Metnitz Philipp G H, Moreno Rui P, Almeida Eduardo, Jordan Barbara, Bauer Peter, Campos Ricardo Abizanda, Iapichino Gaetano, Edbrooke David, Capuzzo Maurizia, Le Gall Jean-Roger
Dept. of Anesthesiology and General Intensive Care, University Hospital of Vienna, Vienna, Austria.
Intensive Care Med. 2005 Oct;31(10):1336-44. doi: 10.1007/s00134-005-2762-6. Epub 2005 Aug 17.
Risk adjustment systems now in use were developed more than a decade ago and lack prognostic performance. Objective of the SAPS 3 study was to collect data about risk factors and outcomes in a heterogeneous cohort of intensive care unit (ICU) patients, in order to develop a new, improved model for risk adjustment.
Prospective multicentre, multinational cohort study.
A total of 19,577 patients consecutively admitted to 307 ICUs from 14 October to 15 December 2002.
Data were collected at ICU admission, on days 1, 2 and 3, and the last day of the ICU stay. Data included sociodemographics, chronic conditions, diagnostic information, physiological derangement at ICU admission, number and severity of organ dysfunctions, length of ICU and hospital stay, and vital status at ICU and hospital discharge. Data reliability was tested with use of kappa statistics and intraclass-correlation coefficients, which were >0.85 for the majority of variables. Completeness of the data was also satisfactory, with 1 [0-3] SAPS II parameter missing per patient. Prognostic performance of the SAPS II was poor, with significant differences between observed and expected mortality rates for the overall cohort and four (of seven) defined regions, and poor calibration for most tested subgroups.
The SAPS 3 study was able to provide a high-quality multinational database, reflecting heterogeneity of current ICU case-mix and typology. The poor performance of SAPS II in this cohort underscores the need for development of a new risk adjustment system for critically ill patients.
目前使用的风险调整系统是十多年前开发的，缺乏预后评估性能。SAPS 3研究的目的是收集重症监护病房（ICU）患者异质性队列中的风险因素和预后数据，以便开发一种新的、改进的风险调整模型。
前瞻性多中心、跨国队列研究。
2002年10月14日至12月15日期间，共有19577例患者连续入住307个ICU。
在ICU入院时、第1、2、3天以及ICU住院的最后一天收集数据。数据包括社会人口统计学、慢性病、诊断信息、ICU入院时的生理紊乱、器官功能障碍的数量和严重程度、ICU和住院时间以及ICU和医院出院时的生命状态。使用kappa统计和组内相关系数对数据可靠性进行测试，大多数变量的系数>0.85。数据完整性也令人满意，每位患者缺失1[0-3]个SAPS II参数。SAPS II的预后评估性能较差，总体队列和七个定义区域中的四个区域的观察死亡率和预期死亡率之间存在显著差异，并且大多数测试亚组的校准效果不佳。
SAPS 3研究能够提供一个高质量的跨国数据库，反映当前ICU病例组合和类型的异质性。SAPS II在该队列中的表现不佳凸显了为重症患者开发新的风险调整系统的必要性。
