Ma Qing-Bian, Fu Yuan-Wei, Feng Lu, Zhai Qiang-Rong, Liang Yang, Wu Meng, Zheng Ya-An
Department of Emergency Medicine, Peking University Third Hospital, Beijing 100091, China.
Chin Med J (Engl). 2017 Jul 5;130(13):1544-1551. doi: 10.4103/0366-6999.208250.
Since the 1980s, severity of illness scoring systems has gained increasing popularity in Intensive Care Units (ICUs). Physicians used them for predicting mortality and assessing illness severity in clinical trials. The objective of this study was to assess the performance of Simplified Acute Physiology Score 3 (SAPS 3) and its customized equation for Australasia (Australasia SAPS 3, SAPS 3 [AUS]) in predicting clinical prognosis and hospital mortality in emergency ICU (EICU).
A retrospective analysis of the EICU including 463 patients was conducted between January 2013 and December 2015 in the EICU of Peking University Third Hospital. The worst physiological data of enrolled patients were collected within 24 h after admission to calculate SAPS 3 score and predicted mortality by regression equation. Discrimination between survivals and deaths was assessed by the area under the receiver operator characteristic curve (AUC). Calibration was evaluated by Hosmer-Lemeshow goodness-of-fit test through calculating the ratio of observed-to-expected numbers of deaths which is known as the standardized mortality ratio (SMR).
A total of 463 patients were enrolled in the study, and the observed hospital mortality was 26.1% (121/463). The patients enrolled were divided into survivors and nonsurvivors. Age, SAPS 3 score, Acute Physiology and Chronic Health Evaluation Score II (APACHE II), and predicted mortality were significantly higher in nonsurvivors than survivors (P < 0.05 or P < 0.01). The AUC (95% confidence intervals [CI s]) for SAPS 3 score was 0.836 (0.796-0.876). The maximum of Youden's index, cutoff, sensitivity, and specificity of SAPS 3 score were 0.526%, 70.5 points, 66.9%, and 85.7%, respectively. The Hosmer-Lemeshow goodness-of-fit test for SAPS 3 demonstrated a Chi-square test score of 10.25, P = 0.33, SMR (95% CI) = 0.63 (0.52-0.76). The Hosmer-Lemeshow goodness-of-fit test for SAPS 3 (AUS) demonstrated a Chi-square test score of 9.55, P = 0.38, SMR (95% CI) = 0.68 (0.57-0.81). Univariate and multivariate analyses were conducted for biochemical variables that were probably correlated to prognosis. Eventually, blood urea nitrogen (BUN), albumin,lactate and free triiodothyronine (FT3) were selected as independent risk factors for predicting prognosis.
The SAPS 3 score system exhibited satisfactory performance even superior to APACHE II in discrimination. In predicting hospital mortality, SAPS 3 did not exhibit good calibration and overestimated hospital mortality, which demonstrated that SAPS 3 needs improvement in the future.
自20世纪80年代以来，疾病严重程度评分系统在重症监护病房（ICU）中越来越受欢迎。医生在临床试验中使用它们来预测死亡率和评估疾病严重程度。本研究的目的是评估简化急性生理学评分3（SAPS 3）及其针对澳大拉西亚地区的定制方程（澳大拉西亚SAPS 3，SAPS 3[AUS]）在预测急诊ICU（EICU）患者临床预后和医院死亡率方面的表现。
对北京大学第三医院EICU在2013年1月至2015年12月期间收治的463例患者进行回顾性分析。收集入选患者入院后24小时内的最差生理数据，计算SAPS 3评分，并通过回归方程预测死亡率。通过受试者操作特征曲线（AUC）下的面积评估生存者与死亡者之间的区分度。通过Hosmer-Lemeshow拟合优度检验评估校准情况，计算观察到的死亡人数与预期死亡人数之比，即标准化死亡率（SMR）。
本研究共纳入463例患者，观察到的医院死亡率为26.1%（121/463）。入选患者分为生存者和非生存者。非生存者的年龄、SAPS 3评分、急性生理学与慢性健康状况评价系统II（APACHE II）评分及预测死亡率均显著高于生存者（P<0.05或P<0.01）。SAPS 3评分的AUC（95%置信区间[CIs]）为0.836（0.796 - 0.876）。SAPS 3评分的约登指数最大值、截断值、敏感性和特异性分别为0.526%、70.5分、66.9%和85.7%。SAPS 3的Hosmer-Lemeshow拟合优度检验显示卡方检验得分10.25，P = 0.33，SMR（95%CI）= 0.63（0.52 - 0.76）。SAPS 3（AUS）的Hosmer-Lemeshow拟合优度检验显示卡方检验得分9.55，P = 0.38，SMR（95%CI）= 0.68（0.57 - 0.81）。对可能与预后相关的生化变量进行单因素和多因素分析。最终，血尿素氮（BUN）、白蛋白、乳酸和游离三碘甲状腺原氨酸（FT3）被选为预测预后的独立危险因素。
SAPS 3评分系统在区分度方面表现令人满意，甚至优于APACHE II。在预测医院死亡率方面，SAPS 3未表现出良好的校准，且高估了医院死亡率，这表明SAPS 3未来需要改进。
