在巴西一家综合重症监护病房中，从急性生理学及慢性健康状况评分系统II（APACHE II）转换为简化急性生理学评分系统III（SAPS III）作为预后模型的可行性。一项回顾性研究。

Feasibility of transitioning from APACHE II to SAPS III as prognostic model in a Brazilian general intensive care unit. A retrospective study.

作者信息

Serpa Neto Ary, Assunção Murillo Santucci Cesar de, Pardini Andréia, Silva Eliézer

机构信息

Faculdade de Medicina do ABC, São Paulo, Brazil.

Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.

出版信息

Sao Paulo Med J. 2015 May-Jun;133(3):199-205. doi: 10.1590/1516-3180.2013.8120014. Epub 2014 Oct 17.

CONTEXT AND OBJECTIVE

Prognostic models reflect the population characteristics of the countries from which they originate. Predictive models should be customized to fit the general population where they will be used. The aim here was to perform external validation on two predictive models and compare their performance in a mixed population of critically ill patients in Brazil.

DESIGN AND SETTING

Retrospective study in a Brazilian general intensive care unit (ICU).

METHODS

This was a retrospective review of all patients admitted to a 41-bed mixed ICU from August 2011 to September 2012. Calibration (assessed using the Hosmer-Lemeshow goodness-of-fit test) and discrimination (assessed using area under the curve) of APACHE II and SAPS III were compared. The standardized mortality ratio (SMR) was calculated by dividing the number of observed deaths by the number of expected deaths.

RESULTS

A total of 3,333 ICU patients were enrolled. The Hosmer-Lemeshow goodness-of-fit test showed good calibration for all models in relation to hospital mortality. For in-hospital mortality there was a worse fit for APACHE II in clinical patients. Discrimination was better for SAPS III for in-ICU and in-hospital mortality (P = 0.042). The SMRs for the whole population were 0.27 (confidence interval [CI]: 0.23 - 0.33) for APACHE II and 0.28 (CI: 0.22 - 0.36) for SAPS III.

CONCLUSIONS

In this group of critically ill patients, SAPS III was a better prognostic score, with higher discrimination and calibration power.

背景与目的

预后模型反映了其起源国家的人群特征。预测模型应进行定制，以适用于其将被应用的普通人群。本文旨在对两种预测模型进行外部验证，并比较它们在巴西重症患者混合人群中的表现。

设计与地点

在巴西一家综合重症监护病房（ICU）进行的回顾性研究。

方法

这是一项对2011年8月至2012年9月期间入住一家拥有41张床位的混合ICU的所有患者的回顾性分析。比较了急性生理与慢性健康状况评分系统Ⅱ（APACHE II）和简化急性生理学评分系统Ⅲ（SAPS III）的校准（使用Hosmer-Lemeshow拟合优度检验评估）和区分度（使用曲线下面积评估）。通过将观察到的死亡人数除以预期死亡人数来计算标准化死亡率（SMR）。

结果

共纳入3333例ICU患者。Hosmer-Lemeshow拟合优度检验显示，所有模型在医院死亡率方面校准良好。对于临床患者的院内死亡率，APACHE II的拟合效果较差。对于ICU内和院内死亡率，SAPS III的区分度更好（P = 0.042）。APACHE II在全人群中的SMR为0.27（置信区间[CI]：0.23 - 0.33），SAPS III为0.28（CI：0.22 - 0.36）。