Division of Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand.
Minerva Anestesiol. 2011 Mar;77(3):305-12.
Recently, the Simplified Acute Physiology Score (SAPS) 3 was developed. The objective of this study was to compare the performance of SAPS 3 with those of SAPS II, the Acute Physiology and Chronic Health Evaluation (APACHE) II and customized scores in predicting hospital mortality in critically ill mixed medical-coronary patients.
A prospective cohort study was conducted over a 2.5-year period in a 10-bed mixed medical-coronary care unit of a tertiary referral university teaching hospital in Thailand. The probabilities of hospital mortality of SAPS 3, SAPS II and APACHE II were calculated using standard equations.
A total of 2022 patients were enrolled. The performance of SAPS 3 was similar to those of the old standard severity scores. All three scores had excellent discrimination, with areas under the receiver operating characteristic curve of 0.916 for SAPS 3, 0.914 for SAPS II and 0.936 for APACHE II. All scores overestimated hospital mortality, with standardized mortality ratios of 0.81, 0.78 and 0.80 for SAPS 3, SAPS II and APACHE II, respectively. The calibration of all scores was poor as demonstrated by the Hosmer-Lemeshow goodness-of-fit H and C statistics, which were <0.05. The calibration of all scores was improved by first-level customization.
The SAPS 3 score provided excellent discrimination but poor calibration, as did the SAPS II and APACHE II scores in our critically ill mixed medical patients. The customization of the severity score improved the calibration performance, and thus this customization may serve as a tool for adjusting the equation of the score to predict mortality and quality assessment in intensive care units (ICUs).
最近开发了简化急性生理学评分（SAPS）3。本研究的目的是比较 SAPS 3 与 SAPS II、急性生理学和慢性健康评估（APACHE）II 以及定制评分在预测危重症混合内科-冠心病患者住院死亡率方面的性能。
在泰国一家三级转诊教学医院的 10 张混合内科-冠心病护理单元进行了为期 2.5 年的前瞻性队列研究。使用标准方程计算 SAPS 3、SAPS II 和 APACHE II 的医院死亡率概率。
共纳入 2022 例患者。SAPS 3 的性能与旧的标准严重程度评分相似。所有三个评分都具有出色的区分能力，SAPS 3、SAPS II 和 APACHE II 的接收者操作特征曲线下面积分别为 0.916、0.914 和 0.936。所有评分均高估了医院死亡率，SAPS 3、SAPS II 和 APACHE II 的标准化死亡率比分别为 0.81、0.78 和 0.80。所有评分的校准都很差，Hosmer-Lemeshow 拟合优度 H 和 C 统计量均<0.05。通过一级定制，所有评分的校准都得到了改善。
SAPS 3 评分提供了出色的区分能力，但校准效果不佳，SAPS II 和 APACHE II 评分在我们的危重症混合内科患者中也是如此。严重程度评分的定制提高了校准性能，因此这种定制可能是调整评分方程以预测 ICU 死亡率和质量评估的工具。
