Doerr Fabian, Badreldin Akmal M A, Can Ferzen, Bayer Ole, Wahlers Thorsten, Hekmat Khosro
Scand Cardiovasc J. 2014 Apr;48(2):111-9. doi: 10.3109/14017431.2014.890248.
Cardiac surgery patients are excluded from SAPS2 but included in SAPS3. Neither score is evaluated for this exclusive population; however, they are used daily. We hypothesized that SAPS3 may be superior to SAPS2 in outcome prediction in cardiac surgery patients.
All consecutive patients undergoing cardiac surgery between January 2007 and December 2010 were included in our prospective study. Both models were tested with calibration and discrimination statistics. We compared the AUC of the ROC curves by DeLong's method and calculated OCC values.
A total of 5207 patients with mean age of 67.2 ± 10.9 years were admitted to the ICU. The mean length of ICU stay was 4.6 ± 7.0 days and the ICU mortality was 5.9%. The two tested models had acceptable discriminatory power (AUC: SAPS2: 0.777-0.875; SAPS3: 0.757-893). SAPS3 had a low AUC and poor calibration on admission day. SAPS2 had poor calibration on Days 1-6 and 8.
Despite including cardiac surgery patients, SAPS3 was not superior to SAPS2 in our analysis. In this large cohort of ICU cardiac surgery patients, performance of both SAPS models was generally poor. In this subset of patients, neither scoring system is recommended.
心脏手术患者被排除在SAPS2之外，但被纳入SAPS3。这两个评分系统均未针对这一特定人群进行评估；然而，它们却每日都在被使用。我们假设在心脏手术患者的预后预测方面，SAPS3可能优于SAPS2。
2007年1月至2010年12月期间所有连续接受心脏手术的患者均纳入我们的前瞻性研究。两种模型均采用校准和鉴别统计进行测试。我们通过德龙方法比较ROC曲线的AUC，并计算OCC值。
共有5207例平均年龄为67.2±10.9岁的患者入住重症监护病房。重症监护病房平均住院时间为4.6±7.0天，重症监护病房死亡率为5.9%。所测试的两种模型具有可接受的鉴别力（AUC：SAPS2：0.777 - 0.875；SAPS3：0.757 - 0.893）。SAPS3在入院当天AUC较低且校准不佳。SAPS2在第1 - 6天和第8天校准不佳。
尽管纳入了心脏手术患者，但在我们的分析中SAPS3并不优于SAPS2。在这一大型重症监护病房心脏手术患者队列中，两种SAPS模型的表现总体较差。对于这一患者亚组，不推荐使用任何一种评分系统。
