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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2019

Open Access 01-12-2019 | Care | Research

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

Authors: Antônio Luis Eiras Falcão, Alexandre Guimarães de Almeida Barros, Angela Alcântara Magnani Bezerra, Natália Lopes Ferreira, Claudinéia Muterle Logato, Filipa Pais Silva, Ana Beatriz Francioso Oliveira do Monte, Rodrigo Marques Tonella, Luciana Castilho de Figueiredo, Rui Moreno, Desanka Dragosavac, Nelson Adami Andreollo

Published in: Annals of Intensive Care | Issue 1/2019

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Abstract

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.
Appendix
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Metadata
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
Authors
Antônio Luis Eiras Falcão
Alexandre Guimarães de Almeida Barros
Angela Alcântara Magnani Bezerra
Natália Lopes Ferreira
Claudinéia Muterle Logato
Filipa Pais Silva
Ana Beatriz Francioso Oliveira do Monte
Rodrigo Marques Tonella
Luciana Castilho de Figueiredo
Rui Moreno
Desanka Dragosavac
Nelson Adami Andreollo
Publication date
01-12-2019
Publisher
Springer International Publishing
Keyword
Care
Published in
Annals of Intensive Care / Issue 1/2019
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-019-0488-9

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