period is critical for surgical patients. SOFA, SAPS 3 and APACHE II are prognostic scores widely used to predict mortality in ICU patients. This study aimed to evaluate these index tests for their prognostic accuracy for intra-ICU and in-hospital mortalities as target conditions in patients admitted to ICU after urgent or elective surgeries and to test whether they aid in decision-making. The process comprised the assessment of discrimination through analysis of the areas under the receiver operating characteristic curves and calibration of the prognostic models for the target conditions. After, the clinical relevance of applying them was evaluated through the measurement of the net benefit of their use in the clinical decision. RESULTS: Index tests were found to discriminate regular for both target conditions with a poor calibration (C statistics—intra-ICU mortality AUROCs: APACHE II 0.808, SAPS 3 0.821 and SOFA 0.797/in-hospital mortality AUROCs: APACHE II 0.772, SAPS 3 0.790 and SOFA 0.742). Calibration assessment revealed a weak correlation between the observed and expected number of cases in several thresholds of risk, calculated by each model, for both tested outcomes. The net benefit analysis showed that all score’s aggregate value in the clinical decision when the calculated probabilities of death ranged between 10 and 40%. CONCLUSIONS: In this study, we observed that the tested ICU prognostic scores are fair tools for intra-ICU and in-hospital mortality prediction in a cohort of postoperative surgical patients. Also, they may have some potential to be used as ancillary data to support decision-making by physicians and families regarding the level of therapeutic investment and palliative care. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13613-019-0488-9) contains supplementary material, which is available to authorized users. Springer International Publishing 2019-01-30 /pmc/articles/PMC6353976/ /pubmed/30701392 http://dx.doi.org/10.1186/s13613-019-0488-9 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Research
Falcão, Antônio Luis Eiras
Barros, Alexandre Guimarães de Almeida
Bezerra, Angela Alcântara Magnani
Ferreira, Natália Lopes
Logato, Claudinéia Muterle
Silva, Filipa Pais
do Monte, Ana Beatriz Francioso Oliveira
Tonella, Rodrigo Marques
de Figueiredo, Luciana Castilho
Moreno, Rui
Dragosavac, Desanka
Andreollo, Nelson Adami
The prognostic accuracy evaluation of SAPS 3, SOFA and APACHE II scores for mortality prediction in the surgical ICU: an external validation study and decision-making analysis
title The prognostic accuracy evaluation of SAPS 3, SOFA and APACHE II scores for mortality prediction in the surgical ICU: an external validation study and decision-making analysis
title_full The prognostic accuracy evaluation of SAPS 3, SOFA and APACHE II scores for mortality prediction in the surgical ICU: an external validation study and decision-making analysis
title_fullStr The prognostic accuracy evaluation of SAPS 3, SOFA and APACHE II scores for mortality prediction in the surgical ICU: an external validation study and decision-making analysis
title_full_unstemmed The prognostic accuracy evaluation of SAPS 3, SOFA and APACHE II scores for mortality prediction in the surgical ICU: an external validation study and decision-making analysis
title_short The prognostic accuracy evaluation of SAPS 3, SOFA and APACHE II scores for mortality prediction in the surgical ICU: an external validation study and decision-making analysis
title_sort prognostic accuracy evaluation of saps 3, sofa and apache ii scores for mortality prediction in the surgical icu: an external validation study and decision-making analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353976/
https://www.ncbi.nlm.nih.gov/pubmed/30701392
http://dx.doi.org/10.1186/s13613-019-0488-9
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